title: Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences.
abstract: OBJECTIVE
  What is the length of the diagnostic delay for endometriosis in Austria and Germany, and what are the reasons for the delay?
  
  
  CONCLUSIONS
  The diagnostic delay for endometriosis in Austria and Germany is surprisingly long, due to both medical and psychosocial reasons.
  
  
  BACKGROUND
  Diagnostic delay of endometriosis is a problematic phenomenon which has been evaluated in several European countries and in the USA, but has not been reported for Germany and Austria.
  
  
  METHODS
  A cross-sectional, questionnaire-based multicentre study was conducted in tertiary referral centers in Austria and Germany. From September 2010 to February 2012, 171 patients with histologically confirmed endometriosis were included.
  
  
  METHODS
  Patients with a previous history of surgically proven endometriosis, internal diseases such as rheumatic disorders, pain symptoms of other origin, gynecological malignancy or post-menopausal status were excluded from the analysis. Patients with histologically confirmed endometriosis completed a questionnaire about their psychosocial and clinical characteristics and experiences. Of 173 patients, two did not provide informed consent and were excluded from the study.
  
  
  RESULTS
  The median interval from the first onset of symptoms to diagnosis was 10.4 (SD: 7.9) years, and 74% of patients received at least one false diagnosis. Factors such as misdiagnosis, mothers considering menstruation as a negative event and normalization of dysmenorrhea by patients significantly prolonged the diagnostic delay. No association was found between either superficial and deep infiltrating endometriosis or oral contraceptive use and the prolongation of diagnosis.
  
  
  CONCLUSIONS
  There was a possible selection bias due to inclusion of surgically treated patients only.
  
  
  CONCLUSIONS
  Several factors causing prolongation of diagnosis of endometriosis have been reported to date. The principal factors observed in the present study are false diagnosis and normalization of symptoms. Teaching programs for doctors and public awareness campaigns might reduce diagnostic delay in Central Europe.
  
  
  BACKGROUND
  No competing interests exist.
authors.affiliation: Department of Obstetrics and Gynaecology/Endometriosis and Pelvic Pain Clinic,  Wilhelminen Hospital, Vienna,  Austria.
authors.forename: G
authors.initials: G
authors.lastname: Hudelist
authors.forename: N
authors.initials: N
authors.lastname: Fritzer
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.forename: C
authors.initials: C
authors.lastname: Niehues
authors.forename: P
authors.initials: P
authors.lastname: Oppelt
authors.forename: D
authors.initials: D
authors.lastname: Haas
authors.forename: A
authors.initials: A
authors.lastname: Tammaa
authors.forename: H
authors.initials: H
authors.lastname: Salzer
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001317:Austria / Q000453:epidemiology; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D004412:Dysmenorrhea / Q000209:etiology; D004715:Endometriosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008572:Menarche / Q000523:psychology; D008598:Menstruation / Q000523:psychology; D011795:Surveys and Questionnaires