Penzer, A. J., & Schweikart, S. J. (2025). Using Policy and Law to Help Reduce Endometriosis Diagnostic Delay. AMA journal of ethics. https://doi.org/10.1001/amajethics.2025.104
Penzer AJ, Schweikart SJ. Using Policy and Law to Help Reduce Endometriosis Diagnostic Delay. AMA journal of ethics. 2025. doi:10.1001/amajethics.2025.104
Penzer, Annika J., and Scott J. Schweikart. "Using Policy and Law to Help Reduce Endometriosis Diagnostic Delay." AMA journal of ethics, 2025.
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RRM Academy Synopsis
Authors argue paying for endometriosis screening may shorten delay
A 2025 health law analysis argues that paying hospitals to ask routine endometriosis screening questions may shorten the 7-year wait for diagnosis. The authors review funding, clinical and social causes of delay. They suggest incentives may work better than a legal mandate.
Key Findings
The authors report that people with endometriosis wait on average 7 years after symptoms begin to receive an accurate diagnosis.
US National Institutes of Health endometriosis funding rose from $13 million in 2019 to $16 million in 2022, roughly $1 to $2 per diagnosed patient.
Crohn's disease received $90 million in 2022, or $130.07 per diagnosed patient, which is 65 times more per patient than endometriosis received.
The annual economic burden of endometriosis in the United States is estimated at between $78 billion and $119 billion.
The authors propose that government or insurers reward hospitals for asking all female patients routine screening questions at intake and flagging possible endometriosis in the file.
Interpretation
The article is a health law and policy analysis. The authors draw on published sources and report no new patient data, so the proposals are reasoned arguments. They group the contributors to delay as financial (research funding per patient far below Crohn's disease), clinical (symptoms that resemble other conditions, and a diagnosis that usually requires laparoscopic surgery) and social (women are more likely than men to have pain dismissed as psychological). The authors state that screening questions will not confirm or deny endometriosis. In their view the questions ensure clinicians consider endometriosis among possible diagnoses.
RRM Context
The authors note that scarring and adhesions grow worse over time, so an early diagnosis helps. RRM looks for the cause of pelvic pain and infertility, and any clinician who thinks of endometriosis starts that search sooner.
Our editorial summary of this paper, not the article's abstract.
Abstract
Despite high incidence of endometriosis internationally and domestically, many patients wait a decade after symptom onset for an accurate diagnosis. This article suggests why diagnostic criteria should be clarified and why endometriosis screening should be incentivized among members of the public, clinicians, and health care organizations.
Ethics and Policy › Policy and Regulation › Access and Coverage Policy · General Gynecology › Screening and Prevention › Cervical Cancer Screening · Clinical Guidelines and Standards › Diagnostic Criteria and Classification › Diagnostic Criteria
Annika J Penzer, Scott J Schweikart
A Penzer, S Schweikart
PMID 39899823 39899823 DOI 10.1001/amajethics.2025.104 10.1001/amajethics.2025.104 Penzer et al. 2025, Penzer 2025
