Clinical diagnosis of endometriosis: a call to action

Sanjay K. Agarwal, Chapron C, Charles Chapron, Linda C. Giudice, Giudice LC, Marc R. Laufer, Laufer MR, Nicholas Leyland, Leyland N, Missmer SA, Stacey A. Missmer, Sukhbir S. Singh, Singh SS, Hugh S. Taylor
American journal of obstetrics and gynecology · 2019 · vol. 220(4) , pp. 354.e1–354.e12 · doi:10.1016/j.ajog.2018.12.039 · PMID:30625295 · W2907530084
article OA: bronze CC0 ⤵ 585 in-corpus citations
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This paper addresses the critical need for improved clinical diagnosis of endometriosis, advocating for urgent action to advance diagnostic methods and patient care.

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Abstract

Endometriosis can have a profound impact on women's lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. Inherent challenges include a gold standard based on an invasive surgical procedure (laparoscopy) and diverse symptomatology, contributing to the well-established delay of 4-11 years from first symptom onset to surgical diagnosis. We believe that remedying the diagnostic delay requires increased patient education and timely referral to a women's healthcare provider and a shift in physician approach to the disorder. Endometriosis should be approached as a chronic, systemic, inflammatory, and heterogeneous disease that presents with symptoms of pelvic pain and/or infertility, rather than focusing primarily on surgical findings and pelvic lesions. Using this approach, symptoms, signs, and clinical findings of endometriosis are anticipated to become the main drivers of clinical diagnosis and earlier intervention. Combining these factors into a practical algorithm is expected to simplify endometriosis diagnosis and make the process accessible to more clinicians and patients, culminating in earlier effective management. The time has come to bridge disparities and to minimize delays in endometriosis diagnosis and treatment for the benefit of women worldwide.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Chronic Pain Dysmenorrhea Dyspareunia Endometriosis Infertility, Female Pelvic Pain Chronic Pain Chronic Pain Delayed Diagnosis Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Endometriosis Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female

Funding

funders
[{'doi': '10.13039/100007819', 'name': 'Allergan', 'awards': []}, {'doi': '10.13039/100000002', 'name': 'National Institutes of Health', 'awards': []}, {'doi': '10.13039/100013733', 'name': 'Ipsen Biopharmaceuticals', 'awards': []}, {'doi': '10.13039/100004334', 'name': 'Merck', 'awards': []}, {'doi': '10.13039/100015340', 'name': 'Bayer Fund', 'awards': []}, {'doi': '10.13039/501100000024', 'name': 'Canadian Institutes of Health Research', 'awards': []}, {'doi': '10.13039/501100003358', 'name': 'Gedeon Richter', 'awards': []}, {'doi': '10.13039/100006483', 'name': 'AbbVie', 'awards': []}]

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (50)

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