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Clinical diagnosis of endometriosis: a call to action

OPEN American journal of obstetrics and gynecology | 10 Jan 2019

SK Agarwal, C Chapron, LC Giudice, MR Laufer, N Leyland, SA Missmer, SS Singh and HS Taylor
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 to 11 years from first symptom onset to surgical diagnosis. We believe 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 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 minimize delays in endometriosis diagnosis and treatment for the benefit of women worldwide.
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