Objective To explore the experience and needs of patients with endometriosis during the treatment decision-making process and provide evidence for developing targeted intervention strategies. Methods Based on the Ottawa Decision Support Framework, a descriptive qualitative study was conducted with a purposive sample of 16 patients with endometriosis.Data were collected with semi-structured interviews and were analyzed using content analysis. Results A total of 3 themes and 8 sub-themes were identified, including individualized dilemmas in treatment decision-making (insufficient disease knowledge and multi-source information trust dilemmas, uncertainty in treatment outcomes and concerns about recurrence, conflicts between treatment goals and personal preferences), insufficient decision support system (information and communication imbalance under physician-dominated decision-making, limited decision support and potential stress from family/intimate relationships, decision support and risks from the other patients), and needs for treatment decision-making (needs for professional decision aids, needs for peer communication and emotional support). Conclusion Patients with endometriosis face multiple dilemmas during the treatment decision-making process.Healthcare professionals should offer more comprehensive information support and develop targeted decision aids, to help patients better cope with the challenges of treatment decision-making.