{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:23:16Z","timestamp":1790785396449,"version":"4.1.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objective<\/jats:title>\n To evaluate the behavioral and clinical characteristics of endometriosis patients at the largest tertiary healthcare center in Lebanon and to analyze the effect of endometriosis symptoms, age of menarche, sexual activity, and infertility on the age of diagnosis with endometriosis.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n Retrospective cross-sectional study of patients who presented to a tertiary healthcare center over 1 year (2018\u20132019) and were diagnosed with endometriosis (\n N\u2009=\u2009688<\/jats:bold>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A\n symptom severity score (SSS)<\/jats:bold>\n ranging from 0 to 3 was employed to estimate the severity of symptoms, specifically focusing on chronic pelvic pain (CPP), dyspareunia, and neuropathic pain. We performed one-way analysis of variance (\n ANOVA<\/jats:bold>\n ), followed by Post Hoc analysis for multiple comparisons using the Least Significant Difference (\n LSD<\/jats:bold>\n ) method to determine the difference in age at diagnosis between groups presenting with different\n SSS<\/jats:bold>\n values. We then conducted a\n multiple linear regression analysis<\/jats:bold>\n to model the age of diagnosis with endometriosis as a function of severity of symptoms while adjusting for age of menarche, sexual activity, and infertility.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean age of diagnosis was\n 29.67<\/jats:bold>\n years, and the mean duration of follow-up was\n 4.74<\/jats:bold>\n years. The most common symptom was dysmenorrhea (75.7%). One-way analysis of variance (ANOVA) demonstrated a significant difference in the age of diagnosis among patients with different\n SSS<\/jats:bold>\n values (\n p\u2009=\u20090.006<\/jats:bold>\n ). In the multiple linear regression analysis model, the age at diagnosis was earlier for patients with more severe symptoms compared to none, yet significance was present for\n SSS\u2009=\u20091 (p\u2009\u2264\u20090.001)<\/jats:bold>\n and\n SSS\u2009=\u20092 (p\u2009=\u20090.01)<\/jats:bold>\n , not for patients with the most severe presentation having\n SSS\u2009=\u20093 (p\u2009=\u20090.23)<\/jats:bold>\n . This analysis further revealed that infertile patients had an earlier diagnosis of\n 2.72<\/jats:bold>\n years on average compared to fertile patients\n (p\u2009\u2264\u20090.001).<\/jats:bold>\n Furthermore, age of menarche didn\u2019t have a significant effect on the age of diagnosis\n (p\u2009=\u20090.73).<\/jats:bold>\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Our results suggest that the severity of pain symptoms is not always indicative of an earlier diagnosis, which underscores the crucial need to enhance awareness regarding the clinical presentation of this condition in both society and the medical field.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0347136","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:37:31Z","timestamp":1776274651000},"page":"e0347136","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Age of diagnosis with endometriosis and potential predicting factors: A single-center cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4992-6073","authenticated-orcid":true,"given":"Soha","family":"Wahab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6072-2299","authenticated-orcid":true,"given":"Zeina","family":"Chehade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dima","family":"El Oueichak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Luna","family":"Russo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miran A.","family":"Jaffa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"issue":"2","key":"pone.0347136.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/j.fertnstert.2011.05.090","article-title":"Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries","volume":"96","author":"KE Nnoaham","year":"2011","journal-title":"Fertil Steril"},{"issue":"11","key":"pone.0347136.ref002","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1016\/j.cell.2021.04.041","article-title":"Endometriosis: etiology, pathobiology, and therapeutic prospects","volume":"184","author":"PTK Saunders","year":"2021","journal-title":"Cell"},{"issue":"3","key":"pone.0347136.ref003","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.fertnstert.2012.05.035","article-title":"Is early age at menarche a risk factor for endometriosis? 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Green-Top Guideline No. 41","author":"Royal College of Obstetricians and Gynaecologists","year":"2012"},{"issue":"10","key":"pone.0347136.ref011","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1016\/j.pain.2011.06.017","article-title":"A new definition of neuropathic pain","volume":"152","author":"TS Jensen","year":"2011","journal-title":"Pain"},{"issue":"2","key":"pone.0347136.ref012","first-page":"117","article-title":"Delays and pathways for patients with endometriosis in France: a multicenter study","volume":"51","author":"G Aubry","year":"2023","journal-title":"Gynecol Obstet Fertil Senol"},{"issue":"1","key":"pone.0347136.ref013","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.fertnstert.2007.11.020","article-title":"Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis","volume":"91","author":"R Greene","year":"2009","journal-title":"Fertil Steril"},{"issue":"1","key":"pone.0347136.ref014","doi-asserted-by":"crossref","first-page":"16253","DOI":"10.1038\/s41598-020-73389-2","article-title":"Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey","volume":"10","author":"M Armour","year":"2020","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0347136.ref015","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1080\/13625187.2022.2128644","article-title":"\u201cBetter late than never but never late is better\u201d, especially in young women. A multicenter Italian study on diagnostic delay for symptomatic endometriosis","volume":"28","author":"I Pino","year":"2023","journal-title":"Eur J Contracept Reprod Health Care"},{"issue":"3","key":"pone.0347136.ref016","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1097\/AOG.0000000000005255","article-title":"Barriers to a timely diagnosis of endometriosis","volume":"142","author":"S Davenport","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"3","key":"pone.0347136.ref017","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1002\/uog.24892","article-title":"Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research","volume":"60","author":"E Pascoal","year":"2022","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"12","key":"pone.0347136.ref018","article-title":"Endometriosis Imaging Diagnosis Beyond Specialized Centers: A Retrospective Cross-Sectional Study","volume":"17","author":"S Wahab","year":"2025","journal-title":"Cureus"},{"issue":"4","key":"pone.0347136.ref019","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/0020764004050334","article-title":"Coping with infertility among Kuwaiti women: cultural perspectives","volume":"50","author":"A Fido","year":"2004","journal-title":"Int J Soc Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:37:34Z","timestamp":1776274654000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347136"}},"subtitle":[],"editor":[{"given":"Iwaho","family":"Kikuchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0347136","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}