SAFE Score Aims to Accelerate Endometriosis Diagnosis

Australia’s SAFE score enables earlier identification of endometriosis risk using adolescent symptoms, addressing diagnostic delays that can exceed a decade. The tool highlights persistent underinvestment in women’s health and carries implications for healthcare systems and labor productivity. In Mexico, earlier diagnosis could help reduce absenteeism and support female workforce participation.

Researchers in Australia have developed a clinical screening tool designed to identify adolescents at high risk of endometriosis, a condition that affects an estimated 10% of women of reproductive age worldwide. The Simplified Adolescent Factors for Endometriosis (SAFE) score seeks to reduce diagnostic delays that often stretch for years by supporting earlier referral in primary care. The model uses six common symptoms and family history indicators reported during adolescence.

Global health organizations and researchers increasingly frame endometriosis as both a medical and equity issue, noting that limited research and persistent diagnostic delays continue to affect millions of women. “Investing in women’s health yields intergenerational returns, from healthier families to stronger economies,” says Bill Gates, Co-Chair, BIll & Melinda Gates Foundation, which has pledged US$2.5 billion through 2030 to advance research in underfunded areas of women’s health.

A tool designed to shorten diagnostic delays

The SAFE score was developed by researchers from the University of Queensland and UNSW Sydney as a referral aid to help clinicians identify patients who may require further evaluation for endometriosis. The condition occurs when tissue similar to the lining of the uterus grows outside the uterus, often affecting pelvic organs such as the ovaries or fallopian tubes. The misplaced tissue responds to hormonal changes and can cause inflammation, chronic pelvic pain and infertility.

Despite its prevalence, diagnosis remains slow. Studies suggest that women often wait six to eight years for confirmation of the disease. Global estimates cited by researchers place diagnostic delays as high as seven to 10 years in some cases, reflecting both the complexity of symptoms and the normalization of menstrual pain in many health systems.

To develop the SAFE score, researchers analyzed data from more than 9,000 participants in the Australian Longitudinal Study on Women’s Health. Using statistical modeling techniques, the team identified six stable risk factors reported between the ages of 16 and 19 that were strongly associated with later diagnosis.

The six indicators include frequent pelvic pain, seeking medical treatment for pelvic pain, use of pain medication for pelvic symptoms, heavy menstrual bleeding, a history of painful periods during adolescence and a family history of endometriosis.

Each factor contributes one point to the overall score, producing a scale from zero to six. According to the study, each additional point roughly doubles the probability of an endometriosis diagnosis.

Researchers found that a score of four or higher suggests that more than half of individuals may have the condition. For practical use in primary care, the study recommends a lower referral threshold of greater than two points. At this level, the model demonstrated a negative predictive value above 94%, indicating that it is effective at identifying individuals with low risk while highlighting those who may require further clinical investigation.

Validation tests showed consistent predictive performance across age groups. In the primary training sample, which included women aged 26 to 33, the model reached an area under the curve score of 0.81, indicating strong predictive capacity. External validation among women aged 45 to 51 produced a score of 0.72, suggesting the model remained reliable even when participants recalled symptoms decades later.

Researchers emphasize that the SAFE score is not intended to replace diagnostic procedures such as imaging or laparoscopy. Instead, it is designed to support clinical decision-making in primary care and guide earlier referral to specialists.

Endometriosis gains recognition as a global health issue

The emergence of new diagnostic tools coincides with growing international attention on endometriosis and other conditions affecting women’s health. Global health organizations report that more than 190 million people worldwide live with the disease, yet research funding and awareness remain limited.

The World Health Organization has called for coordinated action across public and private sectors to address underdiagnosis and improve access to care. In many countries, social stigma and limited clinical awareness continue to delay treatment, leaving patients with chronic pain and long-term health consequences.

Recent reports from the World Economic Forum and Boston Consulting Group highlight a broader structural issue in the health sector. Women’s health accounts for only about 6% of private healthcare investment globally, despite women representing half of the world’s population. Conditions such as endometriosis, polycystic ovary syndrome and menstrual health collectively receive less than 2% of that funding.

The funding gap has economic implications beyond health outcomes. Analysts estimate that closing the gender health gap could generate up to US$1 trillion in global economic growth annually by 2040, reflecting gains in workforce participation, productivity and reduced healthcare costs.

Researchers and policy specialists also point to the cumulative burden of diseases that are often underdiagnosed or insufficiently researched in women. Women tend to live longer than men but spend about 25% more of their lives in poor health or with disability, according to the WEF analysis.

Workforce and policy implications

The socioeconomic impact of reproductive health conditions is increasingly visible in labor markets. In Mexico, a 2025 report by Dalia Empower, Plenna and Essity found that 55% of working women reported missing work because of menstrual discomfort, while 35% experienced salary deductions linked to menstruation-related absences.

The survey also found that 91% of women reported lower productivity during their period. For individuals living with endometriosis or similar conditions, symptoms can be severe enough to cause monthly incapacitation.

Policy responses remain limited. Menstrual leave provisions exist in only four Mexican states — Colima, Hidalgo, Nuevo León and Michoacán — and are largely restricted to the public sector. Only about 5% of workers report that their employers offer policies addressing menstrual health, such as flexible schedules, remote work options or specific leave allowances.

Health authorities and researchers argue that improving diagnosis and treatment could support broader economic participation. Women represent about 40% of Mexico’s workforce, a rate significantly below the 67% average across OECD countries.

Efforts to address women’s health challenges also intersect with broader health system reforms. Mexican authorities have outlined plans to strengthen prevention and primary care through a Universal Health Service model designed to improve continuity of care across institutions. The strategy includes the development of interoperable digital medical records, standardized clinical protocols and expanded access to services.

Tools such as the SAFE score could fit within this type of primary care framework, where early identification and referral play a central role in preventing disease progression. Researchers behind the SAFE score say the next phase will involve additional clinical evaluation and the development of a digital decision-support platform for use in general practice.