BACKGROUND: Endometriosis is a prevalent yet under-recognized gynecological condition that significantly impacts women's quality of life. Despite its burden, data on the knowledge and awareness of endometriosis among women in Southwest China remain limited. OBJECTIVE: This study aimed to assess the level of knowledge and awareness of endometriosis among women in Southwest China and identify factors associated with good knowledge. METHODS: A cross-sectional study was conducted from February to April 2024, involving 724 women aged 18 years and older. Data were collected using a structured questionnaire encompassing sociodemographic characteristics, reproductive and medical history, healthcare utilization, and knowledge of endometriosis. Participants were categorized as having "good" knowledge if they scored ≥ 60% on the knowledge assessment. Descriptive statistics, univariate analyses, and multivariable logistic regression were employed to identify factors associated with good knowledge. A supplementary table was included to present the adjusted odds ratios (AORs) from logistic regression. RESULTS: The mean age of participants was 32.8 years (SD = 9.4). Overall, 69.0% of participants were aware of endometriosis, but knowledge of specific symptoms, such as painful bowel movements (34.5%) and heavy menstrual bleeding (40.1%), was limited. Factors significantly associated with good knowledge included younger age (26-45 years, AOR: 1.75, 95% CI: 1.23-2.50, p <
0.001), higher education (master's degree or above, AOR: 3.10, 95% CI: 1.80-5.30, p <
0.001), being actively employed (AOR: 2.10, 95% CI: 1.40-3.10, p <
0.001), and recent pelvic or vaginal ultrasound (<
3 months, AOR: 2.30, 95% CI: 1.50-3.60, p <
0.001). Conversely, a history of abortion was negatively associated with good knowledge (AOR: 0.40, 95% CI: 0.25-0.60, p <
0.001). CONCLUSIONS: Despite moderate overall awareness of endometriosis, significant gaps in knowledge of symptoms and treatments persist among women in Southwest China. Targeted educational interventions focusing on less-educated, older, and less medically-engaged populations are necessary to improve awareness and reduce delays in diagnosis and treatment.