The $180 Billion Endometriosis Opportunity: Why Investors Are Still Early to This Women's Health Market

Every month, millions of women navigate debilitating pain that disrupts their careers, relationships, and daily lives. For many, this pain has a name: endometriosis. Yet despite affecting one in ten women of reproductive age—roughly 190 million people worldwide; this chronic condition has remained a footnote in healthcare investment strategies for decades. That oversight represents both a profound failure and an extraordinary opportunity.

According to the World Economic Forum and McKinsey Health Institute, the commercial market for potential endometriosis treatments ranges between $180 billion and $250 billion globally. To put that in perspective, this market potential rivals the annual global spending on entire therapeutic categories like immunology and cardiovascular disease. Yet today, women's health receives just 2% of health-related venture capital funding, and endometriosis research funding from 2019-2023 was just $44 million compared to $1.24 billion for erectile dysfunction during the same period.

For investors seeking both financial returns and meaningful impact, the endometriosis market represents a rare convergence: massive unmet need, emerging innovation across diagnostics and therapeutics, and early signs that the broader healthcare system is finally ready to prioritize women's health.

What Makes Endometriosis a $180 Billion Market Opportunity in Women's Health?

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, typically in the pelvic region. This tissue responds to hormonal cycles, causing inflammation, scarring, and adhesions that can affect the ovaries, fallopian tubes, and surrounding organs. The condition is chronic and progressive, meaning without intervention, symptoms typically worsen over time.

For the women living with it, endometriosis isn't an abstract medical condition; it's a constant negotiation with pain. Many describe cycles where they plan their lives around their worst days, cancel commitments at the last minute, and struggle to explain to employers, friends, and even doctors why they can't simply push through. The average woman with endometriosis loses approximately 10 hours of productivity per week due to symptoms, and many report that chronic pain fundamentally reshapes their relationships, career trajectories, and sense of self.

The McKinsey market size estimate—$180 billion to $250 billion—encompasses the full spectrum of current unmet need: diagnostic tools that could replace invasive surgery, medical therapies that address root causes rather than just symptoms, fertility treatments for the estimated 40% of women with endometriosis who experience infertility, and ongoing care management for a condition that spans decades of a woman's life.

Why has a condition affecting 10% of reproductive-age women been treated as niche rather than core healthcare? The answer lies in a complex intersection of medical culture, research priorities, and investment patterns. Women's pain has historically been dismissed or minimized in clinical settings. Funding bodies and pharmaceutical companies have prioritized conditions affecting men. And the lack of non-invasive diagnostic tools has made endometriosis difficult to study and treat at scale. The result is a massive, undercapitalized market waiting for solutions.

How Big Is the Endometriosis Burden for Women, Employers, and Health Systems?

1. Clinical Burden:

‍The symptoms of endometriosis extend far beyond monthly cramping. Women experience chronic pelvic pain that can become constant rather than cyclical, painful intercourse that affects intimate relationships, painful bowel movements and urination, and fatigue that doesn't respond to rest. Up to 50% of women with pelvic pain and/or fertility problems have endometriosis, and the condition is one of the leading causes of infertility.

The mental health burden is equally significant. Research shows that more than two-thirds of women with endometriosis experience mild to high psychological stress. Recent studies have demonstrated that women with endometriosis have significantly higher rates of depression, generalized anxiety disorder, and even eating disorders—and that these associations stem not just from chronic pain but from shared genetic predispositions. Yale researchers found that endometriosis causes actual changes in the brain that contribute to anxiety and depression.

2. Economic Burden:

‍The economic costs of endometriosis rival those of other major chronic diseases like diabetes and heart disease. Studies estimate the annual cost per woman with endometriosis ranges from $9,500 to nearly $21,000, depending on the country and healthcare system. Critically, the majority of these costs—between 65% and 84% across different studies; come from productivity losses rather than direct medical care.

An Australian national survey found that women with chronic pelvic pain faced costs of $16,970 to $20,898 per year, with productivity loss accounting for three-quarters of the total. In the United States, indirect costs due to presenteeism (reduced productivity while at work) alone exceed $14,800 annually per patient—more than four times the costs from actual missed work days.

For employers, these numbers translate into substantial hidden costs. Women with endometriosis have higher absenteeism, more short-term disability claims, and higher healthcare utilization. Yet because the condition is so under diagnosed, many employers don't recognize the scope of the problem—or the potential ROI from benefits that support diagnosis and treatment.

