Released on 18 August, the new Australian report Beyond the Surface 2026 found that more than half of Australian women are experiencing mental health issues. The rates were especially high among women living with endometriosis and polyendocrine metabolic ovarian syndrome (PMOS), the term used in the report for the condition previously known as PCOS.
But the findings point to more than a mental health problem. They show what can happen when physical and mental healthcare continue to operate as separate systems.
A woman seeking help for chronic pelvic pain may see a GP, gynaecologist, pain specialist and physiotherapist before receiving an explanation. If depression, anxiety or thoughts of self-harm emerge during that journey, she may be directed into another system, with a new assessment, another waiting list and another retelling of what has happened to her.
Her body does not separate the physical and psychological effects of illness. The healthcare system often does.
What the report found
Beyond the Surface 2026 is based on a nationally representative survey of 9,000 Australian women aged 18 and over.
It found that 56% were experiencing mental health issues, while one in four were considered likely to be experiencing severe psychological distress (Women's Mental Health Australia, 2026).
The figures were higher among women with certain female-specific health conditions. Almost half of women with endometriosis reported depression, and a similar proportion reported anxiety or generalised anxiety disorder.
The gap also extended to more serious experiences. Thirteen per cent of women with endometriosis reported suicide or self-harm, compared with 4% across the overall sample (Women's Mental Health Australia, 2026).
Psychological distress is not the same as a diagnosed mental disorder, and the results do not prove that these physical conditions directly cause mental illness. They do, however, show a clear overlap between physical health and mental wellbeing, one that health services cannot afford to ignore.
Living with uncertainty
Endometriosis affects around one in seven Australian women by their late forties. Diagnosis has historically taken between six and eight years from the first symptoms (Australian Institute of Health and Welfare, 2025).
During that time, women may live with pain, heavy bleeding, fatigue, poor sleep and uncertainty about fertility. Work, study, relationships and social life can all be affected. Some women also spend years being told that their pain is normal, stress-related or something they simply need to manage. That experience can add another layer of distress to an already difficult condition.
A systematic review found higher levels of depression and anxiety among women with endometriosis than among healthy controls. However, the difference disappeared when they were compared with people living with other forms of chronic pelvic pain (van Barneveld et al., 2022).
This suggests that pain itself may be a major part of the relationship. Poor sleep, fatigue, fertility concerns, changes in sexual wellbeing and the strain of repeatedly seeking care may also contribute.
The referral gap
Beyond the Surface 2026 found that one in three women experiencing mental health issues were not seeking support. Some believed they could manage the problem themselves. Others did not think it was serious enough. Cost, shame, fear of judgement, poor access and long waiting times were also barriers (Women's Mental Health Australia, 2026).
Australian Bureau of Statistics data show that more than a third of people who needed mental healthcare in 2024–25 delayed or missed care on at least one occasion. The rate was even higher among those who needed a psychologist (Australian Bureau of Statistics, 2025).
A referral is only useful when the service is available, affordable and able to respond. For women already dealing with pain, appointments and uncertainty, entering a separate mental health system can become another job. They may need to locate a provider, obtain a referral, check the cost and explain their history again.
Where digital support could help
Digital mental health could make support easier to reach, particularly for women facing long waits, high costs or limited services in their area. Online assessments, telehealth appointments, supported treatment programmes and regular check-ins could all form part of the response. Digital services can also provide support between medical appointments, when symptoms or distress may change.
Support should begin in the health services women already use. An endometriosis or pelvic pain clinic, for example, could offer a voluntary mental health check as part of routine care. If the assessment identifies significant distress, the woman could be connected directly to suitable digital or face-to-face support.
That pathway might include clinician-supported online therapy, telehealth sessions or follow-up after diagnosis, surgery or a change in treatment. It must also include a clear and immediate response when someone reports self-harm or suicidal thoughts.
Digital systems could help GPs, specialists and mental health clinicians work from the same care plan, with the patient's consent, rather than leaving her to carry information between services.
One connected pathway
Women's Mental Health Australia is calling for mental health assessment and support to be included in government-funded Endometriosis and Pelvic Pain Clinics.
That is a practical place to start.
A woman receiving care for a complex physical condition should not have to reach a crisis point before someone asks about her mental health. She should not be expected to coordinate several professionals while managing pain, fatigue and distress. The findings from Beyond the Surface 2026 are not only evidence of poor mental health. They point to a problem in the way care is designed.
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