Six questions in five minutes: a screening score to catch endometriosis years earlier

Six to eight years. That is the average time between when endometriosis symptoms begin and when a woman receives a diagnosis. In that gap, adolescents normalize debilitating pain, GPs cycle through misdiagnoses, and a condition that affects up to 11 percent of Australian women of reproductive age progresses unchecked. By the time many women learn what is wrong, they are in their late twenties and often discovering the diagnosis only because they are struggling to conceive.

Researchers at the University of Queensland believe a five-minute questionnaire could shrink that gap dramatically.

The SAFE score: six questions, one risk number

The Simplified Adolescent Factors for Endometriosis (SAFE) score asks six questions. Do you experience pelvic pain often? Have you sought treatment for pelvic pain? Have you taken painkillers for pelvic pain? Do you experience heavy menstrual bleeding? Do you have painful periods? Is there a family history of endometriosis?

Each affirmative answer adds to a point-based score. The higher the total, the greater the statistical likelihood of endometriosis, and the stronger the case for specialist referral. The tool was designed by Professor Gita Mishra and colleagues at UQ's Australian Women and Girls' Health Research Centre, and the results were published in eClinicalMedicine.

The simplicity is deliberate. The SAFE score does not require imaging, blood tests, or specialist training. A GP, school nurse, or even a digital app could administer it. The target population is adolescents who have recently begun menstruating, the window when early detection could make the most difference.

Built on 9,000 women's longitudinal data

The score was not invented from clinical intuition. It was derived from the Australian Longitudinal Study on Women's Health, a dataset tracking the health of more than 9,000 women over time. The researchers used this data to identify which adolescent-reported symptoms and risk factors most strongly predicted a later endometriosis diagnosis, then distilled those factors into the smallest practical set of questions.

This evidence-based derivation distinguishes the SAFE score from generic symptom checklists. The questions were selected because they demonstrated statistical power in a large, well-characterized cohort, not because they seemed clinically reasonable on their face.

Why early detection changes the treatment calculus

Endometriosis involves tissue similar to the uterine lining growing outside the uterus, causing inflammation, adhesions, and often severe pain. The condition has no cure, but early management can reduce symptom burden and preserve fertility. The treatment pathway shifts depending on when the diagnosis arrives.

Women diagnosed late, often during fertility investigations, frequently end up on IVF pathways. But the research team notes that for women with endometriosis, the standard first-line fertility treatment of ovulation induction is less effective than IVF. Identifying the condition earlier could allow clinicians to bypass less effective interventions and counsel patients about their options before fertility becomes urgent.

Not a diagnostic tool, but a triage filter

It is important to be precise about what the SAFE score does and does not do. It does not diagnose endometriosis. Definitive diagnosis has traditionally required laparoscopic surgery, though experts are increasingly working toward non-surgical confirmation through ultrasound or MRI. What the SAFE score does is identify which patients should be prioritized for specialist evaluation.

In a primary care system where referral to a specialist can itself take months, having a validated triage tool could meaningfully accelerate the diagnostic timeline. The score gives GPs a structured, evidence-based reason to refer, rather than relying on subjective judgment about whether a teenager's menstrual pain is severe enough to warrant investigation.

Limitations and what comes next

The SAFE score was developed using retrospective data from the Australian Longitudinal Study on Women's Health. Its performance in a prospective clinical setting, where it would be administered to adolescents in real time and followed by diagnostic evaluation, has not yet been tested. The next phase of research will evaluate the tool in GP practices and endometriosis clinics in Brisbane, and the team is exploring whether an app-based version could broaden access.

The score was validated in an Australian population, and its performance across different ethnic groups, healthcare systems, and cultural contexts is unknown. Menstrual pain norms and healthcare-seeking behavior vary across cultures, which could affect both how questions are answered and how predictive the responses are.

Self-reported symptoms are inherently subjective. Two women experiencing the same level of pain might answer the questionnaire differently depending on their pain threshold, their family's attitude toward menstrual symptoms, and whether they have been told that period pain is normal. These sources of variability could reduce the score's precision in real-world use.

Still, for a condition where the current standard involves nearly a decade of diagnostic delay, a five-minute questionnaire that sends the right patients to the right specialists faster would represent meaningful progress.