A new series on Contemporary OB/GYN Peer Exchange is attempting to address the gap in understanding regarding endometriosis prevalence. The first installment, titled “Endometriosis Prevalence: Why the True Burden Is Underrecognized,” brought together medical professionals to discuss the condition’s scope and the challenges in diagnosing it.
Expert Perspectives on Diagnosis
Andrea Lukes, MD, MHSc, FACOG, moderated the discussion and was joined by Rosanne Kho, MD, and John Davitt, MD. Dr. Kho describes 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.
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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.
There is often a significant disconnect between published epidemiological data and the clinical reality experienced by doctors. The gap suggests that while the underlying biology of the condition is well understood, the methods used to track its occurrence may fail to capture the full scope of affected patients.
The Biology of the Condition
The panel took time to explain the pathophysiology for those viewers who needed a refresher on the medical basics. 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.
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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.
The discussion sets the stage for the next episode, which will cover risk factors and the economic costs associated with chronic pelvic pain. Dr. Davitt will appear in that segment to detail the hallmark symptoms clinicians should watch for.
