Women’s pain is something that has been overlooked and even normalised throughout history, with periods seen as taboo, and at best, something to be kept private. This could be why endometriosis, a condition linked to both pain and menstruation, is one of the many women’s health concerns neglected by modern medicine.
Over recent decades, global attention to this gender pain gap has gathered pace. And as funding into women’s health increases, important new studies are enhancing our understanding and awareness of endometriosis. Finally, science and society are focusing on improving the wellbeing of those who experience this life-altering condition.
With insight and commentary from our Women’s Health Clinical Lead, Dr Sam Wild, here we explore three of the latest advances in research that are uncovering its root causes, leading to the development of non-invasive diagnostics and offering new ways of managing the disease.
What is endometriosis?
Endometriosis is a common, chronic condition in which tissue that belongs to the womb grows in other parts of the body. This endometrial tissue is typically found in the pelvis – on the ovaries, fallopian tubes, large intestine, rectum, or bladder. The tissue then builds up and breaks away in the same way it would in the womb, causing inflammation and pain in the surrounding areas – especially around the time of a period. Beyond pain, Endometriosis can cause anxiety, depression and infertility. The condition can affect any woman, girl, or AFAB (Assigned Female At Birth) person in their reproductive years.
Symptoms of endometriosis can include:
- Pelvic pain that may not respond to over-the-counter painkillers
- Pain during or after sex
- Heavy periods
- Feeling extremely tired
- Difficulty getting pregnant
Why is endometriosis difficult to diagnose?
Many of the symptoms of endometriosis overlap with other common conditions, which means people can experience delays in diagnosis while other issues are ruled out.
And once those other concerns are explored, there is no one simple, non-invasive test for diagnosing endometriosis. Dr Wild explains that it “still relies on invasive surgery, which adds to delays and means many live with symptoms for years before getting answers.”
She also adds, “healthcare professionals might lack training or awareness that they can still treat the condition without a formal diagnosis of endometriosis, or whilst this is awaited. Not all laparoscopies will yield positive results”. And when combined with poor education in wider society, this could reinforce cycles of stigmatisation and dismissal, leading to missed or delayed diagnoses.
Why has it taken us so long to understand how endometriosis works?
Endometriosis is complex by nature; involving hormones, inflammation, and the immune system. And as Dr Wild points out, “it affects everyone differently.”
She goes on to explain that “tracking how the disease progresses often requires surgery, making research more complex and difficult to carry out.” And continues, “studying endometriosis is especially challenging because there aren’t suitable animal models to replicate the condition.”
These factors, along with historic under-funding in endometriosis and other women’s health conditions, have contributed to the slow pace of research to-date.
Endometriosis in the spotlight
As more and more studies emerge, we are transforming in the way we understand, diagnose and treat endometriosis, which offers new hope and validation to those who live with the condition. But why now?
We asked Dr Wild why she thinks researchers are finally choosing to pay attention to this long overlooked condition. She notes, “women have finally been speaking out – on social media, in clinics, and in policy spaces. Their stories have highlighted the huge impact that endometriosis can have on everyday life, work, and relationships.”
The economic burden of the women’s health gap has also gained increased recognition. A recent report by the McKinsey Health Institute highlighted that with proper investment into women’s health, the global economy could be boosted by $1 trillion annually by 2040.
New discoveries offer hope
From its origins and genetic links, to novel ways of diagnosing and treating the condition, Dr Wild comments on three emerging areas of research that could brighten the outlook of those who experience endometriosis, today and in years to come.
1. Retrograde menstruation
"Emerging findings support the theory that endometriosis may begin with retrograde menstruation. This is where menstrual blood flows backward into the pelvic cavity. This process can deposit viable endometrial cells that form lesions, particularly in the peritoneal area.
Yet a key question remains: why do lesions develop in some people but not others?
Researchers are now investigating factors such as immune system differences, hormonal responses, and genetic variations. This deeper understanding could pave the way for risk profiling to identify those more likely to develop the disease and enable earlier intervention.”
2. Genetic links
"Groundbreaking research shows that people with endometriosis have a 30 - 80% higher risk of developing immune-related conditions such as rheumatoid arthritis, osteoarthritis, coeliac disease, multiple sclerosis, and psoriasis.
We now know that these conditions share genetic pathways, which means there is a biological connection between them. This could open up possibilities in:
- Integrated care – which is when we monitor and manage multiple conditions at the same time.
- Drug repurposing – there is potential that treatments used for autoimmune diseases could be adapted to help manage endometriosis.
- Personalised medicine – by understanding more about genetic links, we could provide individualised care. We could see more accuracy in early diagnosis and look towards targeted treatments.”
3. Innovative diagnostics and holistic management
“Up until now, diagnosis has relied on surgery, which we know can lead to delays. But this is changing as researchers are developing non-invasive tools, including:
- Advanced ultrasound and MRI – for detecting lesions in areas that are more difficult to visualise, for example, deeper inside the pelvis or on the ovaries.
- Transvaginal elastography – a type of ultrasound that assesses the softness or stiffness of the tissue within the pelvic organs. This is a really helpful tool for tracing and diagnosing endometriosis, along with other women’s health conditions.
- PET-CT scans – by injecting a small and safe amount of radiotracer (radioactive fluid) into the body, we can see how well certain organs are functioning. This type of scan can be more effective than a traditional CT scan.
While there is still no single biomarker for diagnosing endometriosis, there have been some recent developments. A new kind of saliva test could detect the biological ‘fingerprints’ of the disease. This would be easy to put into practice and could significantly reduce time to diagnosis.
In addition to advances in diagnostics, there is growing evidence for a holistic approach to management, including:
- Cannabis-based therapies for pain and mood regulation.
- Diet and microbiome interventions to reduce inflammation.
- Physiotherapy, exercise, and behavioural therapies such as CBT and mindfulness.
This gives patients the option to reduce the use of drugs they don’t tolerate or simply prefer not to take. Instead, they can explore other non-pharmacological options which provide opportunities for more personalised care.”
And finally
As innovative studies break new ground, so too do they bring new questions to the forefront. It’s true that our understanding of endometriosis has shifted dramatically in the past several decades, but there is much still to uncover about this hidden condition.
When asked if she feels optimistic about the future of endometriosis research, Dr Wild replied, “yes I do. For the first time, there’s real momentum – more funding, better science, and women’s voices shaping the agenda. That gives me hope we’ll see earlier diagnosis, more effective treatments, and better support for those living with endometriosis.”
