Global inequities and fragmentation in guidelines for endometriosis: a scoping review

Dereje G. Gete, Devon Evans, Jason Abbott, Leticia W. Ribeiro, Krina T. Zondervan, Linda C. Giudice, Luk Rombauts, Mathew Leonardi, Hemantha Senanayake, G. David Adamson, Elsie Wandera, Femke Jansen, Sally Motlock, Angela G. Sison-Aguilar, MD, MSc, MBA, Angela G Sison-Aguilar, Sawsan As-Sanie, Idhaliz Flores, Kaori Koga, Marina Kvaskoff, Jacques W.M. Maas, Ezekiel Onyonka Mecha, Ezekiel Mecha, Engin Oral, Adrienn Salamon, Ertan Saridogan, Ertan Sarıdoğan, Paul J. Yong, Neil P. Johnson, Stacey A. Missmer, Andrew W. Horne, Manjulaa Narasimhan, Gita D. Mishra
Communications medicine · 2026 · vol. 6(1) · doi:10.1038/s43856-026-01907-w · PMID:42875470 · W7221775711
Other OA: gold CC0
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Abstract

BACKGROUND: Despite the availability of endometriosis care guidelines from multiple governmental and professional organisations, their global applicability and recommendations have been insufficiently examined. This scoping review examines endometriosis guidelines worldwide, evaluating their availability, target audiences and populations, methodologies, and clinical recommendations, building on a previous review of region-specific endometriosis care guidance. METHODS: We searched PubMed, EMBASE, and Scopus from inception through October 2025 without language, publication date, or geographic location restrictions. Additional grey literature searches were conducted through March 2026. Eligible guidelines addressed individuals with suspected or confirmed endometriosis of any age, including adolescent-specific guidance and recommendations incorporating adenomyosis. RESULTS: A total of 47 guidelines were included, comprising 28 English-language and 19 non-English-language guidelines from multiple regions. The findings reveal marked regional inequities: most guidelines originate from high-income settings, particularly in Europe (15/47, 32%), with substantial gaps in Africa (2%) and the Eastern Mediterranean (4%). Variation in inclusivity and methodological rigour was observed, including underrepresentation of adolescents (77%), individuals with lived experience (30%), and gender-diverse people (19%), as well as inconsistent approaches to grading evidence. There was also limited consideration of primary care physicians (49%), who play a key role in early diagnosis and management. Gaps in alignment across guidelines on key diagnostic and therapeutic pathways include recommendations on histological confirmation, biomarker use, aromatase inhibitors, repeat surgery, fertility care, non-medical interventions, and self-care interventions. CONCLUSIONS: These findings highlight the need for a global normative guideline, greater standardisation in guideline development methods, context-specific guidance that incorporates the needs and rights of end-users, and coordinated efforts to strengthen equitable, evidence-based care.

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