METHODS: A retrospective database study was performed in Maccabi Healthcare Services, the second largest of four health plans in Israel, representing 2 million members nationwide. The study population included women aged 15-55 years with a diagnosis (ICD-9) of endometriosis and controls (without diagnosed endometriosis) matched (1:4) on sex, age and residence area. The point prevalence (31/12/2015) of endometriosis-related symptoms, and healthcare resource utilization were described. Baseline endometriosis-related symptoms were described in a subset of women with newly diagnosed endometriosis in 2011-2015 (compared to controls, where index date corresponded to that of the matched case). Delay in endometriosis diagnosis was estimated since the first symptom.

RESULTS: A total of 6146 women with prevalent endometriosis (mean age ± SD: 40.4 ± 8.0 y) were identified. Compared to controls (N=24572), women with endometriosis were more likely to have a lower BMI, higher socioeconomic status and higher utilization of health services, pain medication and antidepressants. The most prevalent endometriosis-related symptoms were abdominal pain (48.2%), infertility (36.9%) and dysmenorrhea (8.8%). A total of 56.1% of women with newly-diagnosed endometriosis (N=2148; mean age 34.6 ± 8.3 y) had baseline pain-related symptoms. Compared to controls (N=8550), these women were twice as likely to have baseline dysmenorrhea and infertility. The median delay to endometriosis diagnosis was approximately 5 years from presentation of infertility and over 10 years from earliest symptom.

CONCLUSIONS: Endometriosis poses a significant burden with high healthcare resource utilization and an estimated 10 year delay in diagnosis. These results underline the need to promote awareness of endometriosis diagnosis and management among caregivers.