Impact of a National Public Health Plan on the time frame for moderate and severe endometriosis diagnosis

Objective

to study the time from symptom onset to the diagnosis of moderate and severe endometriosis and to compare this delay before and after the implementation of the French National Endometriosis Public Health Plan.

Design

Monocentric retrospective cohort study.

Exposure

A comparison of diagnostic delays for moderate and severe endometriosis in women before and after the implementation of a National Public Health Plan in February 2022.

Main outcome measures

Diagnostic delay, defined as the time from symptom onset to a final diagnosis of moderate or severe endometriosis confirmed by imaging or surgery.

Results

The median diagnostic delay was 5.0 years (range 1.6–11.2) with no statistically significant difference observed before and after the implementation of the National Endometriosis Public Health Plan: median delay of 5.7 years (range 1.6–11.8) Vs. 4.2 years (range 1.5–11.1) (P = 0.70). The most common presenting symptom was dysmenorrhea (73 %), and 91 women (65 %) experienced primary infertility. Women whose initial symptom was infertility had a significantly shorter diagnostic delay compared to those with pain symptoms: median (IQR) of 1.5 (0.9–3.1) Vs. 6.9 (2.1–12.6) years, P ≤ 0.001. A younger age at symptom onset was associated with a longer diagnostic delay.

Conclusion

Despite increased awareness efforts by Public Health institutions, significant diagnostic delays for moderate and severe endometriosis persist, particularly among younger women. The objective of the National Endometriosis Public Health Plan was to raise awareness among healthcare providers to reduce diagnostic delays; however, further longitudinal studies are needed to confirm its long-term impact.