New Study Reveals New Zealand’s Multi-Billion-Dollar Burden Of Endometriosis And Chronic Pelvic Pain

Aotearoa New Zealand’s first national cost-of-illness estimate for endometriosis and chronic pelvic pain has revealed a multi-billion-dollar annual economic impact, driven overwhelmingly by productivity losses, decades of out-of-pocket expenses, and long diagnostic delays.

The new study, published in MDPI Women, highlights the scale of a major public health issue affecting more than 120,000 New Zealanders — women, girls, and people assigned female at birth. Conducted using the World Endometriosis Research Foundation (WERF) EndoCost tool and adapted to align with up-to-date health economic methodology, it draws on detailed patient-reported outcomes, health service utilisation patterns, and productivity data to provide a comprehensive national estimate.

Led by Dr Jordan Tewhaiti-Smith, Medical Research Institute of New Zealand (MRINZ) Research Fellow and Registrar in Obstetrics and Gynaecology, the research estimates that endometriosis and chronic pelvic pain cost New Zealand more than $22 billion each year. The vast majority of this burden — around 65–75 percent — comes from workplace productivity losses, with thousands needing time away from work or reducing their hours due to pain, treatment, or ongoing symptoms. These losses are felt not only by individuals but also by employers, who face diminished productivity, disrupted staffing, and the long-term economic impacts of a workforce managing unmanaged or undiagnosed chronic pain.

“Our findings reveal decades of accumulated loss for those living with endometriosis and chronic pelvic pain. New Zealanders are carrying the direct costs of repeated appointments, investigations, interventions, and fertility care, alongside enormous indirect costs through lost income, reduced hours, and disrupted careers and education,” says Dr Tewhaiti-Smith. “These figures reflect a major public health issue, consistent with the burden seen in other significant national health conditions such as Diabetes, Crohn’s, or Rheumatoid Arthritis. Yet the majority of costs fall disproportionately on individuals because of under-resourcing, inconsistent care pathways, and delayed diagnosis. For many, the financial impact begins in adolescence and compounds through adulthood.”

Lilly, a 23-year-old from Ōtautahi Christchurch, first experienced endometriosis symptoms at age 12. She went through countless different contraceptives and pain-relief medications, all without answers. Over the past two years her symptoms have become severe, resulting in multiple trips to after-hours clinics and emergency departments. Unfortunately, she is still waiting to see a gynaecologist through the public health system.

Lilly’s condition has significantly impacted her ability to work, with extreme bouts of pain and unsympathetic employers combining to force her out of her last job. Limited further employment options have meant that Lilly faces significant financial insecurity.

It’s not just work, though, because, as Lilly describes, her endometriosis symptoms have also impacted her personal life. “Over the last year, I’ve also lost friends due to my illness. I can’t reliably plan outings because I never know when the pain will strike. Even simple errands, like getting groceries, involve constant worry – do I have my medication with me just in case? It’s exhausting and mentally draining.”

Endometriosis New Zealand Chief Executive Tanya Cooke says the study’s findings lay bare what those living with endometriosis are forced to endure: a serious health condition with profound personal, social, and economic consequences.

“The financial, emotional and physical toll of endometriosis can be enormous, and too often New Zealanders are left to shoulder it alone. This study makes clear just how deeply the condition affects individuals, whānau, businesses, and ultimately the whole economy.”

“The findings confirm that endometriosis is far from a niche women’s health concern,” says Tanya. “It is a major health issue that deserves to be treated with the same urgency and coordination as other significant conditions.”

“Our current approach to endometriosis, which relies on fragmented, piecemeal initiatives, is failing New Zealanders. What we need is national coordination through the development and implementation of a National Endometriosis Action Plan, similar to Australia’s. Such a plan can drive earlier diagnosis, faster and fairer access to treatment, and meaningful support across workplaces, schools, and communities.”

