An Audit of Endometriosis of Pre-Menopausal & Menopausal Women in Aotearoa: A 5-year Study of the Hidden Disease

Abstract

Endometriosis is a chronic inflammatory gynaecological condition affecting women worldwide. In New Zealand, approximately 1 in 10 women is affected, with an average diagnostic delay of 8.7 years. Despite its prevalence, endometriosis remains underdiagnosed and undertreated. Delays in diagnosis are often compounded by inconsistencies in clinical management across age groups, ethnicities, and regions, contributing to inequities in care. This observational cohort study examined diagnostic delay and treatment management patterns among women diagnosed with endometriosis in the Waitematā region between 1 January 2018 and 31 December 2022. Variables analysed included age, ethnicity, geographic region within Waitematā, hospital setting, and treatment type. Routinely collected clinical patient data were used, with cases outside the defined study framework excluded.

A total of 524 women were included in the analysis. The average diagnostic delay was seven months, with 75% of women receiving a diagnosis within nine months. No statistically significant differences in diagnostic delay were observed among Māori, Pacific, Asian, or New Zealand European/Pākehā women; however, women categorised as “Other” experienced longer delays. Age-related analysis showed slightly longer delays among women aged 31–40 years. Combined surgical and hormonal therapy was the most common management approach between 2018 and 2022, with treatment patterns varying by age. Laparoscopic surgery alone was less frequently utilised among older women, while incidental lesion detection increased with age. Standalone non-surgical treatments were not commonly offered. Geographic region and hospital setting had minimal influence on diagnostic timelines.

Overall, the findings indicate relatively timely and consistent diagnosis and management of endometriosis in the Waitematā region, suggesting more timely diagnosis in this region compared with previously reported estimates. Nevertheless, disparities observed among certain ethnic groups and women in their 30s highlight the ongoing need for early symptom recognition, culturally responsive care, and continued efforts to promote equitable healthcare delivery in New Zealand.