Many women’s health conditions continue to be misdiagnosed, misunderstood or quietly dismissed - with Polycystic Ovary Syndrome - PCOS, (renamed PMOS or polyendocrine metabolic ovarian syndrome in May 2026) and endometriosis among the most frequently reported.
These are two of the most prevalent reproductive disorders worldwide, yet they remain under-recognised, underfunded and too often mismanaged. For many women, that means years of unanswered questions, delayed diagnoses or being told their symptoms are simply something to “put up with.”
PCOS/PMOS affects an estimated 8-13% of women of reproductive age, while endometriosis impacts around 10% of women globally.
To be clear, these are not rare conditions. They are common, chronic and systemic disorders. They deserve earlier recognition, better research and care that reflects the reality of the lived experience of these women.
Reproductive Endocrine Disorders Findings from Study; Reproductive Endocrine Disorders: A Comprehensive Guide to the Diagnosis and Management of Infertility, Polycystic Ovary Syndrome, and Endometriosis (2025): https://assets.cureus.com/uploads/review_article/pdf/318310/20250301-501380-7f352i.pdf
The Cureus review describes PCOS and endometriosis as complex hormone-related conditions that affect far more than just reproductive health. They influence multiple systems in the body, shaping everything from metabolism to inflammation. The research takes a closer look at what’s happening beneath the surface, and why these conditions are about much more than periods alone.
PCOS Pathophysiology and Clinical Profile
PCOS is defined by the presence of at least two of the following criteria (Rotterdam criteria): hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. However, the review emphasises that PCOS is fundamentally a metabolic–endocrine disorder.
A central driver is insulin resistance. Elevated circulating insulin levels stimulate theca cells in the ovary to increase androgen production, while simultaneously reducing hepatic production of sex hormone-binding globulin (SHBG). This leads to higher levels of bioavailable testosterone, contributing to clinical features such as irregular cycles, acne, hirsutism, and anovulatory infertility.
Importantly, the review confirms that PCOS exists across BMI categories (previously linked to higher BMIs and obesity). Lean PCOS phenotypes demonstrate that insulin dysregulation and androgen excess can occur independent of obesity. This directly challenges the misconception that PCOS is solely a weight-related condition.
Long-term risks highlighted in the review include impaired glucose tolerance, type 2 diabetes increasing risk of associated diseases. Thus, PCOS is not confined to reproductive years; it has lifelong metabolic implications.
Endometriosis PCOS Pathophysiology and Clinical Profile
Endometriosis is a chronic, oestrogen-driven inflammatory condition in which tissue similar to the uterine lining grows outside the uterus. While many women experience some degree of retrograde menstruation, only a subset develop endometriosis, indicating that additional factors play a role. These may include variations in immune function, persistent inflammation, the formation of new blood vessels that sustain lesions, and alterations in how cells break down and remove tissue.
The condition is perpetuated by ongoing pelvic inflammation, elevated levels of pain-inducing chemicals such as prostaglandins, and oestrogen produced locally within endometriotic tissue. This combination contributes to progressively worsening symptoms, including severe menstrual pain, pain during sexual activity, chronic pelvic discomfort, and often fertility challenges.
Diagnosis is frequently delayed, with confirmation commonly requiring laparoscopic surgery. Therefore, emphasises the importance of recognising symptom patterns early, rather than dismissing intense pain as “normal,” to minimise long-term physical consequences and preserve fertility.
Outcome
The Cureus review concludes that both PCOS and endometriosis require early diagnosis, multidisciplinary care, and individualised treatment strategies integrating pharmacologic, surgical (where indicated), and lifestyle interventions. Both conditions are chronic and systemic, not episodic reproductive events.
Systemic Failure towards Women’s Health
Systemic failure is evident in the continuous delays in diagnosis and the ongoing underinvestment in women’s health research, adding further distress and frustration for women who are often dismissed or must wait years to be diagnosed.
- Women wait an average of 4.4yrs for diagnosis of endometriosis, with some reporting up to a decade Frontiers | Factors contributing to the delayed diagnosis of endometriosis—a systematic review and meta-analysis
- Women commonly wait 2 years to get a diagnosis for PCOS. Heterogeneity in diagnostic criteria and variable clinician awareness contribute to under-recognition, particularly in adolescents and lean phenotypes Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome - PubMed
Illustrating two sides of the same problem: biological complexity compounded by systemic neglect.
Furthermore, a report by the Royal College of Obstetricians and Gynaecologists (RCOG) in 2024 New RCOG report reveals devastating impact of UK gynaecology care crisis on women and NHS staff | RCOG exposes a major UK gynaecology crisis, with over 763,000 women and people waiting months or years for treatment, causing worsening mental health, pain, and daily life disruption. NHS staff are under strain, with many reporting stress and burnout from insufficient resources. The report calls for urgent patient support and long-term government investment to fix the system.
Often these patterns are framed within broader structural inequity in women’s health research funding and service design, arguing that reproductive disorders are often siloed and deprioritised despite their prevalence and long-term health consequences. Disparities in women’s health and clinical considerations from a translational science perspective: A narrative review and framework for future directions - PMC
Both conditions require multidisciplinary collaboration of endocrinology, gynaecology, nutrition, psychology, and primary care to address systemic effects comprehensively.
In summary
The research makes something clear: there is still a gap in how women’s health conditions are recognised and supported, particularly when it comes to PCOS and endometriosis. Delays in diagnosis and misunderstandings around symptoms can mean women spend years searching for answers.
Paying attention to your body matters. Tracking symptoms, noticing patterns and speaking to a healthcare professional if something doesn’t feel right can help move conversations forward sooner. Earlier recognition means earlier support, and that can make a real difference.
Six Take-Home Messages
- PCOS and endometriosis each affect around 1 in 10 women; they are common.
- PCOS is largely driven by insulin resistance and androgen excess, not simply weight.
- Endometriosis is a chronic inflammatory, oestrogen-dependent condition that benefits from early recognition.
- Diagnostic delays remain a major barrier to better outcomes.
- Early, integrated, multidisciplinary care can improve fertility, long-term health, and quality of life.
- If you have concerns about PCOS or endometriosis, track your symptoms and contact your GP.
