Background/Aims: Endometriosis has a long diagnostic delay that is influenced by varying socio-economic and healthcare factors. In the Dutch situation, these factors are not yet identified. The aim of this study is to determine the length of the diagnostic delay of endometriosis in the Netherlands and to identify which variables affect this delay. Methods: A retrospective study among 139 patients diagnosed with endometriosis in a secondary care hospital with a specialized multidisciplinary endometriosis team. The diagnostic process was evaluated using a questionnaire-guided telephonic interview. Results: The median time interval from the onset of symptoms to diagnosis was 89 months or 7.4 years, divided in 7 months patient delay, 35 months general practitioner (GP) delay and 5 months gynecologist delay. Determinants for a longer diagnostic delay were young age at onset of symptoms, use of oral contraceptives or analgesics prescribed by GP, alternative diagnoses considered by the GP, and cyclic symptoms. Subfertility as presenting symptom resulted in faster diagnosis. Conclusion: This study shows that the time interval to the diagnosis of endometriosis is long and mainly consists of the period of time the woman consults her first line medical professional.

1.
Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E, et al: ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005;20:2698-2704.
2.
Burney RO, Giudice LC: Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98:511-519.
3.
Bulun SE: Endometriosis. N Engl J Med 2009;360:268-279.
4.
Seaman HE, Ballard KD, Wright JT, de Vries CS: Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study - part 2. BJOG 2008;115:1392-1396.
5.
Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ: Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 2004;160:784-796.
6.
Eskenazi B, Warner ML: Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997;24:235-258.
7.
Waller KG, Lindsay P, Curtis P, Shaw RW: The prevalence of endometriosis in women with infertile partners. Eur J Obstet Gynecol Reprod Biol 1993;48:135-139.
8.
Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T: High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 2009;92:68-74.
9.
Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, et al: ESHRE guideline: management of women with endometriosis. Hum Reprod 2014;29:400-412.
10.
Kjerulff KH, Erickson BA, Langenberg PW: Chronic gynecological conditions reported by US women: findings from the national health interview survey, 1984 to 1992. Am J Public Health 1996;86:195-199.
11.
Klein S, D'Hooghe T, Meuleman C, Dirksen C, Dunselman G, Simoens S: What is the societal burden of endometriosis-associated symptoms? A prospective Belgian study. Reprod Biomed Online 2014;28:116-124.
12.
De Graaff AA, D'Hooghe TM, Dunselman GA, Dirksen CD, Hummelshoj L, Simoens S: The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod 2013;28:2677-2685.
13.
Abbott JA, Hawe J, Clayton RD, Garry R: The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod 2003;18:1922-1927.
14.
Lazzeri L, Orlandini C, Vannuccini S, Pinzauti S, Tosti C, Zupi E, Nappi RE, Petraglia F: Endometriosis and perceived stress: impact of surgical and medical treatment. Gynecol Obstet Invest 2015;79:229-233.
15.
Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, Jenkinson C, Kennedy SH, Zondervan KT; World Endometriosis Research Foundation Global Study of Women's Health Consortium: Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011;96:366-373.e8.
16.
Brosens I, Gordts S, Benagiano G: Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod 2013;28:2026-2031.
17.
Dancet EA, Apers S, Kremer JA, Nelen WL, Sermeus W, D'Hooghe TM: The patient-centeredness of endometriosis care and targets for improvement: a systematic review. Gynecol Obstet Invest 2014;78:69-80.
18.
Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R: Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril 2004;82:878-884.
19.
Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, Tammaa A, Salzer H: Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod 2012;27:3412-3416.
20.
Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril 2006;86:1296-1301.
21.
Hadfield R, Mardon H, Barlow D, Kennedy S: Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod 1996;11:878-880.
22.
Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL: Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 2003;18:756-759.
23.
Cox H, Henderson L, Andersen N, Cagliarini G, Ski C: Focus group study of endometriosis: struggle, loss and the medical merry-go-round. Int J Nurs Pract 2003;9:2-9.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.