Pulse ·
A five-minute screen that could halve the endometriosis diagnosis wait
A new diagnostic tool — the Simplified Adolescent Factors for Endometriosis (SAFE) score — uses six questions to identify young women at risk of endometriosis, enabling faster specialist referral from general practice.
Developed by University of Queensland researchers from ALSWH data on over 9,000 women, the tool achieved AUC 0.71–0.79 and a negative predictive value of approximately 90–95%, making it a practical triage instrument.
The average diagnostic delay for endometriosis in Australia is six to eight years. The SAFE score, published in eClinicalMedicine in March 2026, is the most rigorously validated GP-deployable screen for closing that gap.
What just happened
She was seventeen when the cramping started. By twenty-five she had been through three GPs, two pelvic ultrasounds both reported as unremarkable, and at least one suggestion that painful periods are something women manage. At thirty-two she got the laparoscopy. Stage-three endometriosis. Six years from the first serious consultation to a diagnosis.
That number — six to eight years, the average diagnostic delay for endometriosis in Australia — has circulated in medical literature for decades without substantively shifting. It is worth sitting with. Six to eight years of a body signalling, pain minimised, fertility window narrowing, surgical staging advancing — and, for most of that time, no validated triage tool available to the GP to distinguish the probable-endometriosis presentation from the broader spectrum of gynaecological complaint.
That may be changing.
In March 2026, researchers at the University of Queensland’s Australian Women and Girls’ Health Research Centre published the Simplified Adolescent Factors for Endometriosis (SAFE) score in eClinicalMedicine (The Lancet). Led by Professor Gita Mishra and team, the score uses six questions to identify adolescents and young women at risk of endometriosis and fast-track specialist referral. The data underpinning it came from the Australian Longitudinal Study on Women’s Health — over 9,000 women followed for three decades, the largest longitudinal study of its kind in this country.
The six domains the SAFE score assesses: frequency of pelvic pain; whether the patient has sought medical treatment for that pain; use of analgesics for pelvic pain; presence of heavy menstrual bleeding; dysmenorrhoea that interferes with function; and family history of endometriosis. Each is scored, with a threshold above two indicating referral for further investigation. The tool achieved an area under the ROC curve of 0.71–0.79, with sensitivity 47–64%, specificity 82–86%, and a negative predictive value of approximately 90–95%.
That last number matters most in general practice. A negative predictive value of 90–95% means that a low SAFE score substantially reassigns downward probability. The tool is not a diagnostic substitute for laparoscopy — that remains the definitive procedure. It is a referral triage instrument. Its job is to identify who belongs in a specialist’s waiting room at month six, not year six.
The both-and
The SAFE score is the most rigorously validated AU-built GP triage tool for endometriosis to date. The system that receives those referrals still needs resourcing. Both are true.
Endometriosis Australia has been calling for a reliable early-detection instrument for years. The SAFE score was built on Australian data, validated in an Australian cohort, and is explicitly designed for the general practice consultation. That is meaningful: the prevalence data, the referral thresholds, the clinical population — they reflect Australian women, not populations derived elsewhere.
The harder tension: the SAFE score improves the front end of the diagnostic pathway. It does not shorten gynaecology wait times, expand the specialist surgical workforce, or address the under-resourcing of public operative lists. A validated referral triage tool is a genuine advance — and whether the system can act on the referrals that advance generates is a separate, equally important question.
There is also an age gap to name plainly. The SAFE score was designed for adolescents and young women. The ALSWH data that anchors the study found one in seven Australian women aged 40 to 44 carry an endometriosis diagnosis — a prevalence higher than previously reported. Many of those women were symptomatic for years before any triage tool existed. The SAFE score arrives in time for the next generation. For the woman who is 42 today and still waiting for her diagnostic answer — this paper is a data point, not a personal solution.
2 cents
If you are a woman reading this with pelvic pain — cyclical or not — heavy periods, dysmenorrhoea that limits activity, regular analgesic use around your cycle, or a mother or sister with diagnosed endometriosis: the SAFE score framework is a structured conversation to take to your GP.
Not a self-diagnosis. A specific question: “Has an endometriosis risk screen been done? The SAFE score is a validated instrument — can we walk through it together?”
A score above two warrants specialist referral for further investigation. That referral is considerably more useful than another cycle of “your ultrasound is normal, let’s observe.”
This is general information. Your clinical picture has its own particulars — uncovering them is work done in the consult, not in an article.
Verdict
Verdict: yes — worth knowing about.
A validated, Australian-built, GP-deployable triage tool for endometriosis is news with direct clinical utility. The average diagnostic delay in this country is six to eight years — not an abstract statistic but a quantified weight of dismissal. The SAFE score does not fix the system. But it gives the GP a structured instrument and the woman a structured question to bring in.