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

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.