On the occasion of National Women’s Health Day, April 22, endometriosis returns to center stage as a chronic, high-incidence, and often disabling condition that affects about 10% of women of reproductive age. The new report from the GIMBE Observatory highlights not only the impact on quality of life and fertility but also stark regional disparities in access to diagnosis and care, underscoring the need for integrated, multidisciplinary models of care across the country.
«Endometriosis represents a public health issue that remains underestimated – says Nino Cartabellotta, president of the GIMBE Foundation – because diagnosis often comes after years of suffering and care remains deeply inconsistent across the national territory».
Epidemiologia e ritardi diagnostici
According to international estimates, endometriosis affects about 10% of women in their reproductive years. In Italy, hospital data report roughly 9,300 new cases per year, but this is an undercount, largely reflecting the more severe forms.
Critically, the diagnostic delay is estimated at 7 to 10 years. «A delay of such magnitude» – highlights Cartabellotta – «means years of pain, deteriorating quality of life, and an increased risk of complications. Reducing it must become a priority for Italy’s National Health Service».
Disuguaglianze regionali nell’assistenza
Persist strong regional differences in how care pathways are organized, in the presence of PDTA, clinical networks, and specialized centers. The landscape remains fragmented and uneven. «The picture remains highly heterogeneous – explains the GIMBE president – with regions that have developed structured clinical networks and pathways and others where care organization is still fragmented».
Esenzioni e accesso alle prestazioni
Endometriosis in advanced stages (III and IV) is included among exempt chronic diseases under the 2017 DPCM on LEA, but the exemption’s operationalization is recent and limited. The guaranteed services mainly include follow-up visits and targeted diagnostic tests, but do not cover the milder forms (stages I and II). «This is a package of diagnostic services – observes Cartabellotta – that excludes the early stages of the disease, does not cover the clinical complexity of endometriosis and leaves pain management partly uncovered».
Some regions have expanded the offering with their own resources: exemption for mild forms and free psychological support (Valle d’Aosta); coverage of hormonal medications (Emilia-Romagna); free oocyte cryopreservation under selected conditions (Tuscany); facilitation measures to access medications (Sicily). «Overall – observes Cartabellotta – there emerges a “variable geometry” protection: formal recognition of the exemption does not guarantee real and uniform access to the services».
Priorità per ridurre le disparità
To improve the management of endometriosis, it is necessary to develop structured regional clinical networks, make PDTA operational, strengthen the integration between community-based and hospital care, ensure uniform access to exempt services, and reduce diagnostic delays.
«Endometriosis – concludes Cartabellotta – requires multidisciplinary organizational models and homogeneous care pathways across the country. Ensuring timely diagnosis and appropriate treatment is not only a clinical objective but a right to be guaranteed to women uniformly across the entire national territory. On the eve of National Women’s Health Day, this must translate into a concrete priority, not merely symbolic commitment».
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