Background: To our knowledge, no systematic update on the descriptive epidemiology of endometriosis and its trends has been published based on the Global Burden of Disease (GBD) datasets. To investigate the burden of endometriosis in 204 countries and territories from 1990 to 2019. Methods: Data were extracted from the Global Burden of Disease (GBD) 2019 datasets. Estimated annual percentage changes (EAPCs) were calculated to assess trends in the incidence and disability-adjusted life-years (DALYs) of endometriosis. Measures were stratified by region, country, age, and socio-demographic index (SDI). Results: From 1990 to 2019, the global incidence and DALYs of endometriosis increased by 10.37% and 16.36%, respectively. However, both the age-standardized incidence rate (ASIR) and age-standardized DALY rate of endometriosis showed downward trends (EAPC = –0.81 and –0.80, respectively). The ASIR decreased in all SDI regions, with the largest decrease observed in low-middle SDI regions [EAPC = –1.19, 95% Confidence Interval (CI): –1.21 to –1.16] except Eastern Europe, the only region where the ASIR increased (EAPC = 0.15, 95% CI: 0.01 to 0.29). The largest decreases in the ASIR and age-standardized DALY rate of endometriosis were observed in Qatar and Oman, respectively. Conclusions: The global incidence and DALYs of endometriosis continued to increase during 1990–2019. However, the ASIR and age-standardized DALY rate have shown decreasing trends worldwide, with increasing trends detected only in Eastern Europe.