A new global review has identified wide geographical disparities in the availability and quality of clinical guidance for endometriosis, highlighting gaps that may contribute to delayed diagnosis and uneven access to care. The findings were published in The Lancet Obstetrics, Gynaecology & Women’s Health.
Endometriosis affects an estimated 190 million people worldwide. Despite its prevalence, a 2025 review noted that symptoms often go unrecognized for years, with diagnostic delays reaching up to 12 years. The condition is also a major contributor to the 75 million disability-adjusted life-year gender health gap.
Researchers reported that many patients could benefit from multidisciplinary expertise, yet access to specialty centers is limited by socioeconomic, clinical, and geographic barriers.
Study Reviewed Global Guidance
The scoping review examined guidance documents that describe region-specific care for endometriosis. Items such as experimental study descriptions, cost analyses, or commentaries were excluded. The team categorized guidance sources on an eight-level hierarchy, ranging from news media at the lowest level to joint government–professional society collaborations at the highest.
Major Gaps in National Guidance
Of 194 World Health Organization (WHO) member countries, 141 had at least one identifiable source of endometriosis guidance. In total, 143 unique sources were included. The remaining 27% of countries had no identifiable guidance of any type.
Only two countries—New Zealand and Peru—had the highest-tier guidance jointly developed by professional societies and national governments. Other categories of guidance across countries included:
- Government clinical guidance: 6%
- Professional society guidelines: 11%
- Government informational resources: 10%
- Professional society informational resources: 2%
- Region-specific published reviews: 9%
- Physician, clinic, or hospital websites: 14%
- Advocacy websites or social media: 9%
- News media (lowest tier): 12%
Every European country had at least some form of guidance, making Europe the best-covered region.
Regional Disparities Persist
In countries without identifiable guidance, 53% had a national endometriosis society, 21% had regional society coverage, and 28% had none. The gaps were most pronounced in Africa: 32 countries had no endometriosis guidance, even though 21 had societies or advocacy groups. Three belonged to regional societies, but none of these organizations provided clinical guidance.
Investigators emphasized the need for reproductive health groups to update both patient-facing and provider-focused digital resources to ensure equitable access worldwide.
Advances in Diagnosis and Training
Improving diagnostic accuracy also remains essential. At the 2025 ACOG Annual Clinical and Scientific Meeting, Megan Wasson, DO, FACOG, chair of gynecology at Mayo Clinic, highlighted the importance of advanced imaging, surgical precision, and mentorship in recognizing subtle disease.
Endometriosis lesions can vary widely in appearance, making early identification challenging, especially for clinicians without specialized training. According to Wasson, enhanced magnification through modern laparoscopy and robotic surgery is helping specialists detect atypical lesions more reliably.
“Being able to really zoom in on these lesions and see the difference in normal versus abnormal peritoneum is incredibly helpful,” she said.
Related topics
