{"paper_id":"9ea8cc40-0ce4-4540-9eee-879eab9c1ce4","body_text":"BMC Medicine  BMC Medicine          (2023) 21:107  \nhttps://doi.org/10.1186/s12916-023-02820-y\nEDITORIAL Open Access\n© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which \npermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the \noriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or \nother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line \nto the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory \nregulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this \nlicence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco \nmmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.\nBMC Medicine\nShining a light on endometriosis: time \nto listen and take action\nBMC Medicine* \nEndometriosis, an often severe and common chronic \ninflammatory condition, affects around 1 in 10 women \nof reproductive age worldwide. It can have devastating \neffects on women’s physical and emotional well-being, \nquality of life, and reproductive health. Across the globe, \nMarch has been declared Endometriosis Awareness \nMonth for a reason—it is time to increase awareness and \neducation to allow for early diagnosis and eliminate the \nstigma surrounding this often-misunderstood condi -\ntion. This editorial will shed light on endometriosis and \nexplore why it is important to start listening and take \naction.\nEndometriosis is characterized by tissue that normally \nlines the inside of the uterus growing outside, usually in \nthe pelvic area. During the menstrual cycle, this displaced \ntissue continues to thicken, break down, and bleed, just \nlike the tissue inside the uterus, causing a chronic inflam-\nmatory reaction that may result in scar tissue forma -\ntion. Oftentimes, the endometrial tissue grows on pelvic \norgans such as the ovaries, fallopian tubes, and the out -\nside of the uterus, resulting in fibrotic lesions and adhe -\nsions. Notably, the extent of endometrial lesions does \nnot necessarily correlate with the severity of symptoms. \nPatients can experience severe symptoms despite the \nabsence of visibly large lesions and vice versa, and they \ncan even be asymptomatic.\nPatients with endometriosis often suffer from pain in \ndiverse manifestations, such as chronic pelvic pain, pain -\nful periods, and pain during intercourse, ranging from \nmild discomfort to severe pain. Some patients may expe -\nrience heavy or irregular menstrual bleeding and fatigue, \npossibly resulting from chronic pain and inflammation \noften associated with this condition. Even worse, endo -\nmetriosis can compromise reproductive health and cause \ninfertility, leading to problems in getting pregnant.\nThese symptoms vary broadly, and not all endometrio -\nsis patients may experience them with the same intensity. \nSome patients may not experience any symptoms at all, \nputting them even more at risk for a delayed diagnosis \nand treatment. Symptoms may also change over time and \noften, but not always, improve after menopause.\nThe symptomatic ambiguity and the lack of aware -\nness of endometriosis among both patients and health -\ncare providers often lead to underdiagnosis and prevent \ntimely treatment of this condition, which has significant \nsocial, public health, and economic implications. Severe \npain, fatigue, and infertility can all contribute to a sig -\nnificantly impaired quality of life for those affected by \nendometriosis. In the worst cases, the debilitating pain \nprevents them from pursuing regular day-to-day activi -\nties and attending school or work. Moreover, their sex -\nual health and partnerships might be affected by painful \nintercourse and infertility.\nConsequently, those affected often develop men -\ntal health problems and may suffer from depression or \nanxiety, accompanied by feelings of frustration, lone -\nliness, and even shame, leading to a downward spiral \nand complex multimorbidities. Too often, patients get \nrelief from their symptoms only after spending years \nwith unsuccessful consultations or continue to suffer in \nsilence as they interpret their symptoms as a normal part \nof their menstruation, which their healthcare provid -\ners may echo. For example, in the UK, more than half of \n*Correspondence:\nBMC Medicine\nBMCMedicineEditorial@biomedcentral.com\n4 Crinan Street, N19XW London, UK\n\nPage 2 of 2BMC Medicine  BMC Medicine          (2023) 21:107 \npeople do not know about endometriosis, including 62% \nof women between the age of 16 and 24. But why is there \nsuch low awareness despite the high prevalence and dev -\nastating consequences?