OP06.05: Transvaginal ultrasound and patient reported outcome measures in non‐invasive endometriosis evaluation

The gold standard for endometriosis diagnosis is laparoscopy, affecting a diagnostic delay of 8 years on average. We aimed to evaluate factors responsible for delay in endometriosis diagnosis in women attending a tertiary referral endometriosis centre using transvaginal ultrasound (TVUS) and patient reported outcome measures (PROMs). Prospective observational study, consisting of a clinical data survey, patient reported outcome measures questionnaires, pelvic floor questionnaire (PFDI20) and dedicated TVUS. Endometriosis was diagnosed on TVUS (IDEA consensus) by three gynecological imaging experts, using 2D/3D capabilities. Women with a known timeline and no previous history of endometriosis diagnosis or surgery were included. Univariate and multivariate (Wald test) analysis was performed for associations with specific timeline categories: time from symptom onset to first physician visit, from first physician visit to diagnosis, and from symptom onset to diagnosis. The data set included 323 women, median age 30 years (IQR 26-36), 62.7% nulliparous, 46% tried to conceive, 22.4% had infertility, 92.2% dysmenorrhea, and 79.6% dyspareunia. Median age at menarche, first pain symptom and at first visit to physician was 13, 18 and 24 years, respectively. Median interval from first pain to endometriosis diagnosis was 9 years (IQR 3-15). The most prevalent symptoms were dysmenorrhea (92.2%), ovulation pain (82.7%) and dyspareunia (79.6%). Factors that were associated with a larger diagnostic delay were younger age at symptom onset, nulliparity, contraceptive use, dysmenorrhea, menorrhagia, analgesia use during menses, and concurrent autoimmune disorders, while infertility, hematuria and defecation disturbances were associated with a shorter diagnostic delay (all P < 0.05). On TVUS peritoneal adhesions and kissing ovaries were more common in patients with a long delay. Dedicated TVUS and PROMs can and should be utilised for non-invasive diagnosis of endometriosis, enabling to decrease the delay from symptom onset and possibly to decrease the need for diagnostic laparoscopy.