Endometriosis Care in Singapore: Where We Have Progressed, and Where Patients Still Fall Through the Gaps

I have been advocating for endometriosis awareness in Singapore for more than a decade through E for Endometriosis. Over those years, I have watched the conversation change.

There has been progress.

Singapore now has dedicated clinical services for endometriosis. KK Women's and Children's Hospital, for example, has an Endometriosis Centre that brings together gynaecologists with endometriosis surgical expertise, pain specialists, colorectal surgery, mental wellness support and nurse coordination. National University Hospital also provides specialised endometriosis care. Singapore clinicians have developed professional guidance to help healthcare providers recognise and manage the disease.

So this is not an article arguing that Singapore has no endometriosis care. We do. The more difficult question is whether our healthcare, financial, social and policy systems fully reflect what it means to live with a complex chronic disease such as endometriosis over many years.

I write about this from two perspectives: as the founder of a patient advocacy movement, and as a patient myself.

My symptoms began when I was around 11. Like many girls, I was told painful periods were normal. Over time, my symptoms affected my bowels, legs, energy, ability to work and eventually my mental health. After approximately 17 years of symptoms, I was finally diagnosed in 2014 with Stage 4 deep infiltrating endometriosis and adenomyosis.

Diagnosis did not mark the end of the disease. On 27 July 2026, I underwent major open abdominal surgery for severe endometriosis and adenomyosis, including a subtotal hysterectomy, bilateral salpingectomy, extensive excision of endometriosis and adhesiolysis. My ovaries were preserved, but my uterus was removed, largely because of the extent of the adenomyosis. With that came the permanent loss of my ability to carry a pregnancy.

After more than a decade of advocacy, these are eight areas where I believe the Singapore conversation still needs greater depth.

1. Diagnostic delay is not only medical. Culture can influence when we recognise that suffering has become dangerous.

When we talk about delayed diagnosis, we understandably focus on healthcare: whether clinicians recognise symptoms, whether the appropriate investigations are ordered and whether patients reach someone experienced in endometriosis.

But sometimes the delay begins before the patient enters the clinic.

There are cultural dimensions to this that I feel remain underrepresented, particularly in discussions about Asian and Southeast Asian patients. Singapore and ASEAN are extraordinarily diverse, so my experience cannot represent every woman in our region. But many of us grow up around strong ideas about family duty, filial responsibility, marriage, motherhood, harmony and sacrifice. Women in particular may absorb the expectation that a 'good' daughter, wife, mother or caregiver should endure, give more and place other people's needs before her own. Suffering quietly can therefore become normalised.

I recognise this conditioning in myself. I became extremely good at tolerating pain, masking it, working through it and caring for other people through it. I once experienced an ovarian cyst rupture without seeking medical attention, and on another occasion, I had a haemorrhaging gallbladder and did not recognise quickly enough how serious the situation had become.

Those were not both endometriosis events. What connects them is that years of living with severe pain, together with the deeply ingrained idea that 'a woman must endure', had distorted my own understanding of what level of pain should constitute an emergency. That is where diagnostic delay can become a patient safety issue.

If a woman has already learnt to minimise her own suffering and then enters a healthcare environment where that suffering is also questioned or normalised, she can eventually lose confidence in her ability to judge her own body.

This connects closely with concepts such as medical misogyny and testimonial injustice. Testimonial injustice describes what happens when somebody's account of their own experience is given less credibility because of assumptions or prejudice. For endometriosis patients, that can manifest when severe pain is normalised, emotionalised or repeatedly treated as less significant than the patient herself is saying it is.

Fertility and motherhood add another cultural dimension. Following my July surgery, I no longer have a uterus and I do not have a living child. I have personally encountered the suggestion that because I am childless, I should compensate by doing more good deeds. I make an important distinction here because I am Muslim, and this is not an Islamic teaching. What I am describing is a cultural interpretation I have personally encountered, in which motherhood, caregiving, sacrifice and a woman's moral worth can become deeply entangled. Within that narrative, women may be seen first and foremost as bearers of children, and when a woman cannot become a mother, it can be implied that an important part of her purpose, or even her perceived pathway towards spiritual virtue, has somehow been taken away. The suggestion that she must then 'compensate' through more good deeds reflects how deeply motherhood can become tied not only to a woman's social identity, but also to perceptions of her worth and goodness.

