Racial Disparities in Endometriosis Diagnosis and Care

Systemic inequities obscure and complicate endometriosis care in African American women.

Key Points

Highlights:

• Racial disparities continue to influence the diagnosis and treatment of endometriosis in Black women.
• Endometriosis is often underdiagnosed in Black patients due to outdated beliefs, clinical bias, and symptom misattribution.
• Black women face higher rates of surgical complications and are more likely to undergo radical procedures like oophorectomy at younger ages.
• These inequities are shaped by systemic racism, medical mistrust, and reduced access to specialist care.

Importance:

• Longstanding misconceptions and racial bias have led to underdiagnosis and undertreatment of endometriosis in Black women.
• Addressing these inequities is essential for achieving timely diagnosis, effective care, and health justice.

What's done here:

• This is an expert commentary, authored by six specialists in reproductive endocrinology and gynecology from leading U.S. academic centers.
• The article explores racial disparities in endometriosis diagnosis and treatment among Black women.
• By drawing on clinical experience and published data, the authors examine how systemic bias, miseducation, and unequal access to care perpetuate health inequities, and propose targeted strategies to address them. 

Key features :

• Black women are less likely to receive a timely diagnosis of endometriosis and more likely to have their symptoms dismissed or misattributed to fibroids or pelvic inflammatory disease.
• When diagnosed, they are less likely to undergo minimally invasive surgery and more likely to experience perioperative morbidity.
• Black patients face higher odds of oophorectomy at younger ages—3x higher in their 20s and 2x higher before age 40.
• Limited access to high-volume surgical centers and specialist referrals contributes to poorer outcomes.
• Implicit bias training, curriculum reform, diverse physician recruitment, and equitable referral practices are among the proposed solutions. 

From the Editor-in-Chief – EndoNews 

"This powerful commentary addresses one of the most urgent and historically overlooked challenges in gynecology: the racial inequities in diagnosing and managing endometriosis. For decades, implicit bias and flawed medical narratives have contributed to the exclusion of Black women from timely diagnosis, accurate symptom recognition, and equitable care.

By confronting these systemic failures, the authors challenge the field to rethink deeply rooted assumptions and call for structural reform at every level—from medical education to clinical practice and health policy.

If we are to advance endometriosis research and care, we must commit to a future in which every patient—regardless of race or background—is seen, heard, and treated with equal dignity. This commentary is not just a critique of the status quo; it is a call to action and a blueprint for lasting transformation."

Lay Summary

A recent expert commentary published in Fertility and Sterility by Dr. Janelle Jackman and colleagues from leading U.S. academic centers calls attention to persistent racial disparities in endometriosis care, particularly affecting Black women.

Endometriosis, a chronic estrogen-dependent condition, can cause severe menstrual pain, chronic pelvic pain, and infertility. While histopathologic examination remains the gold standard for diagnosis, endometriosis continues to be underdiagnosed in Black patients—often due to longstanding misconceptions that it is primarily a “White woman’s disease.”

These misconceptions, deeply rooted in outdated medical literature and training, have contributed to racial bias in clinical practice. Symptoms such as pelvic pain are frequently misattributed in Black women to conditions like fibroids or pelvic inflammatory disease. Additionally, the disproportionately high prevalence of uterine fibroids in this population can mask signs of endometriosis, leading to missed or delayed diagnoses.

The commentary also highlights treatment disparities. Black women are less likely to receive minimally invasive surgical options and more likely to undergo oophorectomy or hysterectomy at younger ages, often without appropriate alternatives or specialist input.

To address these inequities, the authors advocate for reform in medical education, implicit bias training, diverse physician recruitment, and improved access to specialist care. They also emphasize the importance of empowering Black patients through education, advocacy, and support networks.

The authors conclude that current disparities likely represent only the surface of a much deeper issue—and that meaningful change will require systemic reform, research, and collective accountability.

Research Source: https://pubmed.ncbi.nlm.nih.gov/40054559