New research reveals Associations between several sociodemographic factors and endometriosis symptoms

Endometriosis is overlooked and underdiagnosed reflected by a prevalence of hospital-diagnosed endometriosis in Denmark. In addition, the time from symptom presentation to diagnosis can be 7–10 years. This could be due to women’s inaccurate pain perceptions, societal normalization of pain, stigma around menstrual issues, insufficient knowledge and normalization of symptoms among physicians

The pathogenesis of endometriosis is related to multiple interwoven processes, involving genetic and epigenetic predisposition. This could partly explain why the prevalence of hospital-diagnosed endometriosis has been found to vary based on sociodemographic factors such as age, socioeconomic status, race/ethnicity, and geographic region. Whether this can be explained by actual differences in the prevalence of endometriosis and/or disparities in diagnostic access due to healthcare systems, awareness of symptoms, and personal resources is still unknown.

Investigating the prevalence of endometriosis symptoms and indicators, and their distribution across sociodemographic factors may therefore bring new insights that can help guide future interventions aimed at decreasing underdiagnosis and diagnostic delay. Therefore, a study aimed to estimate the prevalence and sociodemographic distribution of endometriosis symptoms and indicators in Denmark.

The study used data from the CYKLUS-survey; a women’s health survey sent to 63,199 Danish women aged 16 to 51 in 2023. Self-reported information on endometriosis symptoms and indicators was linked to Danish register data on sociodemographic factors. Age-standardized prevalence of six endometriosis symptoms and indicators were estimated for each of the nine different regions of residence and for the whole country. In addition, logistic regression analysis was used to estimate the association between sociodemographic factors and the six endometriosis symptoms and indicators.

11,407 women were included in the study. Age-standardized prevalence of symptoms showed little variation across Danish regions. However, younger age, lower socioeconomic status, and non-Danish origin were found to be associated with higher prevalences, and higher education was found to be associated with lower prevalences.

This study did not find regional differences in the prevalence of endometriosis symptoms in Denmark, as the distribution of symptoms across regions only showed small, non-significant differences. Yet, several sociodemographic factors were associated with the prevalence of endometriosis symptoms explored. Women with higher educational levels were less likely to report symptoms, except difficulties becoming pregnant. The odds of reporting all symptoms were higher among women of younger age and of lower SES. Associations between endometriosis symptoms and parity, origin, and household composition were also found, but with a mixed pattern.

Several sociodemographic factors were associated with endometriosis symptoms and indicators. Younger women were more likely to report symptoms compared to older age groups. Women with lower education, lower SES, and immigrants and descendants of immigrants, had higher odds of reporting various symptoms and indicators. Contrary to regional disparities in the incidence of hospital-based diagnoses of endometriosis across Denmark, no major differences were observed in the geographical distribution of symptom prevalence. Altogether these findings suggest an inequitable sociodemographic burden of endometriosis symptoms, warranting further investigation into these disparities.

Source: M. Josiasen et al.; European Journal of Obstetrics & Gynecology and Reproductive Biology 307 (2025) 109–120