symptoms (via birth control pills or other hormonal
contraceptives). Women in this study reported referral
delays from primary to secondary care ranging from 1
month to 22 years (median, 36 months). The length of
time from referral to secondary care to diagnosis was 0
to 84 months (median, 9 months). In a retrospective
study, Pugsley and Ballard looked at the most common
symptoms reported by 101 women with a definitive
endometriosis diagnosis, most of whom had required
multiple provider visits before diagnosis. The women
most likely to be referred to specialists and to receive
shorter delays in diagnosis were those presenting with
infertility (85% of 20 women) and dyspareunia (72% of
29 women). This is consistent with the findings of
Arruda et al., who found greater delay for patients presenting
with pelvic pain than those reporting infertility
or dyspareunia. Another reason identified by Ballard et
al.20 is nondiscriminatory delay (the use of diagnostic
tools that are not reliable for endometriosis).