Women’s health became a prominent policy priority during the last Senedd. The publication of the NHS Wales Women’s Health Plan 2025–2035 marked an attempt to address longstanding inequalities in women’s experiences of healthcare, including concerns that symptoms are too often undervalued, overlooked or dismissed. The Plan was shaped by feedback from around 4,000 women across Wales.
This article looks at what Wales’ Women’s Health Plan could mean for endometriosis and adenomyosis care, while recognising that much of the published evidence on diagnostic delay, treatment access and specialist service pressures relates specifically to endometriosis. Adenomyosis is referenced where relevant, particularly where policy and NHS information discuss the two conditions together.
Endometriosis is a chronic condition in which tissue similar to the lining of the womb grows elsewhere in the body. It can cause severe pelvic pain, painful periods, pain during or after sex, bowel and bladder symptoms, fatigue and fertility problems. It is commonly described as affecting around one in ten women and those assigned female at birth of reproductive age.
Adenomyosis is a condition where the lining of the womb - the uterus - starts growing into the muscle in the wall of the womb. The NHS says treatments can help with symptoms, which may include painful or heavy periods, pelvic pain, bloating or fullness in the abdomen.
Women’s health plan
Women’s Health Plan: Eight Priority Areas |
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Menstrual Health Women’s health hubs, more research and better education for all. |
Endometriosis and Adenomyosis Treat as chronic conditions, with better training and curriculum education. |
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Contraception, Post-Natal Contraception and Abortion Care Clear online information, better data and stronger contraception training. |
Preconception Health Health board strategies, targeted training and support for higher-risk groups. |
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Pelvic Health and Incontinence Better online advice, new research and a symptom checker. |
Menopause Review HRT prescribing, build menopause champions and expand research. |
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Violence against Women and Girls Sexual safety charter, VAWDASV champions and training for all staff. |
Ageing Well and Long-Term Conditions Across the Life Course Help women understand ageing, manage health and take preventative action. |
(Source: Taken from Welsh Government statement, December 2024)
Endometriosis and adenomyosis are one of the Plan’s eight priority areas. That focus reflects sustained campaigning by patients and organisations who have argued that endometriosis care needs earlier recognition, clearer pathways and better access to specialist support.
UK evidence has highlighted long diagnostic delays, repeated contacts with primary care and emergency services, and experiences of not being believed. Endometriosis UK’s latest UK-wide evidence suggests diagnosis times have worsened, reaching an average of 9 years and 4 months in 2026. It also reports that diagnosis takes 11 years on average for ethnically diverse communities.
The most recent Wales-specific figure remains 9 years and 11 months - the longest average diagnosis time of all the UK nations.
Long waits for diagnosis can mean years of unmanaged pain, uncertainty and disruption to daily life, work, relationships and fertility. National Institute for Clinical Excellence (NICE) says delayed diagnosis can lead to prolonged ill health and disease that is more difficult to treat.
Why endometriosis became a test case for women’s health policy
Endometriosis has drawn attention because it sits at the intersection of several problems the Women’s Health Plan is intended to address. NICE explains it is common, often painful and sometimes complex to treat. It can also expose weaknesses in the way services respond to symptoms that are subjective, fluctuating and historically normalised as “period pain”.
The NHS Wales Women’s Health Plan explicitly acknowledges the wider problem of women’s symptoms being dismissed or not taken seriously. Endometriosis UK’s 2024 report found that 78% of respondents, who later received an endometriosis diagnosis, had experienced one or more doctors telling them they were making a “fuss about nothing” or similar comments, or had the severity of their symptoms questioned.
The policy context in Wales has also been shaped by severe pressure on gynaecology services. The Welsh Government’s July 2024 gynaecology summit recorded that total gynaecology waiting lists had grown from 26,138 patient pathways in March 2020 to 49,400 in March 2024. It also highlighted variation between health boards and the need to transform pathways in line with recognised care standards.
In March 2026, there were 41,203 gynaecology pathways waiting across all stages of the pathway in Wales. This included 17,074 pathways waiting for a new outpatient appointment.
The Royal College of Obstetricians and Gynaecologists (RCOG) has linked endometriosis diagnostic delay to wider gynaecology waiting lists and capacity pressures, calling for faster action on women’s health hubs, gynaecological staffing and theatre capacity.
