ArticleSAGE open medicine2026
Misdiagnosis rate of endometriosis and strategies employed to identify endometriosis by analyzing patient characteristics in low-resource settings.
Article in SAGE open medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
Introduction: Endometriosis is a major gynecologic health issue affecting ~10% of women and girls of reproductive age worldwide. Despite its high prevalence, no curative treatment exists. Early diagnosis and treatment are critical to preventing complications; however, these remain limited in many healthcare settings. Diagnosis is also often delayed due to a lack of non-invasive tests. Physician education can also increase awareness of symptoms and accelerate diagnosis. A shift from surgical to non-surgical diagnostic methods could help reduce diagnostic delays. Aim of study: This study aimed to determine the rate of misdiagnosis and identify specific symptoms that could assist in early detection and management. Methods: This descriptive study was conducted at Prof. Dr. Margono Soekarjo General Hospital, Indonesia, involving all patients referred as suspected endometriosis cases to the fertility endocrinology clinic from 2020 to 2024. All participants underwent surgery, and an endometriosis diagnosis was confirmed by histopathology. Cases were grouped as true or non-endometriosis. Patient characteristics were analyzed to identify predictive features and determine the misdiagnosis rate. Result: Among the patients studied, 46.87% were ultimately diagnosed as non-endometriosis, reflecting a high misdiagnosis rate. Analysis revealed that three clinical features, including dysmenorrhea, early onset of dysmenorrhea, and high menstrual volume, were significantly associated with histologically confirmed endometriosis. Conclusion: Nearly half of suspected endometriosis cases were misdiagnosed, contributing to diagnostic delays and delayed treatment. Certain symptoms, particularly dysmenorrhea, its early onset, and increased menstrual volume, may serve as pathognomonic features. Identifying these signs could facilitate earlier diagnosis, especially in settings with limited access to surgical confirmation.
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