Geographical disparities found in endometriosis guidance

Geographical heterogeneity has been reported in the existence and sources of guidelines for endometriosis, according to a recent study published in The Lancet Obstetrics, Gynaecology, & Women’s Health.¹

Endometriosis has been estimated in 190 million women worldwide, with a 2025 review identifying a gap of up to 12 years between symptom onset and diagnosis. Additionally, endometriosis has been indicated as one of the main causes of a 75 million disability-adjusted life-year gender health gap reported globally.

“Many people who are affected by endometriosis might benefit from centres of expertise with multidisciplinary specialist care. However, there are many potential socioeconomic, geographical, and clinical barriers to reaching these specialist services,” wrote investigators.

Scoping review of endometriosis guidelines

The scoping review was conducted to assess the availability of endometriosis guidance worldwide. Documents providing an overview of region-specific care were included in the analysis, while those that were an experimental or study-design description, cost-effective analysis, not region-specific, or commentary on an existing guideline were excluded.

Guidelines were placed into an organizational hierarchy ranging from new media at the lowest level to collaborations between professional societies and national governments at the highest level. The highest organizational level of guidance was selected for each country.

A bibliographic search and grey literature review were conducted to obtain data. Search strategies were developed and tested by a medical information specialist. Databases assessed included Medline, Embase, Global Health, Web of Science, Global Index Medicus, and CINAHL.

Geographical heterogeneity reported

Abstract, title, and full-text screenings were performed by 2 independent authors. After screening, 66 records were considered eligible for inclusion, leading to 143 unique sources for endometriosis guidance across 141 of 194 World Health Organization (WHO)-defined countries after cross-reference with the comprehensive grey literature review.

The remaining 27% of WHO-defined countries did not have an identifiable endometriosis care-related item. Professional society and government guidance were available for New Zealand and Peru, making them the only 2 countries with the highest level of guidance. In comparison, additional guidance rates included:

• Government guidance at 6%
• Professional society guidelines at 11%
• Government information at 10%
• Professional society information at 2%
• Region-specific published reviews at 9%
• Physician, clinic, or hospital websites at 14%
• Advocacy websites and social media at 9%

The lowest level of guidance, news media, was indicated as the highest available source for 12% of countries. Some level of endometriosis care guidance was available in all European countries.

Regional differences

An endometriosis-specific national society was found in 53% of countries with no identifiable care guidance, while 21% had regional international society coverage and 28% had no coverage outside of overlapping regional societies. No endometriosis care guidance was found in 32 African countries, though 21 of these had an endometriosis-specific society or advocacy group.

Additionally, 3 of these countries were listed as members of overlapping regional societies, but none of these societies provided any endometriosis care guidance. Overall, geographical heterogeneity was reported in endometriosis guidance worldwide, with European countries having the greatest availability.

“To ensure that patients and providers have access to high-quality endometriosis care guidance documents—region-specific or not—reproductive health-focused groups and societies need to review and maintain their patient-facing and provider-facing digital resources,” wrote investigators.

Advances in diagnosis

To further improve endometriosis care, Megan Wasson, DO, FACOG, chair of gynecology at Mayo Clinic, conducted a presentation about the need for imaging, surgical precision, and mentorship at the 2025 ACOG Annual Clinical and Scientific Meeting.²

According to Wasson, visual recognition and training are vital, as endometriosis often has a variety in its appearance that may make diagnosis difficult at first. However, advances in laparoscopy and robotic surgery have allowed for improved magnification, allowing clinicians to identify atypical presentations with proper training.

“Being able to really zoom in on these lesions and see the difference in normal versus abnormal peritoneum is incredibly helpful,” said Wasson.

References

1. Evans D, Gibbons T, Skidmore B, et al. Availability of region-specific endometriosis care guidance: a global scoping review. The Lancet Obstetrics, Gynaecology, & Women’s Health. 2025;1(3):E219-E231. doi:10.1016/j.lanogw.2025.100004
2. Wasson M. Megan Wasson, DO, on advancing endometriosis care through imaging, surgical precision, and mentorship. Contemporary OB/GYN. May 19, 2025. Accessed November 20, 2025. https://www.contemporaryobgyn.net/view/megan-wasson-do-on-advancing-endometriosis-care-through-imaging-surgical-precision-and-mentorship.