Abstract
BACKGROUND: This study investigates the association between diagnostic delay (DD) and clinical and behavioral variables among Japanese women with endometriosis, and explores an optimal cut-off point distinguishing short and long DD. METHODS: a cross-sectional online survey was conducted among 220 Japanese women aged 18-49 diagnosed with endometriosis. Data on healthcare behaviors, economic expenditures, and disease-specific outcomes were analyzed by stratifying participants based on DD length. Multivariate logistic regression models were applied. RESULTS: the mean age at initial symptom onset was 24.3 years, and at diagnosis, 27.7 years. The median DD was 1.5 years, with significant differences between short and long DD groups (p < 0.001). Longer DD was significantly associated with greater use of over-the-counter (OTC) pain medication (p = 0.008) and a higher proportion of Stage IV endometriosis (p = 0.022). CONCLUSIONS: diagnostic delays longer than 1.5 years may contribute to disease progression and reliance on self-management, potentially postponing medical consultation. Early intervention strategies, including screenings and public awareness, may promote timely healthcare-seeking behavior. Future studies should prioritize clinical assessments and early diagnosis to reduce the burden of advanced disease.