What has changed?
There has been some progress. The publication of the national Women’s Health Plan gives endometriosis and adenomyosis a more visible place in NHS Wales planning. It also places both conditions within a broader policy shift towards listening to women’s experiences and improving access to joined-up care.
The Plan’s emphasis on women’s health hubs, better information, training, research and pathway development could help address some of the reasons patients have historically fallen between services. But the test will be whether these commitments change what happens when someone first seeks help for symptoms.
There have also been practical developments in information and education. The Welsh Government and NHS Wales-approved Endometriosis Cymru resource provides information on symptoms, diagnosis, treatment and living with the condition. It includes Estr, a symptom reporting tool designed to help people record symptoms and treatment history before speaking to a doctor, which could support more effective conversations and quicker access to appropriate diagnostic testing.
The development of specialist endometriosis nursing roles has also been seen as a practical improvement. Specialist nurses can support patients through complex pathways, provide information about symptoms and treatment options, and help bridge the gap between primary care, general gynaecology and specialist services.
Specialist care under pressure
A key area of concern is the future of accessible NHS specialist care for severe endometriosis. University Hospital of Wales in Cardiff, alongside a centre at Singleton hospital in Swansea Bay University Health Board, are Wales’ only NHS British Society for Gynaecological Endoscopy (BSGE)-accredited tertiary endometriosis centres for complex disease. The centres provide multidisciplinary NHS care for patients with very severe endometriosis, involving gynaecology, colorectal surgery, urology, radiology, pain medicine and specialist nursing.
Concerns have recently focused on Cardiff and Vale University Health Board’s corporate risk register, which identifies the potential loss of BSGE accreditation as a risk, with a target date of December 2026. The register also notes that no identified finances are available to resolve the risk.
A petition has been submitted to the Senedd raising concerns about the potential loss of BSGE accreditation and calling for action to protect access to specialist endometriosis care in Wales.
New treatments and diagnostic developments
Diagnosis is not always straightforward. The RCOG patient information on endometriosis notes that symptoms can overlap with other conditions, and that scans do not always show endometriosis.
Clinical guidance and medical innovation are changing how endometriosis may be recognised and managed. NICE’s guidance reinforces the importance of symptom history and makes clear that endometriosis should not be ruled out simply because an ultrasound or MRI scan is normal. It also supports the use of transvaginal ultrasound and pelvic MRI to help diagnose and assess deep endometriosis. If implemented consistently, this could help shift practice away from waiting for definitive proof before symptoms are taken seriously.
New medicines may also expand options for people whose symptoms have not been controlled by the first treatment usually tried, or previous surgery. In 2025, NICE recommended relugolix combination therapy as an option for treating endometriosis symptoms in adults of reproductive age who have already had medical or surgical treatment. NICE describes it as a daily tablet taken at home, which may reduce the need for clinic-based injections for some patients.
NICE has also recommended linzagolix for symptoms of endometriosis in adults of reproductive age who have previously had medical or surgical treatment. These treatments will not remove the need for surgery in complex cases, and they will not be suitable for everyone, but they may offer additional choices for some patients.
Perhaps the most striking recent development is the prospect of faster, non-invasive diagnostic tests. In July 2026, NICE said two non-invasive technologies, EndoSure and Endotest, could be used in the NHS during a three-year evidence-generation period while further evidence is collected on how well they work. The technologies use different approaches, including saliva-based microRNA analysis and gut sensor-based testing. If they prove effective in routine care, they could help reduce the years many patients currently wait for a diagnosis.
From recognition to delivery
New technology will only bring hope for women in Wales if it is implemented within functioning pathways. A faster test is valuable only if primary care knows when to use it, health boards can act on results, imaging and specialist review are available, and treatment pathways are clear. New medicines will help only if clinicians are supported to prescribe them appropriately and patients receive monitoring and information.
The promise of rapid testing, new oral treatments and clearer guidance should therefore be judged against the Women’s Health Plan’s wider goals: listening to women, reducing delays, improving information and making services easier to navigate. The challenge now is to turn greater recognition of endometriosis and adenomyosis into earlier diagnosis, clearer routes through care and timely access to the support and treatment patients need.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament