| Course | HLTH 8574 Women's Health Issues |
|---|---|
| Week | Week 4 |
| Paper type | Evidence audit |
| Length | About 590 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | PhD in Public Health |
| Updated | October 2026 |
Free sample paper for HLTH 8574 Week 4
Evidence Audit: Tracing the "One in Ten Women" Endometriosis Figure From Fact Sheets Back Through Review Articles to the Surgical Samples Beneath It, and Asking What Those Samples Can Say About Everyone Else
Student Name
Walden University
HLTH 8574: Women's Health Issues
Instructor Name
Month Day, Year
Evidence Audit: Tracing the "One in Ten Women" Endometriosis Figure From Fact Sheets Back Through Review Articles to the Surgical Samples Beneath It, and Asking What Those Samples Can Say About Everyone Else
The Claim Being Audited
Fact sheets and health websites routinely say that endometriosis affects about 10% of women of reproductive age. The World Health Organization's fact sheet puts it at roughly 10%, or 190 million women and girls worldwide (World Health Organization, 2023). This audit asks where the figure came from and what kind of women were counted to produce it.
Step One: The Review Behind the Fact Sheet
A widely cited clinical review by three endometriosis researchers states that endometriosis affects about 10% of reproductive-age women (Zondervan et al., 2020). The review is careful about diagnosis: endometriosis is confirmed by surgical visualization, with or without histology, and the authors note that diagnostic delay and the need for surgery make its true frequency hard to measure. The figure travels from the review to the fact sheet largely intact, but the review's caution does not travel with it.
Step Two: The Older Estimate
Earlier reviews of endometriosis epidemiology, including the one by Eskenazi and Warner (1997), offered the estimate of around 10% as a summary of studies available at the time. Those studies drew mostly on women who were already having pelvic surgery for some reason. The estimate was a reasonable synthesis of what was known, but it was a synthesis of surgical populations.
Step Three: The Samples Underneath
A systematic review by Ghiasi et al. (2020) gathered 69 studies of endometriosis prevalence or incidence and sorted them by who was sampled. The differences are striking.
Women having surgery for pain or infertility are, by definition, women with reasons to suspect a pelvic problem, so prevalence among them will be high. Women having tubal sterilization are closer to a general population because the surgery is not done for symptoms, but they are still women who chose surgery and reached it. The general population studies, which rely on diagnoses recorded in hospital or insurance systems, give lower figures, but they count only women who were diagnosed, which requires surgery or at least imaging and a specialist.
Table 1
Endometriosis Prevalence by Type of Sample, as Summarized by Ghiasi et al. (2020)
| Sample | Prevalence range reported | |
|---|---|
| General population studies | 0.7% to 8.6% | |
| Single clinic or hospital studies | 0.2% to 71.4% | |
| Women with chronic pelvic pain | 15.4% to 71.4% | |
| Women presenting with infertility | 9.0% to 68.0% | |
| Women undergoing tubal sterilization | 3.7% to 43.3% | |
Ranges are as reported in the review's abstract; individual studies differ in diagnostic method and period.
What the Samples Can and Cannot Say
The surgical studies can say how common endometriosis is among women who reached surgery for particular reasons. They cannot say how common it is among women who never had surgery, including women with mild symptoms, women who could not afford or reach a gynecologist and women whose pain was dismissed. The general population studies can say how common a recorded diagnosis is, which reflects access to diagnosis as much as disease.
The honest version of the claim is narrower: endometriosis is common, it is found in a large share of women with pelvic pain or infertility who have surgery, and its frequency in the whole population is not precisely known. That version is less quotable but more accurate. A fact sheet could keep the 10% figure while saying it is an estimate built largely on surgical samples.