These are not peripheral issues. If we want to understand diagnostic delay in our region, we need to understand what patients have been taught about pain, womanhood, duty and endurance before they ever enter the healthcare system.

Sometimes the delay begins before a patient ever enters a clinic. If a woman has already learnt to minimise her suffering, and then enters a healthcare system that questions her pain too, eventually she may stop knowing what level of suffering deserves help at all.

2. Singapore has healthcare financing, but endometriosis can still fall between the financial gaps.

Singapore's healthcare financing system can be difficult to understand from outside the country.

We do not have a system where all healthcare is simply free at the point of use. Instead, Singapore describes its healthcare financing framework as S+3Ms: government subsidies, MediSave, MediShield Life and MediFund. MediSave is a mandatory healthcare savings account, while MediShield Life is the basic national health insurance scheme protecting citizens and permanent residents against large medical bills. MediFund serves as a safety net for eligible Singapore citizens who still face difficulty with their remaining bills after subsidies, insurance and MediSave.

Public specialist outpatient care is subsidised. Singapore citizens can receive subsidies of up to 70 per cent at public Specialist Outpatient Clinics, depending on means testing. So financial support does exist. The gap I am talking about is more specific.

Singapore also has a Chronic Disease Management Programme, or CDMP, allowing MediSave to be used for outpatient management of designated chronic conditions. As of October 2026, there are 23 conditions on that list, including diabetes, hypertension, osteoarthritis, rheumatoid arthritis, anxiety and major depression. Endometriosis and adenomyosis are not included.

That distinction matters because endometriosis is itself a long-term disease. Someone may require years of consultations, imaging, medication, procedures, surgery and follow-up. Patients can still benefit from general subsidies and eligible MediSave or insurance claims, but there is no equivalent endometriosis-specific chronic outpatient financing framework. And the financial impact extends much further than medical bills.

What happens when someone can independently shower, dress, eat, use the toilet and move around, but cannot reliably sustain an eight-hour working day because of pain, fatigue, unpredictable bowel symptoms, repeated appointments or surgery?

Some Singapore long-term care and severe-disability schemes use Activities of Daily Living, or ADLs, as part of their eligibility criteria. For example, a CareShield Life severe-disability claim generally requires the person to need full assistance with at least three of six basic activities: washing, dressing, feeding, toileting, moving around indoors and transferring between a bed and chair or wheelchair.

That is an appropriate measure for the severe-disability support CareShield Life was designed to provide. But it illustrates something important about a disease such as endometriosis. A woman may be fully independent in all six activities and still be unable to maintain reliable employment.

I often describe this as the difference between being functionally independent and economically functional. Being capable of dressing yourself does not necessarily mean being capable of commuting to work every morning, remaining at a desk for eight hours, managing unpredictable pain or bowel symptoms, maintaining attendance and continuing at the same level of productivity year after year.

There are other forms of assistance. ComCare Short-to-Medium-Term Assistance, for example, can support individuals and families who are temporarily unable to work because of illness or caregiving responsibilities, are seeking work or have low incomes. Importantly, Social Service Offices assess circumstances holistically rather than treating the published income benchmark as an absolute cut-off. MediFund similarly considers a person's and family's financial, health and social circumstances.

But these remain general safety nets, rather than support built around the particular long-term trajectory of endometriosis. There is therefore a middle ground that can disappear from conventional measures of financial need: someone may not meet severe disability criteria, may not qualify for substantial social assistance, and yet may have lost working hours, career opportunities and income over many years because of chronic illness.

The financial question should therefore go beyond, 'Was her hospital bill subsidised?' It should also include: How much work has she lost? Has she reduced her hours? Has illness altered her career? How much has she spent across years of consultations and treatment? Has financial capacity affected whether she could seek another opinion?

Financial capacity can influence healthcare choice as well. Singapore's public healthcare system provides highly specialised care, but access through a subsidised pathway does not necessarily provide the same freedom to select a particular named clinician. At KKH, for example, a referral from a polyclinic to a specific doctor attracts non-subsidised rates. For a disease where patients may spend years trying to reach someone with particular expertise, the relationship between affordability, specialist choice and access becomes important.