Associate Professor Mike Armour from NICM Health Research Institute, Western Sydney University and senior author, says the New Zealand findings align with global evidence while revealing urgent systemic gaps. “Cost-of-illness studies worldwide consistently show that productivity loss is the dominant driver of economic burden. We now know that New Zealand is no exception,” says Dr Armour. “This study places New Zealand firmly within the global context and highlights a pressing need for integrated, equitable models of care. Without system-level change, we will continue to see fragmented treatment, delayed diagnosis, and widening inequity for those most affected.”

Lilly says, for her, the human impact sits at the heart of the condition. “This illness is deeply isolating. The constant pain, unpredictability, and limitations have taken a significant toll on my ability to hold down a job, complete basic daily errands, and maintain relationships. All this is having a major impact on my mental health.”

The Cost of Endometriosis and Chronic Pelvic Pain Burden in New Zealand (Aotearoa): Results from a Nationwide Survey is published in MDPI https://doi.org/10.3390/women5040047

Study Key Points:

1. New Zealand’s first national cost-of-illness estimate for endometriosis and chronic pelvic pain shows a multi-billion-dollar annual burden, placing these conditions among the country’s most significant public health issues.
2. The research reveals that 65–75 percent of total costs arise from productivity losses, with thousands experiencing reduced hours, time away from work, and long-term career disruption.
3. Individuals bear a disproportionate share of the financial burden through decades of direct and indirect costs caused by under-resourcing, inconsistent care pathways, and delayed diagnosis.
4. The findings mirror international evidence and highlight major systemic gaps, reinforcing the need for integrated, equitable models of care and national leadership.
5. The study strengthens calls for a coordinated National Endometriosis Action Plan, aligning New Zealand with global efforts to improve diagnosis, treatment, and long-term outcomes.

Biographies

Dr Jordan Tewhaiti-Smith, Clinical Research Fellow, Medical Research Institute of New Zealand (MRINZ), Registrar in Obstetrics and Gynaecology

Dr Jordan Tewhaiti-Smith, MBChB, works across clinical obstetrics and gynaecology, hauora Māori, and the development of equitable models of care for people experiencing gynaecological conditions. He contributes to national and international governance groups focused on improving Indigenous health outcomes, including global initiatives on Indigenous adolescent health and local research led through the University of Auckland examining the experiences of Māori adolescents with racism. Jordan is committed to advancing high-quality clinical research as a pathway to reducing health inequities and improving outcomes for whānau affected by gynaecological disease.

Dr Mike Armor, Honorary Fellow, Medical Research Institute of New Zealand
Senior Research Fellow, NICM Health Research Institute — Western Sydney University, Clinical Advisory Committee Member, Endometriosis Australia

Dr Mike Armor is a women’s health researcher whose work bridges western biomedicine and traditional Chinese medicine. He holds an honours degree in Biomedicine, trained as a traditional Chinese medicine practitioner, and completed his PhD on acupuncture for primary dysmenorrhoea. Mike has taught research methodology at the University of Auckland and the New Zealand School of Acupuncture and Traditional Chinese Medicine, and previously ran a clinical practice specialising in women’s health. Since joining NICM in 2016, he has focused on gynaecological pain, integrative approaches to care, and improving outcomes for people experiencing endometriosis and related conditions.

Tanya Cooke, Chief Executive, Endometriosis New Zealand

Tanya Cooke’s expertise has supported the delivery of services and programmes for tens of thousands of women, girls, and people assigned female at birth living with endometriosis Driven by a passion for women’s issues, youth, education, and equality, Tanya is committed to advocating for improved women’s health services and championing change for those affected by endometriosis. She represents the more than 120,000 NewZealanders living with the condition, ensuring Endometriosis New Zealand continues to grow its impact across Aotearoa.

About the Medical Research Institute of New Zealand
Rangahautia Te Ora
The Medical Research Institute of New Zealand (MRINZ) is New Zealand’s leading independent medical research institute. MRINZ research is guided by a simple philosophy: it must challenge dogma, increase knowledge, and have the potential to improve clinical practice and outcomes, both in New Zealand and internationally. Committed to contributing toward a more equitable society that celebrates Te Ao Māori and upholds Te Tiriti o Waitangi, MRINZ’s research teams are dedicated to investigating important public health problems, delivering high-quality evidence on which to improve the management of disease and patient care.

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