Benign gynecological diseases and women’s health burden: time to remove the invisibility cloak

Women face throughout their life-course a set of conditions which are considered benign, despite the fact that they may deeply interfere with their health and quality of life (Wijeratne et al. Citation2024). Such benign diseases may affect the female reproductive system in various ways, leading to anovulation, infertility, chronic pelvic pain and heavy uterine bleeding. Examples of benign gynecological diseases (BGC) include an array of conditions such as adenomyosis, uterine fibroids, endometriosis, abnormal uterine bleeding, pré-menstrual syndrome (PMS), polycystic ovary syndrome (PCOS) and menopausal and perimenopausal syndrome (Wolfe and Craig Citation2024). Other gynecological diseases included in the Global Burden of Disease Database include menstrual and non-menstrual conditions which also contribute to increase women’s disease burden (He et al. Citation2025; Wijeratne et al. Citation2024). Although major advances in worldwide health have occurred from 1990 to 2019, the burden of benign gynecological diseases has progressed when compared to other non-communicable diseases (NCD) (Cao et al. Citation2024). Data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study (IHME Citation2024) (https://www.healthdata.org/research-analysis/gbd) reveals appalling numbers regarding BGC. GBD numbers in 2021 includes evaluation of 371 diseases in 204 countries since 1990 which resulted in health loss. It is interesting to note that menstrual-related diseases could not be properly evaluated (Cao et al. Citation2024), so the burden may be even higher. Wijeratne et al. (Citation2024) studied the global burden related to GBC and results in terms of years lost to disability (YLD), which measures disease morbidity of non-fatal diseases. The numbers for BCG are alarming: BGC are responsible for roughly 5 percent of all YLD, which is five times more than YLD associated with human immunodeficiency vírus and acquired immunodeficiency syndrome, malaria, and tuberculosis which adds up to roughly 1.1 percent. To make matters worse, YLD is even higher in low-income countries (LIC; YLD: 8.11 percent) and low-middle-income countries (LMIC YLD: 7.75 percent). A word of caution is warranted as numbers may not reflect the reality in many regions as the GBD group could not obtain data from some countries and not all relevant BCG were included in the analysis. These figures however delineate the picture and may help direct policy priorities. Endometriosis, infertility PCOS and leyomiomas or fibromas are good examples of BGC that affect women’s lives which are ignored and often gaslighted. Recent published papers have used the GBD dataset to assess the burden associated with these benign female diseases. Uterine fibroids are benign neoplasms that may be found in almost 70–80 percent of reproductive age women and result in relevant symptoms in up to 30 percent including pelvic pain, infertility, abnormal uterine bleeding and pregnancy complications. Delays in diagnosis are not rare which may further contribute to fibroid-related burden. Moreover, noninvasive treatment options remain restricted and fibroids end up accounting for about one-third of the hysterectomies worldwide (Stewart, Laughlin-Tommaso, and O’Malley Citation2024). Lou et al. (Citation2023) used the GBD database to study uterine fibroids incidence, prevalence and morbidity in terms of YLD in 204 countries between 1990 and 2019. YLD increased in 174 countries with a 77 percent increase over the years evaluated, mainly in less developed countries where access to helathcare and treatment is scarce and thus further contributes to raise the burden of uterine fibroids. Direct and indirect health costs have increased in recent years and consumed billions of dollars in the USA alone. Sadly, investments in uterine fibroid research remain low and impair a relevant change in this scenario in the near future (Hazimeh et al. Citation2024) Endometriosis is an entrogen-dependent disease which may be found in 10 percent of reproductive-age women, leading to chronic pelvic pain and infertility. As the disease is clinically hereteogenous, and there is no reliable noninvasive diagnostic method, it may take three to 12 years to properly identify and treat endometriosis (Bourdon et al. Citation2024). Since the disease has no cure so far, heavy burden is expected due to infertility, chronic pelvic pain, and repeated failed treatments which result in elevated direct and indirect health costs. Moreover, women with endometriosis need long-term care which should be preferably provided by scarcely available multidisciplinary care teams (Carneiro Citation2023; Sommer et al. Citation2024). Proper endometriosis treatment may entail assisted reproduction, surgery and hormonal drugs as well as the expertise of specialized surgeons, gynecologists, pain specialists and physical therapists among other health-care professionals. Sadly, only very few women have access to such care (Bourdon et al. Citation2024; Carneiro Citation2023). Xu et al. (Citation2025) presented GBD data from 1990 to 2021 depicting a global reduction in endometriosis prevalence and burden which showed an inverse relationship with income level. Despite the reduction which should continue up to 2040, the disease burden remained high, affecting mostly young women (25–29 years of age) with dire effects on their lives, making their path to proper diagnosis and treatment long and painful. To make matters worse, research funding for endometriosis remains low which makes any significant change in the current disease landscape a farfetched dream (Valee et al., Citation2024). PCOS is the most common female endocrinopathy characterized by chronic anovulation and hyperandrogenism (clinical or biochemical) once secondary causes are eliminated (Chang and Dunaif Citation2021). Current diagnostic guidelines require the presence of at least two abnormalities: anovulation, clinical or biochemical androgen excess and polycistic ovarian morphology on ultrasound. Anti-mullerian hormone (AMH) has been added and may replace ultrasound (Teede et al. Citation2023). An association with obesity, metabolic disturbances, cardiovascular risk, infertility and pregnancy complications is also reported. The disease affects 10–13 percent women from puberty to menopause making the burden of PCOS a relevant issue in female health. PCOS etiology remains ellusive and the heterogeneity of clinical symptoms as well controversies in diagnostic criteria result in delayed access to adequate diagnosis and treatment (Chang and Dunaif Citation2021; Teede et al. Citation2023). PCOS cases have been increasing in recent years (1990–2021) mainly in more economic developed regions, according to analysis of GBD data recently published (Lin et al. Citation2025). Explanations for such an increase may lie in the obesity epidemic affecting mainly in women, environmental factors with increased exposure to endocrine disruptors as well as increased awareness, better health-care infrastructure and the adoption of international diagnosis criteria for diagnosis in these regions. The situation in low-income regions however needs urgent attention (Lin et al. Citation2025). It is clear from the data published that there is an urgent need to prioritize these benign female diseases both in the health-care and research agenda with special attention to countries with low socio-demographic index where disease burden is higher (Cao et al. Citation2024; He et al. Citation2025). When women aged 15–49 years are considered, the burden of these BGC is of great concern. In 2021, the numbers in this age-group were staggering: uterine fibroids (85.18 million), endometriosis (21.05 million), and PCOS (110.09 million). Since these BGC are commonly associated with infertility, it is not difficult to understand the steep rise in female infertility numbers (110.9 million) in women of reproductive age (He et al. Citation2025). Fertility rates have been dropping to alarming numbers in recent years driven by social, political and economical changes and thereatening economic prosperity and social development on a global scale as the population ages and birth rates remain below replacement level (Carneiro Citation2025). Although defined as “benign”, this group of diseases may adversely affect women’s lives compromising not only their quality of life but their education carreer, relationships, social life and even family building expressed in the years lost to disability (YLD). Moreover, disease burden increases as the country’s socio-economic index decreases (Cao et al. Citation2024). The United Nations “Every Woman Every Child Global Strategy for Women’s, Children and Adolescents’ Health (2016–2030)” (World Health Organization Maternal, Newborn, Child & Adolescent Health & Ageing (MCA)) published in Citation2022 sets a grim scenario for the women’s health agenda which was further complicated by the COVID-19 pandemic. The document concludes with hopeful remarks that the 2030 agenda goals may still be achieved as long as all stakeholders including governments, public and private institutions, non-governmental agencies, health-care organizations, universities and research groups as well as society as a whole agree to join efforts and truly embrace the cause. A set of recommendations to catch up with the agenda would include reinforcing primary health care to provide proper care for women, adolescents and children while integrating partnerships among involved stakeholders to increase availability of services. Enhancing private–public collaborations to raise funding and services and increasing women’s and girl’s empowerment and leadership as well as boosting public investments in health care should also be considered. It seems clear from the available data, despite its limitations, that women urgently need a life-cycle approach to their health care that surpasses reproductive health care and encompasses care from adolescence to menopause and beyond (Lassi, Wade, and Ameyaw Citation2025). Such endeavor entails providing not only heathcare but also implementing preventive measures with specific approaches throughout a woman’s life-cycle involving menstrual health as well as noncommunicable diseases and cancer (Lassi, Wade, and Ameyaw Citation2025). There is no denying this is a formidable task if we are to include more than four billion women in the health-care and research agenda and finally remove the invisibility cloak thrown on menstrual health and female benign diseases (Carneiro Citation2024; Sommer et al. Citation2024). The data published on BGC burden in several studies is the deafening alarm which can no longer be ignored as the problem surpasses gender issues since it affects the future and welfare of generations to come. Disclosure statement No potential conflict of interest was reported by the author(s). References - Bourdon, M., C. Maignien, G. Giraudet, J. P. Estrade, E. Indersie, C. Solignac, E. Arbo, H. Roman, C. Chapron, and P. Santulli. 2024. “Investigating the Medical Journey of Endometriosis-Affected Women: Results from a Cross-Sectional Web-Based Survey (ENDOVIE) on 1,557 French Women.” Journal of Gynecology Obstetrics and Human Reproduction 53 (2): 102708. 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