Shortening the Endometriosis Diagnostic Pathway: A Narrative Review and Research Agenda

Endometriosis is often diagnosed several years after the first onset of symptoms; however, the duration of this delay may vary depending on the population studied, the assessment starting point, and the timing of diagnosis. This narrative review, which also utilises a structured evidence mapping methodology, examined interventions aimed at ensuring timely diagnosis across six measurable process domains and distinguished process changes from indirect outcomes. Targeted, iterative searches were conducted in PubMed/MEDLINE, guideline databases and reference lists up to 2 August 2026. The review includes 61 sources published between 1996 and 2026, including 23 empirical reports published between 2015 and 2026 that were mapped. The search was not systematic, the screening was not repeated, and no formal bias assessment was carried out. The identified literature provided limited controlled evidence that interventions effectively reduced diagnostic delays; none of the reviews considered diagnostic accuracy, patient outcomes, service demand, cost or equity measures, or timing. Whilst educational initiatives may increase knowledge in the short term, the effectiveness of symptom assessment tools and emerging diagnostic techniques varies across the selected populations. Imaging methods may improve the detection and characterisation of endometriosis; however, a comparative historical analysis indicates changes in the diagnostic pathway and management approach, without quantifying the time elapsed. Current guidelines do not mandate laparoscopy for every patient before establishing a provisional diagnosis and treatment plan. We propose a framework-combining a structured symptom assessment, differential diagnosis, appropriate imaging, diagnostic tests when clinically justified, a safety net, and post-referral follow-up-whose validity has not yet been established. Pragmatic comparative studies are required to determine whether coordinated diagnostic pathways provide earlier, more appropriate and, ultimately, more beneficial care.