Causes of Delayed Endometriosis Diagnosis: A Systematic Review

Introduction: Endometriosis is a chronic gynecological condition characterized by the presence of endometrial-like tissue outside the uterus and is frequently associated with substantial diagnostic delay. This delay negatively affects patients' quality of life, exacerbates pain severity, increases disease progression, and imposes significant economic and psychosocial burdens. Despite growing research attention, delayed diagnosis remains a persistent global challenge. Understanding the multifactorial contributors to diagnostic delay is therefore essential to inform effective interventions and improve clinical outcomes. Methods: A systematic review was conducted to identify factors associated with delayed diagnosis of endometriosis. Electronic searches were performed in PubMed, ProQuest, and Web of Science for studies published between January 2020 and December 2024. Eligible studies included original research published in English with full-text availability. Study selection followed PRISMA guidelines using Rayyan AI for screening and duplicate removal. Data were extracted independently and synthesized qualitatively, with quantitative meta-analysis performed where homogeneous data were available. Random-effects models were applied, and heterogeneity was assessed using the I² statistic. Results: From 205 records identified, four studies met the inclusion criteria and were included in the qualitative synthesis and quantitative analysis. The findings revealed that diagnostic delay in endometriosis is driven by interrelated patient-related and healthcare provider–related factors. Key contributors included normalization of menstrual pain, stigma surrounding women's health issues, reliance on patient self-advocacy, dismissive attitudes from healthcare providers, limited clinical knowledge and technical competence, and power imbalances within the clinician–patient relationship. These factors collectively contribute to prolonged diagnostic pathways and delayed access to appropriate care. Conclusion: Diagnostic delay in endometriosis is a complex, multifactorial issue requiring systemic, patient-centered, and gender-sensitive approaches to improve early recognition and diagnosis