\nThe underlying problems are diverse and spread across \ndifferent levels. At the scientific level, we must acknowl -\nedge that endometriosis remains an underresearched \ncondition. Research efforts towards a better under -\nstanding of the pathophysiology and diagnostic treat -\nment options are progressing only slowly. At the societal \nlevel, the situation is worsened by the normalization of \nwomen’s pain and persisting stigmatization around men-\nstrual issues, which becomes even more problematic \nwhen entering the clinical level: Many people, including \nhealthcare providers, may dismiss the symptoms of endo-\nmetriosis as “normal” menstrual pain, leading to a delay \nin diagnosis and treatment. Additionally, the stigma sur -\nrounding menstruation and reproductive health can add \nbarriers to seeking help, making those affected endure \nthe consequences silently.\nTherefore, we urgently need approaches towards better \ndisease management, education, and awareness involving \nall relevant stakeholders to eliminate stigmatization and \nprovide timely diagnosis and treatment. It is important to \nnote that there is no cure at the moment. Still, good man-\nagement options, including pain management, hormone \ntherapy, or surgery, can significantly improve patients’ \nlives. For example, studies suggest a 62.5% improvement \nor resolution of pain 6 months after laparoscopy, a stand-\nard surgical treatment to remove endometrial tissue, with \n90% still improved 1  year post-surgery. However, the \naverage time to diagnosis is lengthy, and it can take over \n7  years for patients to receive a proper diagnosis and, \nthus, treatment.\nSimple solutions seldom resolve complex problems. \nImproving the lives of patients with endometriosis will \nrequire a multifaceted approach that involves the sci -\nentific community, healthcare providers, and society at \nlarge by focusing on the following:\n– Research funding: We must invest in endometriosis \nresearch to build knowledge about the pathophysiol -\nogy and develop new treatments. Advocacy groups \nand government agencies should be encouraged to \nfund studies to increase our understanding of the \ncondition and provide better treatment options.\n– Medical education: Medical schools and residency \nprograms should include more information about \nendometriosis and its symptoms to ensure that \nhealthcare providers can recognize the condition ear-\nlier and provide timely and appropriate care.\n– Patient advocacy and public awareness cam -\npaigns: Support groups for people with endometrio -\nsis should be encouraged to share information and \nresources on various platforms, such as social media \nand blogs. Providing an open forum for exchange \nwill help increase the chances of early diagnosis and \nalleviate patients’ mental burden by making them feel \nheard and connected.\nWorking collaboratively, patients, advocates, health -\ncare providers, and researchers can significantly improve \ncare for those affected by endometriosis and break new \nground. The Endometriosis Awareness Promotion Project \n(EAPP), a multinational and multicentre epidemiological \nstudy, is an excellent example of how collaborative efforts \ncan lead to meaningful action: This study explores the key \naspects of menstrual pain and endometriosis, including its \npersonal and social impact. Promising first results suggest \nthat an educational scheme can improve young women’s \nawareness and knowledge of endometriosis, highlighting \nthe role of education for better outcomes.\nAlthough initiatives such as the EAPP are encourag -\ning, women’s health has been neglected for far too long. \nTo shake things up and eventually improve the lives of \nthose impacted by endometriosis, we must continue rais -\ning awareness at all levels. These efforts will pave the way \nfor achieving the core goals proclaimed by the UK Endo -\nmetriosis Association: reducing diagnosis time and pro -\nviding access to treatment and support for patients. By \ntaking action against endometriosis, we can make a huge \ndifference in the lives of those affected and empower \nthem by supporting their human right to the highest \nstandard of sexual and reproductive health.\nAuthors’ contributions\nThe authors read and approved the final manuscript.\nAuthor’s information\nThis article is an editorial published on behalf of the BMC Medicine editorial team.\nDeclarations\nCompeting interests\nThe author declares that there are no competing interests.\nReceived: 7 March 2023   Accepted: 7 March 2023\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in pub-\nlished maps and institutional affiliations.","source_license":"CC0","license_restricted":false}