Factors contributing to delayed diagnosis of endometriosis. A systematic review

Wenwei LiHuiyan FengQingjian Ye^*

• Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Background: Endometriosis is a common gynecological disorder that is estimated to affect about 10% of women of childbearing age globally. However, the condition is still greatly under- or misrecognized, and the mean time to diagnosis is several years. These delays lead to high symptom severity, poor quality of life, and adverse far-off reproductive outcomes. Therefore, the objective of this systematic review and meta-analysis was to estimate the sources of diagnostic delay and their effects.Methods: The articles were retrieved from PubMed, Cochrane, and Google Scholar database after performing a rigorous literature search. The initial search yielded 2,348 records, and 10 articles were included in the final analysis. Causes of diagnostic delay were classified under patient, physician, and systems attributes. Random-effects analysis was used to estimate the overall SMDs with 95% CIs. For the primary post hoc analysis, subgroup analyses and evaluation of heterogeneity (I² statistic) were conducted. Publication bias was checked by Egger's test and funnel plots.Results: Patient-related factors demonstrated a significant pooled effect size (SMD: 1.94, 95% CI: 1.62–2.27, p < 0.001), with delays in seeking medical attention (SMD: 2.14, 95% CI: 1.36–2.92) contributing most prominently. Provider-related factors, including misdiagnosis and reliance on non-specific diagnostics, also had a substantial pooled effect size (SMD: 2.00, 95% CI: 1.72–2.28, p < 0.001), with low heterogeneity (I² = 3%). System-related factors, such as referral pathways and geographic disparities, were not analyzed separately due to insufficient subgroup data. Funnel plot analysis showed no significant publication bias (Egger's test p = 0.57).Conclusions: The results indicate that diagnostic delays in endometriosis are a function of many factors, with key contributions from patient and provider related barriers. To close these gaps, targeted interventions such as public education to combat symptom normalization and stigmatization, more comprehensive provider training, and streamlined diagnostic pathways are needed. Further future research can evaluate system level changes and non invasive diagnostic tools to further reduce systemic delays.