Endometriosis Sucks: An Emergency Physician’s Unofficial, Highly Biased Case Study

Haddijatou Hughes, Howard L. Hughes
In: Women's Reproductive Health · 2025 · vol. 13(2) , pp. 400–407 · doi:10.1080/23293691.2025.2559825 · W4415400974
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This case study offers a biased, unofficial perspective on endometriosis from an emergency physician's viewpoint.

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This reflective case study by an emergency physician of African heritage examines the profound personal, educational, and economic burdens associated with endometriosis. The author highlights significant disparities in diagnosis and care, noting that societal misconceptions often obscure the condition in people of color and that transgender men are frequently overlooked in research. Key findings include data on the high annual costs of the disease in Australia and evidence that pelvic pain clinics can reduce emergency department presentations through specialized management. The paper advocates for integrating the National Action Plan for Endometriosis into emergency care to improve patient outcomes and provider education. This paper is centrally about endometriosis — specifically focusing on emergency department management, health equity, and the lived experiences of diverse patient populations.

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Abstract Endometriosis is a chronic, painful condition that affects individuals from diverse and intersecting backgrounds. The personal toll of endometriosis is profound: It disrupts education, relationships, and careers. The financial burden is just as significant, with billions lost each year through healthcare expenses and reduced productivity. In this piece, I reflect on my lived experience as an emergency physician of African heritage with endometriosis and explore the historical and societal perceptions that have shaped our understanding of the disease. Emergency physicians play a vital role as both educators and advocates for patients with endometriosis. We must possess a foundational understanding of the condition, alongside effective communication skills for engaging with people in pain. A proposed script is included to support compassionate and informed clinician–patient interactions. Management should be evidence-based, and I advocate for the integration of strategies from the National Action Plan for Endometriosis (NAPE) into emergency department (ED) care. The NAPE seeks to improve quality of life for those living with endometriosis by increasing access to education, clinical resources, and multidisciplinary support. Greater implementation of NAPE, supported by sustained government investment, will enable both patients and providers to navigate this complex condition better. People with endometriosis are used to enduring discomfort. When we present to the ED, it is not a reflection of low resilience, but rather the culmination of ongoing suffering and limited alternatives. KEY FINDINGS A 2008 study across 10 high-income countries found that endometriosis costs an average of €9579 per person annually, primarily due to productivity loss and healthcare expenses. Sensitivity analyses estimate that the annual economic burden of endometriosis in Australia ranges from $1.4 billion to $6.5 billion, depending on prevalence rates. An Australian survey revealed that endometriosis significantly disrupts social and work life, with most participants reporting reduced participation in leisure activities, social withdrawal, and impacts on employment despite some workplace support. Between 2020 and 2021, more than 3,700 women presented to Australian emergency departments with concerns related to endometriosis. Patients find that using pain scales alone is inadequate and should be supplemented with qualitative descriptions and assessments of daily impact. The long-standing societal misconception that people of African background are not commonly affected with endometriosis continues to obscure diagnosis and care and must be dismantled through sustained education and advocacy. While research often centers on cisgender women, up to 25% of transgender men are also affected by endometriosis, highlighting the need for inclusive care. Australian pelvic pain clinics have reduced ED presentations, short-stay admissions, and opiate use among patients with chronic pelvic pain. Culturally sensitive, intersectional research is essential to better understand endometriosis in diverse populations. Acknowledgment I acknowledge Harvard University’s Effective Writing for Health Care certificate program. Disclosure Statement No potential conflict of interest was reported by the authors. Data Availability Statement The author confirms that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

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endometriosis

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