Global Endometriosis Burden in Decline

Yet Total Cases Rise and Regional Disparities Persist

Key Points

Highlights: 

• The global burden of surgically confirmed endometriosis declined between 1990 and 2021.
• Significant regional disparities persist, with slower improvement in low- and middle-income regions.
• Population growth remains the major driver behind the increase in total cases and years lived with disability (YLDs).

Importance:

• The findings emphasize the ongoing need for targeted policies and equitable access to diagnosis and treatment of endometriosis, particularly in regions where surgical confirmation and healthcare resources remain limited.

What’s done here:

• The data from the Global Burden of Disease 2021 database was analyzed to assess global and regional trends in incidence, prevalence, and YLD rates of surgically confirmed endometriosis from 1990 to 2021.
• Temporal patterns were compared across Socio-Demographic Index (SDI) categories to identify disparities and potential determinants of disease burden.

Key results:

• Age-standardized incidence, prevalence, and YLD rates of endometriosis all declined over the 31-year period.
• The disease burden remained concentrated among women aged 20–30 years.
• Despite reduced per-capita rates, total global cases continued to rise, largely due to population growth.
• Oceania, Eastern Europe, and Western Sub-Saharan Africa maintained the highest rates in 2021.
• Population growth remains the main driver of increasing absolute case numbers worldwide.
• High-SDI regions demonstrated faster declines, whereas low-SDI regions showed slower improvement and likely underdiagnosis.

Limitations:

• The data from specific regions, time periods, or age groups is sparse of unreliable, and this can affect the accuracy of the estimates of endometriosis burden.
• Disease burden may be underestimated in some regions due to limited data or a lack of gold-standard diagnostic techniques.
• Changes in diagnostic criteria throughout the study period may affect the analysis of the temporal trend.
• Data about possible driving factors like environment, diet, lifestyle, or genetic susceptibility are missing from the analysis.

From the Editor-in-Chief – EndoNews

"This study offers a rare, panoramic view of endometriosis as a global public health issue, rather than a localized gynecologic concern. The observed decline in age-standardized rates is encouraging but must be interpreted cautiously. It reflects improvements in surgical access and awareness in high-income regions, while limited diagnostic capacity in low-SDI countries likely masks the true disease burden.

The authors’ decomposition analysis is particularly revealing—population growth remains the dominant force behind the rise in absolute case numbers, underscoring that epidemiologic progress does not necessarily equate to fewer women living with the disease. The persistent clustering of cases in women aged 20–30 years highlights the continued intersection between reproductive health, socioeconomic opportunity, and healthcare inequity.

From a policy perspective, the message is clear: declining rates are not the same as equitable progress. Investment in diagnostic infrastructure, clinician training, and population-level awareness campaigns is essential to translate epidemiologic trends into meaningful clinical impact. The future of endometriosis care must therefore shift from surveillance to intervention—bridging data with action, and progress with parity."

Lay Summary

Over the past three decades, the global burden of surgically confirmed endometriosis has shown a steady decline, reflecting advances in awareness, diagnostics, and healthcare infrastructure. However, this apparent progress conceals a more complex picture: while per-capita rates have fallen, the total number of women affected worldwide continues to rise, driven by population growth and persistent regional inequalities.

In a comprehensive analysis published in BMJ Reproductive Biology and Endocrinology, Li and collegues examined data from the Global Burden of Disease 2021 project across 204 countries between 1990 and 2021. Their findings show that age-standardized incidence, prevalence, and years lived with disability (YLDs) have all decreased, yet the disease burden remains concentrated among women aged 20–30 years, the peak reproductive years.

The researchers found that high-SDI regions, such as North America and parts of East Asia, demonstrated the most significant declines, likely reflecting improved awareness and access to care. In contrast, low-SDI regions—particularly in Africa, the Middle East, and Oceania—showed slower improvement and probable underdiagnosis due to limited surgical and diagnostic capacity.

Importantly, decomposition analysis revealed that population growth alone accounted for much of the rise in total global cases, indicating that the apparent epidemiologic improvement does not necessarily translate into a reduced clinical or economic burden.

Together, these findings suggest that while global indicators may signal progress, endometriosis remains an inequitable disease, with persistent diagnostic gaps and regional disparities. Addressing this imbalance will require region-specific strategies, equitable access to minimally invasive diagnostics, and continued investment in women’s health policy worldwide.

Research Source: https://pubmed.ncbi.nlm.nih.gov/40483411/