How Second Medical Opinions Transform Endometriosis Diagnosis

Jan 23, 2026

Second medical opinions improve diagnostic precision in endometriosis: evidence from 3,000 patients

Key Points

Highlights:

Second medical opinions substantially improve diagnostic accuracy in endometriosis.
More than half of patients receive a revised diagnosis after expert reassessment.
Expert review shortens the diagnostic journey for many patients with persistent symptoms.

Importance:

Delayed diagnosis remains one of the greatest challenges in endometriosis care.
Real-world evidence by this study shows that access to expert second medical opinions can markedly improve diagnostic precision and reduce prolonged uncertainty.

What’s done here:

Researchers analyzed nationwide data from a French digital platform connecting patients with endometriosis experts to provide second medical opinions.
Using structured questionnaires, imaging review, and expert assessment, they evaluated how second opinions influenced diagnostic outcomes in nearly 3,000 patients.

Key results:

A second medical opinion changed the initial diagnosis in 51.1% of patients.
Diagnostic uncertainty decreased from 24.7% to 5.0% after expert review.
For patients ultimately diagnosed with endometriosis, diagnosis was reached at a mean of 3.8 ± 1.5 years after symptom onset.
More than half of all patients received a definitive diagnosis following the second medical opinion.

Strengths and imitations:

Strengths are: a large, nationwide cohort of nearly 3,000 patients; the use of a dedicated expert network with multidisciplinary evaluation; the quantitative assessment of diagnostic change using a defined diagnostic convergence index; demonstration of clinically meaningful reduction in diagnostic uncertainty, a key unmet need in endometriosis care.
Limitations are: The definition of an “endometriosis expert” is not standardized in international literature, potentially affecting reproducibility; the digital, patient-initiated platform may introduce selection bias toward more proactive or digitally literate patients; findings may not be directly generalizable to healthcare systems with different referral pathways or access to expertise; reliance on self-reported prior diagnoses introduces potential reporting bias; and no standardized diagnostic protocol or staging system (e.g., rASRM or ENZIAN) was applied across cases.

From the Editor-in-Chief – EndoNews

"This nationwide study provides rare, large-scale quantitative evidence for something patients and clinicians have long suspected but rarely measured: in endometriosis, the first diagnosis is often not the final one. By showing that expert second medical opinions lead to diagnostic reclassification in more than half of patients and markedly reduce diagnostic uncertainty, the authors highlight a critical vulnerability in current diagnostic pathways rather than a failure of individual clinicians.

The findings should not be interpreted as a call for routine diagnostic escalation, but rather as a reflection of the intrinsic complexity of endometriosis. The disease lacks definitive biomarkers, presents with heterogeneous symptoms, and relies heavily on clinical interpretation of imaging and history—conditions under which diagnostic variability is almost inevitable. In this context, second medical opinions function less as a correction mechanism and more as a structural safeguard, compensating for limitations inherent in single-point clinical assessment.

Importantly, this study also reframes diagnostic delay. The reduction in unresolved cases from nearly one-quarter to 5% suggests that uncertainty itself is a major contributor to prolonged diagnostic journeys. Addressing uncertainty—through expert review, standardized imaging interpretation, and multidisciplinary reasoning—may be as important as accelerating access to care. The results also underline that expertise is not only a matter of availability but of concentration and organization, with measurable impact when applied systematically.

At the same time, the digital, platform-based nature of second opinions raises important questions for future implementation. Who accesses these services, who is left behind, and how second opinions are integrated into existing care pathways will determine whether this model reduces or reinforces healthcare inequities. The study therefore points to a broader challenge: designing diagnostic systems that are both expert-driven and universally accessible.

Ultimately, this work positions second medical opinions not as an exception, but as a potential component of modern endometriosis care in complex or unresolved cases. The next step is not wider use alone, but smarter integration, guided by evidence, equity, and clear clinical thresholds."

Lay Summary

Seeking a second medical opinion from an endometriosis expert can make a meaningful difference for patients whose pain has been unsuccessfully treated or whose diagnosis remains uncertain, according to a new nationwide study from France.

In this study, researchers led by Dr. Sofiane Bendifallah from the American Hospital of Paris analyzed data from a national digital platform that connects patients with expert physicians for second medical opinions. Between January 2020 and March 2024, 3,061 patients requested a second opinion for suspected or confirmed endometriosis through the platform.

Most patients reported severe and long-lasting symptoms: more than 60% experienced chronic pain that interfered with daily life, half had painful periods, and nearly 70% reported stopping sexual intercourse because of pain. These findings highlight the heavy burden of endometriosis on everyday functioning and quality of life.

Among the 2,987 patients with complete medical records, the second medical opinion changed the diagnosis in more than half of cases (51.1%), showing how often endometriosis can be misdiagnosed or overlooked. Importantly, diagnostic uncertainty dropped sharply after expert review: only 5% of cases remained unresolved, compared with almost 25% after the first medical opinion.

For patients who ultimately received an endometriosis diagnosis, the second opinion helped establish the diagnosis at an average of 3.8 years after symptom onset, shorter than delays commonly reported in the literature.

The authors conclude that access to expert second medical opinions can substantially improve diagnostic accuracy and reduce uncertainty, especially for patients who have been living with pain for years without clear answers. They also stress the importance of making expert care more accessible, particularly in underserved regions