3. Social and Family Impact:

‍Beyond what shows up in claims data, endometriosis affects relationships, family planning, and quality of life in ways that are difficult to quantify but impossible to ignore. Women describe strain on partnerships from painful intimacy, difficult decisions about whether and when to pursue fertility treatment, and the emotional toll of having their symptoms dismissed by healthcare providers, sometimes for years.

Why Does It Take Seven to Ten Years to Diagnose Endometriosis?

One of the most troubling aspects of endometriosis is the diagnostic delay. Global studies consistently show that women wait an average of 6.6 to 8.8 years between symptom onset and diagnosis. A 2024 UK survey found the average delay has actually increased to nearly 9 years—10 months longer than in 2020. Some women wait more than a decade; documented delays of up to 27 years exist in the medical literature.

The delays begin early. Symptoms of endometriosis—severe menstrual pain, pelvic discomfort, fatigue—overlap with conditions that are often normalized in women. Young women are told that painful periods are simply part of being female. When they do seek care, symptoms are frequently attributed to stress, irritable bowel syndrome, or psychological factors. One study found that women typically see seven different healthcare providers before receiving a diagnosis.

Structural factors in healthcare compound the problem. Most medical training includes minimal education on endometriosis recognition and management. Primary care providers often lack confidence in gynecological symptoms. Referral pathways to specialists are unclear or inaccessible. And critically, until recently, the only definitive way to diagnose endometriosis was through laparoscopic surgery—an invasive procedure that many providers and patients understandably want to avoid.

These delays have real consequences. Endometriosis is a progressive disease; early intervention can prevent the severe scarring and adhesions that develop over time. Women who wait longer for diagnosis report lower quality of life scores and higher rates of depression. The fertility impacts compound with age. And from a health economics perspective, diagnostic delay drives up costs as women cycle through emergency visits, ineffective treatments, and repeated consultations.

For investors, the diagnostic gap represents one of the largest opportunities in the endometriosis market. Any solution that can meaningfully reduce time to diagnosis—whether through better biomarkers, improved imaging, or clinical decision support addresses a bottleneck that affects every downstream element of care.

Where Is Innovation Emerging in the Endometriosis Market?

After decades of underinvestment, the endometriosis innovation landscape is finally showing signs of life. The National Institutes of Health recently announced finalists for its RADx Tech ACT ENDO Challenge, focused specifically on non-invasive diagnostic technologies. Venture capital flowing into women's health reached $2.6 billion in 2024, a 55% increase from the previous year. And scientific understanding of endometriosis pathophysiology is advancing rapidly, opening new therapeutic targets.

Which Endometriosis Diagnostics Are Moving the Market Forward?

The holy grail of endometriosis care is a reliable non-invasive diagnostic test. Currently, while advanced imaging can detect later-stage disease (endometriomas and deep infiltrating endometriosis), early-stage endometriosis still typically requires surgical confirmation. Several promising approaches are in development.

1. Biomarker-based diagnostics:

‍Researchers are exploring blood-based, saliva-based, and menstrual fluid-based biomarkers that could identify endometriosis without surgery. MicroRNA signatures from saliva samples have shown promise in European studies, though questions remain about validation across diverse populations. Companies are also pursuing combinations of existing markers (like CA-125) with novel proteins and genetic signals to improve accuracy.

2. Novel sensing technologies:

‍One NIH-supported approach uses electroviscerography (EVG)—measuring electrical activity in smooth muscles—to detect a unique physiological signature associated with endometriosis. This technology claims to deliver results in 30 minutes without surgery. Other teams are developing wearable sensors that measure uterine electrical patterns, similar to how ECGs work for the heart.

3. AI-enhanced imaging:

‍Machine learning algorithms are being trained to identify subtle endometriosis markers in ultrasound and MRI images that human readers might miss. These tools could help extend specialist-level diagnostic capability to broader clinical settings.

For investors evaluating diagnostic companies, key questions include: Has the technology been validated in populations beyond the initial development cohort? Does it perform consistently across disease stages? What's the path to clinical adoption—point-of-care, reference lab, or integration with existing imaging workflows? And critically, how does a positive or negative result change clinical management?

How Are Endometriosis Treatments Evolving Beyond Pain Pills and Surgery?

Current endometriosis treatment options are limited and often unsatisfying. Hormonal therapies, birth control pills, GnRH agonists and antagonists, progestins can suppress symptoms but don't cure the disease and often come with significant side effects. Pain medications address symptoms rather than causes. And surgery, while sometimes necessary, doesn't prevent recurrence. Up to 50% of women experience symptom return within five years of surgical treatment.

