Understanding diagnostic delay for endometriosis: a scoping review

Abstract Introduction Diagnostic delay for endometriosis is a well-established phenomenon. Despite this, little is known about where in the health care system these delays occur or why they occur. Our review is the first attempt to synthesise and analyse this evidence. Methods A systematic scoping review with a pre-specified protocol was used to incorporate the global mixed methods literature on diagnostic delay for endometriosis. Four databases (PubMed, MEDLINE, EMBASE, PsychINFO) were searched from inception to September 2023 with a search strategy designed specifically for each. Results The search yielded 367 studies, 22 of which met the inclusion criteria. A third of studies has been published since 2020 and 65% were from high income countries. Six were qualitative and 16 were quantitative studies. The average age of onset of endometriosis was 14 years for adolescents and 20 for adults. On average, the diagnostic delay reported for endometriosis across the included studies was 6.6 years (range 1.5 to 11.3 years) but this masked the very wide differences reported between countries such as a 0.5-year delay in Brazil to a 27-year delay in the UK. Discussion Health system barriers included access to private healthcare for those with limited finance, physical access for those using public health systems and a general lack of knowledge amongst patients and health care professionals. Women often reported feeling unheard by health professionals. Considering the impact on individuals and the health system, addressing diagnostic delay for endometriosis must remain a priority for researchers, health care providers and policy makers. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement We thank our employers for supporting this work. JF received support from Harrogate Borough Council, AMJ received support from the University of York and AW received support from York St John University. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.