A person can be independent in every basic activity of daily living while still having her earning capacity substantially reduced by chronic illness.

3. Multidisciplinary endometriosis care exists. But multidisciplinary disease care is not always the same as whole-person care.

One area where Singapore has clearly progressed is multidisciplinary clinical care. KKH's Endometriosis Centre currently describes a team involving gynaecologists with endometriosis surgical expertise, pain specialists, colorectal surgery, women's mental wellness and dedicated nurse coordination. It also provides physiotherapy, colorectal assessment for bowel disease and mental wellness consultations.

That infrastructure matters enormously, particularly for deep or multi-organ disease. But I think we also need to distinguish between multidisciplinary disease care and multidisciplinary person care. A patient never walks into a consultation room as only 'endometriosis'. She may also be neurodivergent, chronically ill, disabled, infertile, experiencing mental health difficulties, financially strained or carrying substantial caregiving responsibilities.

I learnt this from another direction when, shortly before turning 40, I was diagnosed with Autism Spectrum Disorder Level 1 by a clinical psychologist. I subsequently had a gynaecologist dismiss that diagnosis, despite having my psychologist's letter, because I apparently did not 'look autistic'. I do not present one clinician's response as representative of Singapore healthcare. What the encounter highlighted for me was something broader. I had spent years encountering versions of 'you do not look sick' with endometriosis. Then I encountered 'you do not look autistic'. Neither endometriosis nor autism has one appearance.

Neurodivergence can affect sensory processing, communication, executive functioning, pain expression and how a person copes with medical environments. Someone may communicate articulately during a consultation while experiencing substantial difficulty outside that room.

This is why multidisciplinary care cannot only mean having several medical specialties available for several organs. It must also ask: Who is the person living inside this disease, and what else shapes her ability to access and tolerate care?

4. Awareness has improved, but some of the language used to explain endometriosis has not evolved at the same pace as the science.

Singapore has made progress in recognising endometriosis. A professional Singapore quick-reference protocol describes endometriosis as endometrial-like tissue outside the uterus and recognises that delays of seven to ten years may occur between symptom onset and diagnosis.

A SingHealth article by a KKH clinician has also discussed how lack of awareness among the public and healthcare providers, normalisation of symptoms and stigma around menstruation contribute to delayed treatment. But one issue I continue to raise is how we teach what the disease actually is.

When I began advocating more than a decade ago, endometriosis was commonly explained through two ideas: that it was essentially the lining of the womb growing outside the womb, and that retrograde menstruation provided the principal explanation for how it developed. Some institutional patient-facing language remains rooted in that older shorthand.

KKH's current Endometriosis Centre page, for example, describes endometriosis as the 'womb lining responsible for menstruation' being found outside the womb, even though Singapore's own professional quick-reference protocol uses the more precise term endometrial-like tissue outside the uterus.

The World Health Organization similarly describes endometriosis as a chronic disease involving tissue similar to the lining of the uterus growing outside the uterus and states that its causes remain unknown.

Retrograde menstruation remains an important scientific hypothesis and may contribute to disease development. The theory, associated with John Sampson's work about a century ago, proposes that menstrual material moves backwards through the fallopian tubes into the pelvic cavity. But contemporary research increasingly describes endometriosis as multifactorial. Retrograde menstruation by itself cannot explain the entire disease spectrum, including why retrograde menstruation is so common while only a minority develop endometriosis, or every form of extra-pelvic disease. Current research considers interactions involving genetic, hormonal, inflammatory, immune, epigenetic and other mechanisms.

Why does terminology matter? Because language shapes what people look for. If endometriosis is continually framed primarily through menstruation and reproductive organs, it is understandable that society continues to see it as “bad periods”, infertility or simply a gynaecological problem. But endometriosis is not necessarily confined to the pelvic cavity. Although pelvic disease is the most common, endometriosis has been reported in multiple sites outside the pelvis and across different organ systems, including the diaphragm, thorax and lungs, abdominal wall, nerves and, in exceptionally rare cases, even the brain. These presentations are uncommon, but they matter because they challenge the persistent idea that endometriosis is simply a disease of menstruation, the uterus or the ovaries. Depending on where the disease is located, a patient may require expertise beyond gynaecology, including colorectal, urological, thoracic, pain or other specialist care. Even within the pelvis, some patients may present predominantly with bowel symptoms, urinary symptoms, chronic pelvic pain, nerve-related pain or fatigue rather than the stereotypical picture of severe menstrual pain.