The treatment pipeline is beginning to show more innovation. Non-hormonal approaches are in development, including immunomodulators that target the inflammatory processes driving endometriosis progression. Some companies are exploring whether existing drugs approved for other conditions might be repurposed for endometriosis based on new understanding of disease mechanisms.

Digital therapeutics and behavioral interventions represent another frontier. Given the strong connections between endometriosis, chronic pain, and mental health, integrated approaches combining pain management, pelvic floor physical therapy, nutrition guidance, and psychological support may improve outcomes more than any single intervention alone. Companies building comprehensive care platforms rather than standalone products may capture more of the patient journey.

The intersection of fertility care and endometriosis treatment is particularly important. Companies like Gameto are developing technologies that could shorten and simplify IVF protocols, making fertility treatment more accessible for women with endometriosis-related infertility. Others are exploring whether early endometriosis intervention could preserve fertility before damage occurs.

What Service and Platform Models Can Redefine Endometriosis Care?

Beyond discrete diagnostic tests and therapeutic products, significant opportunity exists in reimagining how endometriosis care is delivered. Virtual clinics focused on women's health are expanding access to specialists who previously were available only in major academic centers. These platforms can provide coordinated care that addresses the multiple dimensions of endometriosis from diagnosis to treatment to ongoing symptom management to fertility support.

Employer and payer programs represent another avenue for innovation. Given the substantial productivity costs associated with undiagnosed and undertreated endometriosis, there's a clear business case for benefits that support women's health. Forward-thinking employers are beginning to offer enhanced coverage for women's health services, including fertility benefits, specialized mental health support, and access to virtual care platforms.

Data platforms that track symptoms and outcomes over time could transform both individual care and population-level understanding of endometriosis. The field has been hampered by fragmented data and inconsistent outcome measures. Companies that can aggregate real-world evidence with appropriate privacy protections may create competitive moats while advancing the entire field.

How Does Endometriosis Fit Portfolia's Women's Health Investing Thesis

Portfolia was the first venture capital fund focused on women's health in the United States and remains one of the most active investors in the space globally, with investments across 46 health companies spanning fertility, maternal health, menopause, autoimmune disease, oncology, cardiovascular health, mental health, and more.

The Portfolia thesis centers on conditions with outsized unmet need—where large patient populations have been historically underserved by both medical research and venture investment. The fund looks for women-specific conditions (like endometriosis, polycystic ovarian syndrome, and menopause), conditions that affect women differently (like cardiovascular disease and Alzheimer's), and conditions that affect women disproportionately (like autoimmune diseases and certain cancers).

Endometriosis sits at the center of this thesis. It is a chronic condition affecting a substantial portion of the female population, with clear connections to other high-priority areas like fertility, mental health, and chronic pain management. Solutions that address endometriosis pathways often have applicability across multiple conditions.

Portfolia's portfolio includes companies working across the endometriosis care continuum. Gameto is developing engineered ovarian support cells that could transform IVF by maturing eggs outside the body—reducing the hormone burden of fertility treatment and making care more accessible to women with conditions like endometriosis. Mirvie offers RNA-based liquid biopsy to predict pregnancy complications, addressing maternal health in ways that could benefit women whose endometriosis affects fertility and pregnancy. YourChoice Therapeutics is developing the first hormone-free male birth control pill—expanding contraceptive options for couples where hormonal contraception for women isn't appropriate or desired.

These investments reflect a broader conviction: the women's health market, estimated at $600 billion or more globally, has been systematically undercapitalized relative to its size and the severity of unmet need. Investors who recognized this early and built portfolios addressing the full spectrum of women's health—are positioned to benefit as the market matures.

What Should Investors Ask Before Backing Endometriosis Companies?

Not all endometriosis opportunities are created equal. As the space attracts more attention, investors need frameworks for evaluating which companies are positioned for success.

1. How Does This Solution Change Time to Diagnosis?

For diagnostic companies, the core value proposition should be measurable reduction in diagnostic delay. Key metrics to evaluate include: sensitivity and specificity across disease stages, performance in populations beyond academic medical centers, time to result, and evidence that positive tests actually accelerate access to appropriate treatment. A diagnostic that identifies endometriosis but doesn't change what happens next has limited clinical or commercial value.

