Why Endometriosis Diagnosis Is Often Delayed by a Decade

In "Why Endometriosis Diagnosis Is Often Delayed by a Decade," the panel unpacks the factors behind a diagnostic delay that can stretch a decade.

Dr. Davitt explains that several factors contribute to the substantial delay, often up to 10 years, between symptom onset and an endometriosis diagnosis. A large part of the problem is variability in presentation. Many patients have the hallmark dysmenorrhea, dyspareunia, and dyschezia, but others present with nausea, headaches, or fatigue, symptoms that don't fit neatly into a classic endometriosis picture and make it harder to focus on the disease as the underlying cause. He adds that a persistent lack of awareness, among both patients and clinicians, compounds the problem, leading to symptoms being raised but not addressed and red flags going unnoticed, usually from a lack of understanding rather than intentional dismissal. The panel builds on this, pointing to differential diagnosis as another obstacle, since not all pelvic pain stems from endometriosis and several other organ systems can contribute. The panel also highlights limited diagnostic tools, noting that without surgery, identifying endometriosis has never been as simple as diagnosing a heart murmur with a stethoscope, which is why the field has spent the last 10 to 15 years working to optimize both clinical and imaging diagnosis. Dr. Davitt describes how even well-trained, well-intentioned providers can order a normal ultrasound or MRI and be left without a clear next step. The panel counters that a basic pelvic ultrasound only evaluates the uterus and ovaries, so endometriosis outside those structures goes undetected unless the ovary is involved. Citing a 2024-2025 Society of Radiology consensus guideline and recent ACOG guidance, the panel describes an augmented transvaginal ultrasound approach that evaluates soft and hard markers and the sliding sign, which can signal a frozen pelvis or deep disease. High-resolution MRI, read by imagers trained in structured reporting, adds further detail on lesion location, size, and number, information the panel says is transforming pre-surgical planning.

The next episode in this series, "ACOG's New Guidance on Diagnosing Endometriosis Without Surgery," features Dr. Davitt reacting to ACOG's updated diagnostic guidance.