References
Eskenazi, B., & Warner, M. L. (1997). Epidemiology of endometriosis. Obstetrics and Gynecology Clinics of North America, 24(2), 235-258. https://doi.org/10.1016/S0889-8545(05)70302-8
Ghiasi, M., Kulkarni, M. T., & Missmer, S. A. (2020). Is endometriosis more common and more severe than it was 30 years ago? Journal of Minimally Invasive Gynecology, 27(2), 452-461. https://doi.org/10.1016/j.jmig.2019.11.018
World Health Organization. (2023). Endometriosis [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/endometriosis
Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. New England Journal of Medicine, 382(13), 1244-1256. https://doi.org/10.1056/NEJMra1810764
The Walden HLTH 8574 Week 4 instructions
Students audit a widely cited health statistic by tracing it to its original sources and evaluating the samples behind it. Faculty expect the audit to follow the figure step by step, from the version most readers see to the studies that produced it, and to describe who was sampled at each step. The strongest audits explain how sample selection shaped the figure and what the samples cannot say about the wider population. A table comparing prevalence across sample types is a useful tool. The audit should not simply reject the figure; it should propose a more accurate statement. Sources should include the public-facing source, the reviews that repeated the figure and at least one systematic review of the underlying studies.
How the HLTH 8574 Week 4 example is put together
The audit begins with the WHO fact sheet's figure of roughly 10%. Step one examines the 2020 New England Journal of Medicine review by Zondervan and colleagues, noting its caution about surgical diagnosis. Step two traces the figure to Eskenazi and Warner's earlier review of studies of women undergoing pelvic surgery. Step three presents Ghiasi and colleagues' sorting of 69 studies by sample type, with Table 1 showing the prevalence ranges for general population, clinic, pain, infertility and tubal sterilization samples. A section explains why each sample type gives the figures it does and what none of them can show about undiagnosed women. The audit closes with a narrower statement of the claim and a suggestion for fact sheets.
Where the marks sit in the HLTH 8574 Week 4 rubric
Faculty grade the audit on the completeness of the trace and the quality of the reasoning about samples. A paper that notes a figure is often repeated and calls it questionable earns little; one that traces it through each source and shows how the samples shaped it earns much more. Credit rises when sample types are compared explicitly and when the audit explains what each type can and cannot say. Accurate reporting of review findings is checked closely, and ranges should be reported as the sources give them. Faculty value an audit that proposes a more accurate version of the claim instead of dismissing the figure. Recognition that general population studies count diagnoses, which reflect access, shows depth.
Common HLTH 8574 Week 4 mistakes, and how to avoid them
Evidence audits often stop at the first source, a fact sheet or website, and either accept or reject the figure. To write a stronger audit, trace the claim through each source that repeated it until you reach the studies that produced the number. Note who was sampled at each step: women having surgery, women attending a clinic or women in a general population. Ask what kind of person could not have been counted. Look for a systematic review that sorts studies by sample type. Report its ranges accurately. Then write a narrower, more honest version of the claim. An evidence audit tracing the statistic your section chose can be prepared for your prompt.
Get a HLTH 8574 Week 4 example written to your instructions
Send the claim your Week 4 prompt asks you to audit, or the topic it leaves open, with the rubric; the audit follows that claim to the samples beneath it and restates what it supports. Your first custom sample carries no fee, arrives in 24-48 hours, and lists every study in the chain so you can pull each one.
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HLTH 8574 Week 4 questions, answered
Is the audit saying endometriosis is rare?
No. It says the widely repeated figure rests on samples of women who reached surgery, so it cannot speak for women who never did. The true burden could be higher or distributed differently, and the audit declines to guess. That restraint is the point: an evidence audit reports what the studies support rather than replacing one unsupported number with another.
Where can I find a free HLTH 8574 Week 4 sample paper?
The full Week 4 evidence audit is shown here, tracing the one-in-ten endometriosis figure from a WHO fact sheet back through reviews to surgical samples and comparing prevalence by sample type, with four references.
Where did the 10% figure come from?
It was carried forward through clinical and epidemiology reviews, including Eskenazi and Warner in 1997, which summarized studies drawn mostly from women already having pelvic surgery. Later reviews repeated the estimate with cautions that fact sheets often drop.
Why do prevalence estimates range so widely?
Because studies sample different women. Studies of women with chronic pelvic pain found prevalence from 15.4% to 71.4%, while general population studies based on recorded diagnoses found 0.7% to 8.6%. Neither counts women who were never diagnosed.
Does the audit name the sources it traced?
Yes. It cites the World Health Organization fact sheet, the 2020 clinical review by Zondervan and colleagues, the 1997 review by Eskenazi and Warner and the 2020 systematic review by Ghiasi and colleagues, so each step can be checked.