Investors should also probe what happens with inconclusive results. Given endometriosis heterogeneity, any diagnostic approach will have gray zones. Companies with clear protocols for borderline cases—rather than just focus on clean positive/negative scenarios; demonstrate clinical sophistication.

2. How Does This Company Create Measurable Value in the Endometriosis Market?

For therapeutic and care delivery companies, outcomes should be defined and trackable. Pain is notoriously difficult to measure, but validated instruments exist. Quality of life scales (like the EHP-30 for endometriosis) can capture improvements that matter to patients. Functional outcomes—days of work missed, ability to engage in normal activities—translate into economic value for payers and employers.

The path to reimbursement deserves particular scrutiny. Endometriosis care is currently fragmented across gynecology, pain management, fertility, and mental health—none of which has a clear ownership stake in comprehensive solutions. Companies need realistic strategies for working within existing reimbursement frameworks or credible plans to create new ones.

3. How Is the Team Centering Women's Lived Experience in Endometriosis Innovation

Given the history of endometriosis being dismissed and minimized, companies that genuinely center patient experience have both ethical and commercial advantages. Look for evidence of patient involvement in product design—not just as focus group participants, but as ongoing advisors. Clinical trials should include diverse populations; endometriosis affects women across racial and ethnic groups, but research has historically overrepresented white women. Leadership teams with firsthand experience of endometriosis (directly or through close relationships) often bring insights that pure technologists miss.

Patient advocacy organizations like Endometriosis UK and the Endometriosis Foundation of America can provide perspective on whether companies are genuinely serving patient needs or just capitalizing on a trendy category. Their endorsement or criticism carries weight.

Why the Endometriosis Market Is a Missed but Timely Opportunity for Women's Health Investors

Several converging trends suggest the endometriosis market is reaching an inflection point. Scientific understanding has advanced dramatically, with researchers now recognizing endometriosis as a systemic disease with manifestations beyond the reproductive system. Regulatory bodies including the NIH are prioritizing non-invasive diagnostic development. And cultural conversations around women's health; amplified by social media and advocacy are eroding the historical silence around menstrual pain and pelvic conditions.

Venture investment in women's health broadly has surged, reaching $2.6 billion in 2024—a 55% increase from the prior year. Yet this growth is starting from a remarkably low base. Women's health still receives just 2% of total healthcare venture capital despite representing a far larger share of health burden and spending. The gap between market size and investment allocation represents opportunity for investors willing to move early.

Investors who establish positions in endometriosis now may have outsize influence on how the market develops. Standards of care are being written in real-time as new diagnostics reach the market and clinical guidelines evolve. Early investors can support the companies that shape these standards and capture the returns that come from category leadership.

The parallel with other therapeutic areas is instructive. Diabetes, cardiovascular disease, and oncology all went through periods of rapid innovation that created substantial returns for early investors. Women's health—and endometriosis specifically—appears to be entering a similar phase. The question for investors is not whether this market will develop, but whether they'll be positioned to participate in the upside.

How Can Investors Partner with Portfolia to Advance Endometriosis Innovation?

Portfolia offers a distinctive model for women's health investing. As a community-based investment platform, Portfolia aggregates capital, networks, and expertise from its members to invest in early- to growth-stage companies with strong potential for both impact and returns. The fund's nearly 2,000 investing members across 20 countries bring diverse perspectives and connections that enhance both deal sourcing and portfolio company support.

The Women's Health Fund IV, Portfolia's most recent and focused strategy in women's health, is actively investing in breakthrough companies across the care continuum. The fund partners—including biotech pioneers, venture capital veterans, longevity investors, and healthcare operators; bring an average of 15+ years of investing experience and deep sector networks.

For founders working in complex women's health markets like endometriosis, Portfolia offers more than capital. The fund's community includes healthcare executives, clinical experts, and patient advocates who can provide strategic guidance on clinical development, regulatory pathways, and go-to-market strategy. Portfolio companies gain access to a network of supporters with direct stake in their success.

Women's health represents one of the largest and most persistent gaps in healthcare innovation. Endometriosis exemplifies both the problem ; decades of underinvestment leaving millions of women without adequate care—and the opportunity. The market potential is clear. The innovation pipeline is accelerating. And the investors who move now have the chance to shape how this market develops while generating returns that reflect its true scale.

Ready to invest in the future of women's health? Contact us and know more about Portfolia's Women's Health Fund IV and how you can be part of the community reshaping healthcare for women at portfolia.co.