Endometriosis Prevalence: Why the True Burden Is Underrecognized

Welcome back to another Contemporary OB/GYN Peer Exchange series. In "Endometriosis Prevalence: Why the True Burden Is Underrecognized," moderator Andrea Lukes, MD, MHSc, FACOG is joined by Rosanne Kho, MD and John Davitt, MD to open the series on endometriosis.

Dr. Kho introduces herself as chair at the University of Arizona College of Medicine Phoenix and Banner University Medical Center, describing a focused practice in complex benign gynecology and minimally invasive surgery. Dr. Davitt describes his Phoenix-based practice, which centers on chronic pelvic pain and endometriosis management. The panel then turns to the true clinical burden of the disease. Citing a recent JAMA article and updated ACOG guidelines, the discussion notes that endometriosis affects up to 10% of reproductive-age women, translating to roughly 9 million women in the United States. Dr. Davitt says he was surprised to see a lower, 6.4% figure cited elsewhere, since the data he sees in practice reflects the higher 10% estimate, and he suspects real-world incidence runs even higher than what current data capture. The panel adds that prevalence climbs further among women presenting with infertility or difficulty conceiving, reaching an estimated 48% to 50% in that population. The discussion then works through the basic pathophysiology for viewers who may want a refresher. Endometriosis is defined as endometrium-like tissue found outside the uterus, most commonly on the back of the uterus, the top of the vagina, or the bowel, and it can also involve the bladder. Some patients have extra-pelvic endometriosis, meaning endometrium-like tissue found entirely outside the pelvic area. Because this tissue responds to the same estrogen and progesterone fluctuations that drive a woman's normal menstrual cycle, it undergoes the same physiologic rise and fall each month. The panel notes this cyclic hormone sensitivity helps explain why symptoms track with the menstrual cycle, and why hormonal therapy targets the disease's underlying biology rather than pain alone. This framing sets up the rest of the series, which moves toward specific risk factors and diagnostic advances.

The next episode in this series, "Endometriosis Risk Factors and the Cost of Chronic Pelvic Pain," features Dr. Davitt detailing the risk factors and hallmark symptoms clinicians should watch for.