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Endometriosis hospitalisation twice as likely to be self-funded: AIHW

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A new Australian Institute of Health and Welfare (AIHW) report on endometriosis has shown that the condition is increasingly common, leading to more hospitalisations, and that women and girls are often relying on their own funds or private health cover to access the care they need.
 
According to the new research, among females, endometriosis-related hospitalisation is more likely to be funded by private health than for any other reason and approximately twice as likely to be self-funded.
 
Associate Professor Anusch Yazdani, medical director of Endometriosis Australia, told newsGP that hospitalisation rates for endometriosis were ‘shocking’, having increased by 24% over the past 10 years, according to the AIHW report.
 
‘So many women are self-funding their care and I think that’s a terrible indictment unfortunately of where we are,’ Associate Professor Yazdani said.
 
‘The sooner we intervene, the more likely it is that we can stop them from having persistent pain and fertility problems later on.’
 
Between 2021 and 2022 alone, more than 40,000 endometriosis-related hospital admissions were recorded, with the condition now the 20th most common reason for hospitalisation for women and girls aged 15–44.
 
Associate Professor Yazdani believes the findings may reflect increasing awareness surrounding endometriosis and highlights that pelvic pain and endometriosis should be a public health priority.
 
‘[The report] appears to show an increase in the prevalence of endometriosis,’ he said. ‘Whether that is a true increase or an increase in presentations of women with endometriosis is a matter for us to determine.
 
‘A lot of this data is from self-reported patients about the identification of endometriosis and it certainly demonstrated an increase in prevalence from what was one in 12, to one in nine, and now it’s one in seven.
 
‘It probably really reflects an increased empowerment of particularly younger women … putting up with pelvic pain and putting up with periods and being told that “this is all okay” is no longer okay.’
 
On average women experience delays of 6–8 years after symptom onset before they are given a diagnosis, while growing wait lists in the public health system mean 7% of patients wait more than one year if they require a laparoscopy, which could contribute to the high rates of private and self-funded care.
 
According to Australian clinical practice guidelines endometriosis should be suspected in individuals presenting with one or more of the following symptoms:

• Persistent pelvic pain
• Dysmenorrhoea affecting daily activities and quality of life
• Deep pain during or after sexual intercourse
• Period-related or cyclical gastrointestinal symptoms, in particular, painful bowel movements
• Period-related or cyclical urinary symptoms, in particular, blood in the urine or pain passing urine
• Infertility in association with one or more of the above 

A symptom diary alongside abdominal and pelvic examination, if appropriate, is also recommended and referral for ultrasound can be considered. Associate Professor Yazdani says that above all, the validation of the pain and the experience of patients who live with endometriosis is key.
 
‘Saying “look, you’re in pain, I completely understand that” [is important],’ he said.
 
‘Let’s investigate and make sure that there isn’t something abnormal going on and let’s try and manage your pain.’
 
First-line therapy is addressing lifestyle factors, simple analgesia and using hormonal treatments depending on patient preference. Organising follow-up to ensure that treatment has been effective is also important and if the patient has not responded to treatment or their symptoms are severe, they should be referred for gynaecological review.
 
Research published last month in the Australian Journal of General Practice investigated the challenges GPs face in diagnosing and managing endometriosis that may contribute to diagnostic delay.
 
The researchers identified many factors at play, including difficulties in navigating multiple complex symptoms that may be non-specific, time constraints, cultural barriers, gender bias and a lack of pragmatic clinical guidelines that include local referral options.
 
The National Action Plan for Endometriosis lists strategies to overcome some of these obstacles and aims to offer a blueprint for how to improve care for affected individuals, including awareness and education, improved clinical management and care alongside medical research.
 
Maree Davenport, CEO of Endometriosis Australia, told newsGP the opening of 22 pelvic pain clinics as part of the plan has been a positive step.
 
‘Certainly, the work in the past 10 years in the endometriosis awareness space has absolutely led to greater diagnosis of endometriosis and recognition of the symptoms,’ she said.
 
‘However, we still have a long way to go.’
 
She also urged GPs not to dismiss women, girls and those assigned female at birth who present with symptoms of endometriosis.
 
‘They often understate how they’re actually feeling and their symptoms,’ Ms Davenport said.
 
‘They are there because they are concerned about managing their symptoms. It can have such a dreadful effect on their mental health, their employment, their sexual relationships and intimacy, their family life and every aspect of their lives.’
 
The first pelvic pain clinics were opened in March and continue to expand nationally. A list of pelvic pain clinics that are currently in operation is available via the Department of Health and Aged Care.
 
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AIHW chronic pain endometriosis women’s health

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