This is why I believe our understanding of endometriosis cannot remain confined to the pelvis, menstruation or reproduction. That matters not only clinically, but also in how we explain and create awareness around the disease. If our language continues to centre almost entirely on periods, the womb and fertility, then our understanding becomes narrowed by the same boundaries. Endometriosis can then too easily be reduced to a “women’s problem”, “bad periods” or simply a reproductive issue.

That narrow framing has consequences. It influences what patients recognise in themselves, what families and employers take seriously, what clinicians consider when symptoms do not fit the expected picture, and ultimately which patients may be overlooked.

For me, improving awareness therefore also means decoupling endometriosis from the idea that it is simply a period problem. It does not mean removing menstruation or fertility from the conversation. They remain very important parts of the disease for many patients. It means expanding the conversation so that they are not treated as the boundaries of what endometriosis can be.

More than a decade ago, much of our advocacy understandably centred on one essential message: Severe period pain is not normal. That message remains important. But it cannot be where awareness ends.

The next stage is helping people understand that endometriosis is not only about periods. It is a complex chronic disease whose effects can extend across multiple body systems and into fertility, mental health, relationships, employment, finances and quality of life.

If scientific understanding evolves, patient education and healthcare education must evolve alongside it. Otherwise, patients whose disease does not resemble the traditional picture we have taught for generations may continue to be missed.

5. Singapore has endometriosis research, but we still lack a comprehensive national picture of its burden.

Singapore does have clinical research relating to endometriosis. What we do not currently have is a national endometriosis disease registry.

The National Registry of Diseases Office currently manages four national disease registries: cancer, chronic kidney failure, stroke and acute myocardial infarction. Endometriosis and adenomyosis are not among them.

I have also not been able to identify comprehensive national population-level data telling us how many people in Singapore are living with endometriosis or adenomyosis, the average diagnostic delay specifically within our population, and their combined impact on employment, education, caregiving, mental health, fertility, finances and quality of life. That is different from saying Singapore has no research. We do. The issue is whether we have enough coordinated population-level evidence to understand the true national burden.

For me, this is particularly important in an Asian context. Research questions should also originate from our societies. How do filial responsibility and caregiving affect whether someone prioritises her own healthcare? How do gender expectations influence the normalisation of pain? Does stigma around menstruation affect help-seeking differently across communities? How does neurodivergence affect communication with healthcare providers? How do language, socioeconomic circumstances, religion and family structures interact with chronic illness? These are endometriosis questions too.

Global evidence is invaluable. But if Asian experiences are underrepresented, we risk understanding the disease biologically while missing important parts of how illness is actually lived.

6. Specialist hospital care exists, but endometriosis still lacks clear national ownership as a broader health issue.

This distinction is important.

Singapore has endometriosis services within hospitals. What I have not been able to identify, as of October 2026, is a dedicated national government programme for endometriosis and adenomyosis bringing together awareness, population data, research, financing, psychosocial support, employment considerations and patient education.

In 2021, I had an opportunity to speak with representatives from the outreach department of one of our government health agencies. My understanding from that conversation was that there was no dedicated department specifically responsible for endometriosis. That experience also changed the way I thought about advocacy.

Rather than discussing endometriosis only within a gynaecological space, I began asking where it intersects with issues Singapore already considers nationally significant. One example is fertility.

Singapore's resident total fertility rate fell to 0.87 in 2025, its lowest recorded level. In April 2026, the Government established an interagency Marriage & Parenthood Reset Workgroup and described declining fertility as requiring a multi-faceted, whole-of-society response. This is one reason I have tried to raise endometriosis within Singapore's wider discussions about fertility and family formation. I am very careful not to claim that endometriosis explains Singapore's declining birth rate. We do not have evidence to establish that.

My question is different: If Singapore is already examining the barriers affecting people's ability or decision to have children and build families, should chronic reproductive diseases such as endometriosis and adenomyosis also be examined within that picture? These conditions can intersect with infertility, pregnancy loss, repeated surgery, chronic pain, sexual health and decisions around when or whether to pursue parenthood.

