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Am J Obstet Gynecol. 2019 Apr;220(4):354.e1-354.e12. doi: 10.1016/j.ajog.2018.12.039. Epub 2019 Jan 6.

Clinical diagnosis of endometriosis: a call to action.

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Center for Endometriosis Research and Treatment, University of California San Diego, La Jolla, CA.
Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA.
Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School; Division of Gynecology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada.
Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI.
Department of Obstetrics and Gynaecology, University of Ottawa, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT. Electronic address:


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.


chronic pelvic pain; cyclic progressive pain syndrome; diagnosis; endometriosis; infertility; pelvic pain

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