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Am J Obstet Gynecol. 2017 May;216(5):451-458.e1. doi: 10.1016/j.ajog.2016.11.1007. Epub 2016 Nov 11.

Googling endometriosis: a systematic review of information available on the Internet.

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Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Yvonne Carter Building, London, United Kingdom.
Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom; Radcliffe Women's Health Patient and Public Involvement Group, University of Oxford, Oxford, United Kingdom.
Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom; Balliol College, University of Oxford, Oxford, United Kingdom. Electronic address:



The demand for health information online is increasing rapidly without clear governance.


We aim to evaluate the credibility, quality, readability, and accuracy of online patient information concerning endometriosis.


We searched 5 popular Internet search engines:,,,, and We developed a search strategy in consultation with patients with endometriosis, to identify relevant World Wide Web pages. Pages containing information related to endometriosis for women with endometriosis or the public were eligible. Two independent authors screened the search results. World Wide Web pages were evaluated using validated instruments across 3 of the 4 following domains: (1) credibility (White Paper instrument; range 0-10); (2) quality (DISCERN instrument; range 0-85); and (3) readability (Flesch-Kincaid instrument; range 0-100); and (4) accuracy (assessed by a prioritized criteria developed in consultation with health care professionals, researchers, and women with endometriosis based on the European Society of Human Reproduction and Embryology guidelines [range 0-30]). We summarized these data in diagrams, tables, and narratively.


We identified 750 World Wide Web pages, of which 54 were included. Over a third of Web pages did not attribute authorship and almost half the included pages did not report the sources of information or academic references. No World Wide Web page provided information assessed as being written in plain English. A minority of web pages were assessed as high quality. A single World Wide Web page provided accurate information: Available information was, in general, skewed toward the diagnosis of endometriosis. There were 16 credible World Wide Web pages, however the content limitations were infrequently discussed. No World Wide Web page scored highly across all 4 domains.


In the unlikely event that a World Wide Web page reports high-quality, accurate, and credible health information it is typically challenging for a lay audience to comprehend. Health care professionals, and the wider community, should inform women with endometriosis of the risk of outdated, inaccurate, or even dangerous information online. The implementation of an information standard will incentivize providers of online information to establish and adhere to codes of conduct.


accuracy; credibility; endometriosis; online information; patients; quality; readability; systematic review

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