My own journey eventually resulted in hysterectomy and the permanent loss of my ability to carry a child. That does not establish a population-level relationship between endometriosis and Singapore's fertility rate. My story is one story. But it explains why I believe the question deserves to be asked.

The Marriage & Parenthood Reset Workgroup itself recognises that marriage and parenthood outcomes are influenced by multiple factors, including social attitudes, workplace practices, government policies and family and community support. From my perspective as an advocate, reproductive health conditions belong among the factors worth investigating too.

I am not asking anyone to assume the answer. I am asking that the question not be absent simply because we do not yet know the answer.

If Singapore is already examining the barriers affecting people's ability or decision to have children and build families, should chronic reproductive diseases such as endometriosis and adenomyosis also be examined within that picture?

7. Patients continue to perform a great deal of the connective work themselves.

One of the things that has struck me over more than a decade of advocacy is how much of the practical knowledge surrounding endometriosis travels patient to patient.

Hospital services provide medical treatment. But patients often turn to one another for another layer of information: Who understands this disease? What questions should I ask? What is this medication actually like to live with? How did another patient navigate work after surgery? Where can I find emotional support? How do I explain this to my family? What should I expect when I seek another opinion?

E for Endometriosis is completely volunteer-led, and many of the people contributing to the work are patients themselves. What began for me as a place to process my own experience became a community because other women began telling me that they, too, had felt dismissed, frightened or alone. Community support is not a replacement for healthcare, nor should peer recommendations replace clinical assessment. But patient organisations often become the connective tissue between the parts of the formal system. They translate information into language patients understand. They create spaces where people can ask questions they may be embarrassed to ask elsewhere. They identify recurring concerns. They provide the reassurance of meeting somebody who has lived through something similar. And frequently, they are doing this while managing the disease themselves.

That patient labour deserves to be recognised as part of the endometriosis ecosystem rather than treated as something peripheral to healthcare.

8. Even identifying an "endometriosis specialist" can be confusing for patients.

Perhaps one of the most practical questions patients ask us is: Who is actually an endometriosis specialist in Singapore?

The answer is surprisingly complicated.

Singapore absolutely has doctors with substantial endometriosis experience. KKH explicitly identifies gynaecologists with an interest and surgical expertise in managing endometriosis within its Endometriosis Centre, and specialised endometriosis care also exists elsewhere. But endometriosis itself is not a formally recognised medical subspecialty under Singapore's Specialists Accreditation Board. Obstetrics & Gynaecology is a recognised specialty, but endometriosis does not appear among Singapore's formally recognised subspecialties.

So for a patient looking at credentials, there is no national register where she can simply select 'endometriosis specialist' and know exactly what level of disease or surgical complexity each doctor manages.

This becomes particularly relevant with deep infiltrating or complex endometriosis. A general gynaecologist may be entirely appropriate for initial assessment and many aspects of endometriosis management. But complex disease involving structures such as the bowel, bladder, ureters or extensive adhesions may require a different depth of surgical experience and multidisciplinary planning.

From the patient's side, that distinction is not necessarily obvious. International platforms can create another layer of confusion. As of October 2026, the Singapore directory on iCareBetter, an international platform that assesses endometriosis providers, displays one Singapore doctor with its VideoVetted designation. But this does not mean Singapore has only one competent endometriosis doctor, nor does absence from iCareBetter mean that another clinician is unreliable.

iCareBetter is not Singapore's official medical accreditation authority. Participation involves an application process, and its video-vetting pathway involves surgeons submitting full surgical videos for peer review. Its published criteria also include endometriosis-focused surgical experience and advanced training. A directory based on voluntary participation therefore cannot be treated as a complete census of all endometriosis expertise in Singapore.

And that leaves patients with a very difficult task. They may find themselves comparing professional biographies, surgical experience, hospital affiliations, overseas directories and other patients' experiences while trying to answer questions such as: Does this doctor regularly manage deep disease? Do they work with colorectal or urological surgeons when necessary? How much endometriosis surgery do they perform? Do they understand adenomyosis as well? Will they listen to my priorities? Are they patient-centred?

