Page 31 - Diagnostic delay of endometriosis

making referral not indicated. The diagnosis endometriosis will therefore not be made immediately in these patients. This is not, by definition, a negative factor. Only when the effect of medication is insufficient, a proper diagnosis and more adequate treatment should be aimed at.
A long patient’s delay is associated with a long doctor’s delay, as is the case in the presence of relatively mild initial symptoms, a younger age at onset of symptoms, and presentation with cyclic symptoms only. Both patients and doctors may be willing to accept these symptoms for a period of time, explaining them as common menstrual pains.
The consideration of alternative diagnoses, including IBS and somatisation, is related to a long diagnostic delay. The fact that women with endometriosis often present with symptoms including abdominal pain, dyspareunia, dyschezia or dysuria may be responsible for the consideration of other diagnoses first. This study shows that when the first-line medical professional recognizes endometriosis-associated symptoms, referral to a gynaecologist and subsequent additional diagnostic testing are implemented quickly and the diagnosis is made within 5 months. Recognition of endometriosis- associated symptoms by the first-line medical professional is thus crucial for early diagnosis. It is important to understand why certain factors lead to the failure of recognition of endometriosis associated symptoms.
After finishing the interview, a majority of patients spontaneously pointed out that the fact that a study had been undertaken concerning the diagnostic delay of endometriosis made them feel understood better and taken more seriously. Moreover, they felt that participating in the study helped them to emotionally deal with the disease. This, and the finding that some patients refused to take part in the study because they found it too hard to talk about their disease, illustrates that the long time until recognition of their symptoms as a disease may be a traumatizing experience and that attention is found helpful by patients.
In conclusion, this study shows that the time interval to the diagnosis of endometriosis is long and consists of a patient’s delay of 7 months, a first- line medical professional’s delay of 35 months and a second-line medical professional’s delay of 5 months. The presence of aspecific symptoms may cause the first-line medical professional to be more susceptible to biases in the diagnostic process leading to diagnostic delay in endometriosis. More
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