The Significance of Diagnostic Delay in Endometriosis

Adi Y. Weintraub
In: Women's Health · 2016 · vol. 2(1) · doi:10.15406/mojwh.2016.02.00018 · W2578578321
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This paper reviews the significant diagnostic delay in endometriosis, citing patient factors, physician-related issues, and healthcare policy voids as contributing causes.

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This editorial discusses the significance of diagnostic delay in endometriosis, defining it largely as the interval between symptom onset and diagnostic surgery, and synthesizing findings from earlier studies showing substantial delays (estimated up to 10.4 years), frequent misdiagnosis, and longer delays for pelvic pain compared with infertility; it also notes that delay for deep infiltrating endometriosis diagnosis can be longer in advanced stage IV disease. It highlights potential contributors at patient, disease, and physician levels—such as normalization or suppression of symptoms, reliance on nondiscriminatory investigations, lack of awareness or confidence, and overlapping symptoms with other morbidities—and emphasizes additional health-system policy factors, including gaps and contradictions in clinical guidelines and limited evidence from randomized trials. A key limitation is that the piece is not a new primary study and presents an interpretive review of published reports rather than original data. This paper is centrally about endometriosis — it focuses specifically on diagnostic delay in endometriosis and the multi-level causes and implications of delayed diagnosis.

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Acknowledgements

None. Conflict of interest The author declares no conflict of interest.

References

1. Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268–279. 2. Olive DL, Schwartz LB. Endometriosis. N Engl J Med . 1993;328(24):1759–1769. 3. Cramer DW. Epidemiology of endometriosis. In: Wilson EA editor. En- dometriosis. New York, USA: Alan R Liss publishers; 1985. 5 p. 4. Strathy JH, Molgaard CA, Coulam CB, et al. Endometriosis and infer - tility: laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril. 1982;38(6):667–672. 5. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gyne- col Clin North Am. 1992;24(2):235–258. 6. Missmer SA, Cramer DW. The epidemiology of endometriosis. Obstet Gynecol Clin North Am. 2003;30(1):1–19. 7. Rogers PA, D Hooghe TM, Fazleabas A, et al. Priorities for endome - triosis research: recommendations from an international consensus workshop. Reprod Sci. 2009;16(4):335–346. 8. D Hooghe TM, Hill JA. Endometriosis. In: Berek JS editor. Novak’ s Gy- necology. 14th ed. USA: Lippincott Company; 2006. 9. Sinaii N, Cleary SD, Ballweg ML, et al. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Re- prod. 2002;17(10):2715–2724. 10. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366–373. 11. Viganò P, Parazzini F, Somigliana E, et al. Endometriosis and aetiologi- cal factors. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):177–200. 12. Royal College of Obstetricians and Gynaecologists. The initial manage- ment of chronic pelvic pain. Guideline number 41, London, UK: RCOG; 2005. p. 1–12. 13. Hadfield R, Mardon H, Barlow D, et al. Delay in the diagnosis of endo - metriosis: a survey of women from the USA and the UK. Hum Reprod. 1996;11(4):878–880. 14. Hudelist G, Fritzer N, Thomas A, et al. Diagnostic delay for endome - triosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27(12):3412–3416. 15. Husby GK, Haugen RS, Moen MH. Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand . 2003;82(7):649– 653. 16. Hummelshoj L, Prentice A, Groothuis P. Update on endometriosis. Wo- mens Health (Lond Engl). 2006;2(1):53–56. 17. Dmowski WP, Lesniewicz R, Rana N, et al. Changing trends in the diag- nosis of endometriosis: a comparative study of women with pelvic endo- metriosis presenting with chronic pelvic pain or infertility. Fertil Steril. 1997;67(2):238–243. 18. Vercellini P, Somigliana E, Viganò P, et al. Surgery for endometriosis-as- sociated infertility: a pragmatic approach. Hum Reprod. 2009;24(2):254– 269.

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endometriosis

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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.

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