Flying Blind: unveiling the patchy landscape of global R&D for endometriosis, polycystic ovary syndrome and uterine fibroids

Common yet ignored: the neglect of gynaecological conditions in medical research

Endometriosis, polycystic ovary syndrome (PCOS) and uterine fibroids are common gynaecological conditions that affect the health and wellbeing of millions of women¹ worldwide. Despite their high prevalence and burden, medical knowledge and therapeutic options are limited, because of a historical neglect of women’s health conditions.

Currently, the pathophysiology of these three conditions is poorly understood, although various pathways are implicated (e.g. endocrine, inflammatory, etc). As a result, clinical management relies on repurposed medicines for symptoms only, and there are no cures available aside from fertility impacting surgery, such as hysterectomy for uterine fibroids.

Diagnostics are also limited. Uterine fibroids are detected by ultrasound, while diagnosing PCOS relies on identifying a cluster of symptoms – often subjectively and using inconsistent thresholds – through clinical examination, ultrasound and endocrine biomarkers, many of which are inaccessible in low-resource settings. For endometriosis, the gold standard, and until recently, only available diagnostic, is laparoscopic examination. This is invasive and not always accessible, leading to severe diagnostic delays – estimated to be between 4 to 11 years – and a massive underestimation of disease prevalence.

Despite the high prevalence and burden associated with these common gynaecological conditions, the research and development landscape is underdeveloped and underfunded, leaving women with few diagnostic and therapeutic options to address or manage symptoms that seriously affect their quality of life. While endometriosis R&D has benefited from recent momentum, enormous gaps in knowledge persist – as they do across all three conditions – requiring greater and more ambitious investment to drive progress.