Underdiagnosed endometriosis: Repercussions of diagnostic delay on chronic pain, fertility, and quality of life

Underdiagnosed endometriosis: Repercussions of diagnostic delay on chronic pain, fertility, and quality of life DOI: https://doi.org/10.70164/ihsr.v2i3.178Keywords: Endometriosis; Delayed Diagnosis; Chronic Pelvic Pain; Infertility; Quality Of Life; Women's Health.Abstract Endometriosis is a chronic estrogen-dependent inflammatory disease defined by the presence of endometrial-like tissue outside the uterine cavity, affecting an estimated ten percent of women of reproductive age. Despite its high prevalence and substantial morbidity, the time interval between symptom onset and diagnosis remains long, frequently exceeding seven years, which characterizes the disease as systematically underdiagnosed. The present narrative review aimed to critically analyze the repercussions of diagnostic delay in endometriosis on chronic pelvic pain, fertility, and quality of life. A literature search was conducted in PubMed/MEDLINE, SciELO, Cochrane Library, and Google Scholar, prioritizing articles published over the last fifteen years, including international guidelines, systematic reviews, observational studies, and seminal references. The reviewed evidence indicates that diagnostic delay is associated with progression to deep infiltrating disease, central sensitization, opioid exposure, reduced ovarian reserve, increased need for assisted reproductive technologies, occupational impairment, and elevated rates of anxiety and depression. Strategies focused on educating clinicians and patients, validating non-invasive diagnostic tools, and structuring multidisciplinary referral pathways appear to mitigate these consequences. Reducing diagnostic delay should be considered a public health priority in women's health, with implications for clinical management, reproductive planning, and biopsychosocial well-being. References AGARWAL, S. K. et al. Clinical diagnosis of endometriosis: a call to action. American Journal of Obstetrics and Gynecology, v. 220, n. 4, p. 354.e1-354.e12, 2019. AS-SANIE, S. et al. Assessing research gaps and unmet needs in endometriosis. American Journal of Obstetrics and Gynecology, v. 221, n. 2, p. 86-94, 2019. BECKER, C. M. et al. ESHRE guideline: endometriosis. Human Reproduction Open, v. 2022, n. 2, p. 1-26, 2022. BULUN, S. E. Endometriosis. New England Journal of Medicine, v. 360, n. 3, p. 268-279, 2009. BURNEY, R. O.; GIUDICE, L. C. Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility, v. 98, n. 3, p. 511-519, 2012. CHAPRON, C. et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nature Reviews Endocrinology, v. 15, n. 11, p. 666-682, 2019. DUNSELMAN, G. A. J. et al. ESHRE guideline: management of women with endometriosis. Human Reproduction, v. 29, n. 3, p. 400-412, 2014. FALCONE, T.; FLYCKT, R. Clinical management of endometriosis. Obstetrics and Gynecology, v. 131, n. 3, p. 557-571, 2018. GIUDICE, L. C. Endometriosis. New England Journal of Medicine, v. 362, n. 25, p. 2389-2398, 2010. JOHNSON, N. P.; HUMMELSHOJ, L. Consensus on current management of endometriosis. Human Reproduction, v. 28, n. 6, p. 1552-1568, 2013. NNOAHAM, K. E. et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertility and Sterility, v. 96, n. 2, p. 366-373.e8, 2011. PRACTICE COMMITTEE OF THE AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE. Endometriosis and infertility: a committee opinion. Fertility and Sterility, v. 98, n. 3, p. 591-598, 2012. SAMPSON, J. A. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. American Journal of Obstetrics and Gynecology, v. 14, p. 422-469, 1927. SOLIMAN, A. M. et al. Factors associated with time to endometriosis diagnosis in the United States. Journal of Women's Health, v. 26, n. 7, p. 788-797, 2017. VERCELLINI, P. et al. Endometriosis: pathogenesis and treatment. Nature Reviews Endocrinology, v. 10, n. 5, p. 261-275, 2014. ZONDERVAN, K. T.; BECKER, C. M.; MISSMER, S. A. Endometriosis. New England Journal of Medicine, v. 382, n. 13, p. 1244-1256, 2020. Downloads Published How to Cite Issue Section License Copyright (c) 2026 Izabella Monteiro Teixeira Scarparo; Caroline Zanella; Mateus Souza Cardoso, Anna Silveira Martins, Ana Carolina Farias Leandro This work is licensed under a Creative Commons Attribution 4.0 International License.