Introduction

Endometriosis is a chronic, inflammatory disease affecting an estimated 10% of reproductive-age women worldwide [1]. It is estrogen-based and associated with infertility, pelvic pain, and diminished quality of life [2,3]. Diagnosis is often delayed by 7-12 years after symptom onset, contributing to worsening physical, emotional, and social outcomes [3,4]. Diagnostic delay has been consistently attributed to symptom normalization, dismissal of pain complaints, and variability in presenting symptoms [5-7]. Beyond its clinical burden, endometriosis imposes significant quality of life burdens and economic costs, with estimates exceeding $69 billion annually in the United States (US) due to both medical costs and loss of work productivity among affected women [3,8].

Growing evidence indicates that the burden of endometriosis and access to effective care are not experienced equally across populations. Racial, ethnic, and socioeconomic disparities contribute to inequities in diagnosis, management, and surgical outcomes [2,9]. Historically believed to primarily affect White women, endometriosis is now recognized as similarly or more prevalent among Hispanic, Black, and Asian women, yet inequities in care persist [2,9]. For example, Hispanic and Black women are less likely than White women to undergo minimally invasive surgery and more likely to experience perioperative complications [9], reflecting systemic differences in referral patterns, insurance coverage, and access to specialists [3].

Hispanic patients with endometriosis appear to face particularly pronounced barriers to obtaining comprehensive care possibly due to differences in pain expression and cultural norms [10,11]. These barriers persist despite many Hispanic respondents being educated and employed, suggesting structural rather than individual-level factors. Additional studies show that women from minority racial and ethnic groups in the US are more likely to encounter misdiagnosis, stigmatization, and dismissal of pain complaints when seeking care for endometriosis-related symptoms [3,12].

Younger women and women from racial and ethnic minority groups consistently report lower satisfaction with their endometriosis care and reduced perceptions of patient-centeredness [4]. Conceptual frameworks such as the Perceived Access to Healthcare Questionnaire (PAHQ) emphasize that meaningful access extends beyond availability and affordability to include acceptability, accommodation, and awareness [13]. These dimensions are particularly relevant for Hispanic patients, who may face compounded language, cultural, and geographic barriers.

Despite the high prevalence of endometriosis, the disproportionate challenges experienced by marginalized populations, and persistent gaps in equitable care, little is known about how Hispanic women, particularly those living outside the US, perceive access to endometriosis care across referral, financial, and geographic domains. To address this gap, we conducted an international, web-based survey to examine perceived access to care and patient-centeredness among women with endometriosis. The primary objective was to assess perceived access to care across groups defined by Hispanic ethnicity and country of residence. Secondary objectives were to compare referral experiences, specialist access, financial barriers, and geographic access between groups to identify barriers that may inform more culturally responsive and equitable models of endometriosis care.