Clinical diagnosis of endometriosis: a call to action

• Published in: American journal of obstetrics and gynecology Vol. 220; no. 4; pp. 354.e1 - 354.e12
• Main Authors: Agarwal, Sanjay K., Chapron, Charles, Giudice, Linda C., Laufer, Marc R., Leyland, Nicholas, Missmer, Stacey A., Singh, Sukhbir S., Taylor, Hugh S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: Chronic Pain - etiology; Chronic Pain - physiopathology; chronic pelvic pain; cyclic progressive pain syndrome; Delayed Diagnosis; diagnosis; Dysmenorrhea - etiology; Dysmenorrhea - physiopathology; Dyspareunia - etiology; Dyspareunia - physiopathology; endometriosis; Endometriosis - complications; Endometriosis - diagnosis; Endometriosis - physiopathology; Female; Humans; infertility; Infertility, Female - etiology; Infertility, Female - physiopathology; Laparoscopy; pelvic pain; Pelvic Pain - etiology; Pelvic Pain - physiopathology; Sensitivity and Specificity; Time-to-Treatment; Ultrasonography; endometriosis; chronic pelvic pain; diagnosis; pelvic pain; infertility; cyclic progressive pain syndrome
• DOI: 10.1016/j.ajog.2018.12.039
• ISSN: 0002-9378; 1097-6868

Endometriosis can have a profound impact on women’s lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. Inherent challenges include a gold standard based on an invasive surgical procedure (laparoscopy) and diverse symptomatology, contributing to the well-established delay of 4–11 years from first symptom onset to surgical diagnosis. We believe that remedying the diagnostic delay requires increased patient education and timely referral to a women’s healthcare provider and a shift in physician approach to the disorder. Endometriosis should be approached as a chronic, systemic, inflammatory, and heterogeneous disease that presents with symptoms of pelvic pain and/or infertility, rather than focusing primarily on surgical findings and pelvic lesions. Using this approach, symptoms, signs, and clinical findings of endometriosis are anticipated to become the main drivers of clinical diagnosis and earlier intervention. Combining these factors into a practical algorithm is expected to simplify endometriosis diagnosis and make the process accessible to more clinicians and patients, culminating in earlier effective management. The time has come to bridge disparities and to minimize delays in endometriosis diagnosis and treatment for the benefit of women worldwide.