Call to Action
Clinical diagnosis of endometriosis: a call to action

https://doi.org/10.1016/j.ajog.2018.12.039Get rights and content
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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.

Key words

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

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S.K.A. is a consultant for and has received research support from AbbVie. C.C. is consultant for Ipsen, Bayer, AbbVie, and Gedeon Richter. He is an advisor/consultant for AbbVie, Bayer, Ipsen, and Gedeon Richter Preglem. L.C.G. is a consultant for AbbVie, Myovant Sciences, ForEndo Pharma, NextGen Jane, and Merck. M.R.L. is a consultant for AbbVie and NextGen Jane. N.L. is a consultant for and has received research support from AbbVie, Allergan, and the Canadian Institutes for Health Research. S.A.M. is a consultant for AbbVie, Oratel Diagnostics, and Celmatix, and receives research support from the National Institutes of Health and the Marriott Family Foundations. S.S.S. is a consultant for and has received research support from AbbVie, Bayer, and Allergan. H.S.T. is a consultant for AbbVie, Bayer, Obseva, OvaScience, ForEndo, and DotLab.

Support for the development of this manuscript was provided by AbbVie, Inc. AbbVie had the opportunity to review the final manuscript draft, but the manuscript content was solely at the discretion of the authors and reflects the opinions of the authors. The authors received no direct compensation for their efforts.