This is one reason community knowledge becomes so influential. Patients frequently rely on other patients to help identify clinicians who not only have appropriate experience but communicate well, take symptoms seriously and involve the patient meaningfully in decisions. Again, peer recommendation cannot prove clinical competence. But the fact that patients need to perform this much detective work tells us something about transparency and navigation.

There is also a financial dimension. At KKH, patients entering through eligible referral routes can access subsidised specialist care, while referral to a particular named doctor from a polyclinic is classified as non-subsidised.

So the issue is not simply: Does expertise exist in Singapore? It does.

The more useful questions are: Can patients identify the level of expertise they need? Can they reach it? Can they choose it within the financial pathway available to them? For somebody with severe disease, those questions can have consequences lasting years.

Where does this leave us?

The Singapore endometriosis story is not simply one of absence. We have skilled clinicians. We have specialist hospital services. We have public healthcare subsidies and national healthcare financing mechanisms. Awareness has improved significantly compared with when I began advocating.

At the same time, a patient can still fall through the spaces between these systems.

She may have grown up believing that women should endure pain quietly.

She may look outwardly functional while becoming increasingly unable to sustain employment.

She may have several diagnoses that do not fit neatly within one specialty.

She may encounter educational material that still frames endometriosis primarily through menstruation.

She may struggle to understand who genuinely has experience with complex disease.

She may discover that choosing a particular clinician affects the financial pathway available to her.

And she may find that some of the most practical knowledge she needs comes not from a coordinated national system, but from other patients who have already navigated it.

That is why, for me, the next stage of endometriosis awareness in Singapore has to become more nuanced. It cannot stop at 'period pain is not normal'. It must also ask what culture teaches us about suffering, how financial systems understand chronic illness, how neurodivergence and other conditions interact with care, how medical education evolves with science, how specialist expertise is communicated to patients, and how endometriosis intersects with wider questions about work, fertility, family and quality of life.

My own journey has taught me that a disease does not exist only inside an organ. It is lived inside a person, a culture, a family, a healthcare system and a life. And if we want to understand endometriosis properly, all of those dimensions deserve to be part of the conversation.

A disease does not exist only inside an organ. It is lived inside a person, a culture, a family, a healthcare system and a life.

Resources and further reading

The links below provide background on the clinical, healthcare financing, policy and specialist-navigation issues discussed in this article.

World Health Organization: Endometriosis fact sheet - Current WHO overview of endometriosis, symptoms, impact and knowledge gaps.

KK Women's and Children's Hospital: Endometriosis Centre - Information on KKH multidisciplinary endometriosis services.

Singapore Endometriosis Diagnosis & Management quick-reference guide - Singapore professional clinical guidance.

Ministry of Health: Singapore's healthcare financing framework - Overview of subsidies, MediSave, MediShield Life and MediFund.

Ministry of Health: MediSave outpatient care and CDMP conditions - Current Chronic Disease Management Programme coverage and MediSave outpatient rules.

Ministry of Health: Specialist Outpatient Clinic subsidies - Subsidy framework for public specialist outpatient care.

Ministry of Health: MediFund - Medical financial safety net for eligible Singapore citizens.

Agency for Integrated Care: CareShield Life - Severe-disability and Activities of Daily Living criteria.

Ministry of Social and Family Development: ComCare - General social assistance for eligible individuals and families.

National Registry of Diseases Office: About NRDO - Current national disease registries in Singapore.

National Population and Talent Division: Marriage & Parenthood Reset Workgroup - Government context on marriage, parenthood and declining fertility.

Specialists Accreditation Board: Recognised specialties and subspecialties - Official Singapore specialist accreditation structure.

iCareBetter: Singapore endometriosis provider directory - International voluntary provider directory.

iCareBetter: Surgeon application and assessment criteria - How the platform assesses participating surgeons.

SingHealth: Battling endometriosis, a chronic, silent and painful disease - Discussion of awareness, delayed care and endometriosis in Singapore.

Research review: Pathogenesis and multifactorial theories of endometriosis - Background on contemporary theories beyond a single-cause explanation.

Note: This article combines personal lived experience, patient advocacy observations and publicly available information current to October 2026. It is intended for awareness and discussion, not as individual medical or financial advice.

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Written by:

Namira

Founder, E for Endometriosis