Cosmos Study

Endometriosis Rates Increasing Across All Ages, Most Common in Women 35–49

July 29, 2025

Team A:Kersten Bartelt, RNGrant Keane

Team B:Matthew Gracianette, MDEric Barkley

Key Findings

The rate of endometriosis diagnoses per 10,000 patients increased 32% from 24.9 in 2017 to 32.8 in 2024.
In 2024, diagnosis rates were highest among women aged 35 to 49 (85.4 per 10,000) and lowest among those aged 15 to 24 (18.6 per 10,000).
Among patients diagnosed in 2024, 55.9% had documented abdominal or pelvic pain within the two years prior, representing the most common symptom preceding the diagnosis.

Endometriosis, a chronic inflammatory condition characterized by endometrial tissue in areas outside of the uterus, affects approximately 1 in 10 women of reproductive age and is associated with pain, infertility, and decreased quality of life. There is often a significant delay between the onset of symptoms and diagnosis of the condition. Multiple factors contribute to this delay, including the nonspecific nature of the symptoms and the need for an invasive surgical procedure to definitively establish a diagnosis.¹ In recent years, there has been an increase in awareness of the condition, particularly through social media.²

To better understand the changing landscape of endometriosis diagnoses, we studied over 25 million women 15 years of age and older who had at least one outpatient face-to-face encounter between 2017 and 2024 and determined the annual rate of new endometriosis diagnoses. Between 2017 and 2024, the annual rate of endometriosis diagnoses increased by 32%, from 24.9 to 32.8 per 10,000 patients, as seen in Figure 1. Age-specific trends show consistently higher diagnosis rates among women aged 35 to 49, who reached a rate of 85.4 per 10,000 in 2024. Diagnosis rates among women aged 25 to 34 also increased moderately, while rates in younger women (15 to 24) remained lower.

Figure 1

Endometriosis Diagnosis Rates by Age

Figure 1. The rate of endometriosis diagnoses by age and year.

When we evaluated symptoms in the two years leading up to the endometriosis diagnosis, we found that abdominal or pelvic pain was the most frequent, affecting 55.9% of patients who were diagnosed in 2024, as seen in Figure 2. Neuropsychiatric symptoms, including anxiety, headache, dizziness, and depression, affected nearly half of women, while menstrual problems affected 44.8%. Dyspareunia (6.3%) and infertility (3.4%) were relatively uncommon.

Figure 2

Symptom Documentation Within Two Years Prior to Endometriosis Diagnosis

Figure 2. The rate of symptoms being present in the two years preceding an endometriosis diagnosis in 2024.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,700 hospitals and more than 40,000 clinics from all 50 U.S. states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. The New England Journal of Medicine, 382(13), 1244–1256. https://doi.org/10.1056/NEJMra1810764
Seo H, Burkett KM, Okocha M, et al. Social media activism and women’s health: Endometriosis awareness and support. Digit Health. 2025;11:20552076251314905. Published 2025 Jan 21. doi:10.1177/20552076251314905

Data Definitions

Study period: 2017 to 2024

Study population

Patients with:

A reliable sex of female or ambiguous
An outpatient face-to-face encounter between 2017 and 2024

Exclusions:

Patients who had a problem list diagnosis of endometriosis documented before their first non-problem list diagnosis of endometriosis
Patients who did not have at least one endometriosis-related symptom documented between two years before their first endometriosis diagnosis and the diagnosis date
Patients who had an endometriosis diagnosis before the year in question

Outcomes: Endometriosis: ICD-10-CM code N80*

Endometriosis related symptom

Symptoms of endometriosis bucketed as:
Abdominal or pelvic pain:

ICD-10-CM code R10*
Or a chief complaint of:
Abdominal Burn
Abdominal Cramping
Abdominal Pain
Abdominal Pressure
Pelvic Pain
Chronic Pelvic Pain
Groin pain

Low back pain:

ICD-10-CM code M54.5*
Or a chief complaint of Back pain

Menstrual problems:

ICD-10-CM code N94.6, N92*, N91*
Or a chief complaint of:
Dysmenorrhea
Female GU problem
Menometrorrhagia
Menstrual problem
Metrorrhagia
Irregular menses
Oligomenorrhea

Dyspareunia:

ICD-10-CM code N94.1*
Or a chief complaint of Dyspareunia

Infertility:

ICD-10-CM code N97*
Or a chief complaint of:
Infertility
Primary Ovarian Insufficiency
Tubal Factor Infertility
Ovarian Failure

Ovarian mass:

ICD-10-CM code N83.[012] *
Or a chief complaint of Ovarian Cyst

Urinary symptoms:

ICD-10-CM code R35* or R39.15
Or a chief complaint of:
Urinary Frequency
Urinary Incontinence
Urinary Problem
Urinary Symptom
Genitourinary Symptoms
Urinary Urgency
Blood in urine

GI symptoms:

ICD-10-CM code R19.7, K59.[01], K59.0[09], or R11*
Or a chief complaint of:
Diarrhea
Constipation
Nausea
Nausea/Vomiting

Neuropsychiatric symptoms:

ICD-10-CM code R41, R42*, R51*, R53.8[23], G44*, F40*, F41*, F94.0*, F32*, F33*, or F34.1*
Or a chief complaint of:
Dizziness
Anxiety
Headache
Depression
Morning Headache
Adjustment Disorder with Mixed Anxiety and Depressed Mood
Pre Syncope
Fatigue

Outpatient face-to-face: Encounter type of “Emergency,” “Office Visit,” “Well Child,” “Follow-Up,” “Telemedicine,” “Urgent Care,” “Walk-In,” “Routine Prenatal,” “Postpartum Visit,” or “Fetal Care Consult”