Endometriosis is a complicated chronic disease that stays undiagnosed for several years (Simoens S. 2012). Estimations report that 10% of women of reproductive age could be affected (Eskenazi B.1997). The aim of this paper was to draw on the French retrospective EndoCost data to calculate lifetime costs of surgery, infertility and hormonal treatment related to endometriosis; to quantify annual costs of other health care, transportation, support with household activities, productivity loss; and to explore whether the time since symptoms or diagnosis is associated with annual costs. These results serve to underline that the economic burden of endometriosis-associated symptoms is sufficiently high and persists over time to warrant a significant increase in studies that focus on the cause, diagnosis and treatment of endometriosis. Study objective: To calculate costs of endometriosis-associated symptoms over an annual or lifetime horizon and to explore whether time since symptoms or diagnosis is associated with endometriosis costs.Design: Retrospective, prevalence-based, French cost-of-illness analysis (2009). Patients: Women with laparoscopic and/or histological diagnosis of endometriosis and at least one patient contact related to endometriosis in 2008.Results: 85 women (27 % response rate) incurred lifetime costs of â‚¬ 1,449 per woman due to surgery, â‚¬3,635 due to infertility treatment, and â‚¬1,730 due to hormonal treatment. Lifetime costs were positively associated with time since first symptoms (Mann-Whitney U-test: P = 0.02; Spearman correlation coefficient = 0.261 P = 0.023) and with time since diagnosis (U-test: P = 0.001; Spearman coefficient = 0.349, P < 0.001). Annual total other costs were â‚¬11,609 per woman, with productivity loss (â‚¬6,368) costing four times more than health care (â‚¬5,241). In general, there was no association between annual total, direct or indirect costs and time since first symptoms or diagnosis. Conclusions: Costs of endometriosis-associated symptoms persist over time. Annual total costs were mainly related to productivity loss, reflecting the observation that women with endometriosis-associated symptoms may experience pain and impaired quality of life that causes productivity loss (Gao X. 2006). We did not find an association between annual total, direct or indirect costs and the number of years since first symptoms or diagnosis.