Endometriosis Still a Significant Health Problem

May 28, 2026

The Global Burden of Endometriosis Is Declining—But Unequally

Key Points

Highlights:

The global burden of endometriosis declined modestly from 1990 to 2021, yet substantial regional and socioeconomic disparities persist.
Women aged 20–24 years demonstrated the highest global incidence rates of endometriosis.

Importance:

Persistent geographic and socioeconomic inequalities suggest that improvements in endometriosis awareness, diagnosis, and access to care remain uneven worldwide.

What’s done here:

This is a large-scale epidemiologic analysis using the Global Burden of Disease (GBD) 2021 database to evaluate incidence, prevalence, Disability-Adjusted Life Years, and age-standardized burden of endometriosis among reproductive-aged women across 204 countries and 21 global regions between 1990 and 2021.
Decomposition analysis and frontier modeling were additionally used to examine the relative contributions of population growth, aging, epidemiologic change, and socioeconomic development to global disease burden patterns.

Key results:

Women aged 20–24 years had the highest global incidence of endometriosis, declining from 399.49/100,000 in 1990 to 304.31/100,000 in 2021.
Population growth represented the major contributor to the global endometriosis burden.
Disease burden fluctuated substantially in both low- and high-SocioDemographic Index (SDI) regions over time.
Most countries with SDI values between 0.2 and 0.6 demonstrated gradual reductions in endometriosis burden.
Higher SDI levels were generally associated with lower age-standardized incidence, prevalence, and Disability-Adjusted Life Years rates.

Limitations:

This study provides one of the most comprehensive contemporary global assessments of endometriosis burden using multidimensional GBD2021 epidemiologic modeling across countries, regions, age groups, and socioeconomic strata.
However, underdiagnosis of mild or asymptomatic disease, regional differences in diagnostic access, and ICD-based coding constraints may have resulted in underestimation of the true burden of endometriosis.

From the Editor-in-Chief – EndoNews

"Endometriosis is frequently discussed as an individual gynecologic disorder, yet studies such as this remind us that it also represents a persistent global public health challenge shaped by demographic, socioeconomic, and healthcare inequalities.

While the overall burden appears to have modestly declined over recent decades, the substantial regional variability observed across SocioDemographic Index (SDI) strata suggests that improvements in diagnosis, awareness, and access to care have not occurred uniformly worldwide.

Particularly notable is the continued concentration of disease burden in young reproductive-age women, together with the complex interaction between population growth, healthcare access, and epidemiologic transition. These findings further highlight an important paradox in endometriosis epidemiology: regions with the greatest probable burden are often those where diagnostic capacity and disease recognition remain most limited.

Although global burden modeling studies inevitably rely on heterogeneous reporting systems and diagnostic coding frameworks, they remain essential for recognizing large-scale epidemiologic trends that are often difficult to appreciate in routine clinical settings.

Importantly, this study shifts attention beyond prevalence estimates alone and emphasizes the need for region-sensitive strategies that address diagnostic delay, inequities in women’s health resources, and the long-term societal burden of chronic pelvic pain and infertility associated with endometriosis."

Lay Summary

Endometriosis continues to impose a substantial global health burden on reproductive-age women despite modest overall declines in disease burden over the past three decades, according to a new study published in the scientific journal PLOS One.

The study showed that the burden of endometriosis varies considerably across countries and socioeconomic settings, with persistent regional disparities observed between 1990 and 2021.

“To improve outcomes, regionalized disease management strategies may be needed to address differences in disease burden across countries and regions,” the authors noted.

This large-scale epidemiologic analysis was led by Dr. Chuanjia Guo and colleagues from the Department of Obstetrics and Gynecology at the First Affiliated Hospital of Dalian Medical University in China. Using data from the Global Burden of Disease (GBD) 2021 database, the investigators evaluated incidence, prevalence, Disability-Adjusted Life Years (DALYs), and age-standardized burden of endometriosis among reproductive-age women across 204 countries and 21 global regions between 1990 and 2021.

The analysis demonstrated that women aged 20–24 years had the highest global incidence of endometriosis. Incidence rates in this age group declined from 399.49 per 100,000 women in 1990 to 304.31 per 100,000 women in 2021.

The investigators further found that population growth was the major contributor to the global endometriosis burden, followed by epidemiologic changes. Disease burden fluctuated substantially in both low- and high-SDI regions over time, whereas many countries with intermediate SDI levels demonstrated gradual improvement.

The authors concluded that improving awareness, reducing diagnostic delay, and increasing access to care remain essential steps toward lowering the long-term health and fertility burden associated with endometriosis worldwide.