The Invisible Burden of Endometriosis: A Review of Diagnostic, Treatment, and Health Policy Challenges

Background: Endometriosis is a chronic, estrogen-dependent inflammatory disease affecting approximately 6-13% of women worldwide, with estimates exceeding 100 million individuals. It presents with heterogeneous symptoms, including chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, significantly impairing quality of life. Despite its prevalence, endometriosis remains under-recognized and often inadequately addressed at clinical and policy levels. Objective: This review aims to examine the multifaceted burden of endometriosis, including its epidemiology, impact on quality of life and productivity, diagnostic delays, treatment limitations, and health system and policy barriers. Methods: A narrative review of the literature was conducted using major databases, including PubMed, Scopus, and Web of Science. Recent systematic reviews, meta-analyses, observational studies, and policy reports were analyzed to identify key themes and evidence gaps. Results: Endometriosis is associated with substantial physical, psychological, and economic burden, including reduced work productivity and high healthcare costs. Diagnostic delay remains a major challenge due to factors at the patient, provider, and system levels. Current treatments are often limited in effectiveness and accessibility, with high recurrence rates. Fragmented healthcare systems, insufficient specialist training, and a lack of national policies further exacerbate inequalities in care. Conclusions: Endometriosis represents a significant yet often invisible public health issue. Addressing its burden requires integrated care models, improved diagnostic strategies, increased research funding, and comprehensive policy action.