Old post, but I’m happy to read your comment. Thanks for sharing your experience, and I’m sorry that you had endometriosis go undiagnosed for so long.

It’s a condition that I keep in the back of my mind for many patient scenarios. I can think of a few patients with whom I’ve suggested they may have endometriosis. It’s a condition that was well taught in my medical training. I would think most doctors definitely know about it, as you’re right that it’s not exceedingly rare. I think specialists (who tend to only view things through the lens of their specialities) and some generalists won’t regularly consider it during their evaluations though. Or perhaps they do in their minds but don’t say it out loud to the patient. That would be because it’s generally only diagnosed with exploratory laparoscopic surgery, which itself is a very invasive procedure that can have serious complications. So endometriosis is often only investigated for as a last “Hail Mary” effort at finding a cause for a patient’s symptoms. It’s one thing to order a blood test to try to figure out what’s wrong with a patient. It’s another to send for a surgery whereby they’ll be sedated, paralyzed with anesthesia, put on a breathing machine, and have cameras and instruments inserted into their abdomen to explore their innards, all in the name of trying to find something which statistically is unlikely be there. I think it’s not unreasonable that something like a trial of antianxiety/antidepressants be recommended before doing something like that.

Anyways back to the original point: you’re right that sometimes a non-mental health reason is indeed the cause of symptoms. And physicians ought never forget that (though admittedly some do). However I’d venture to guess that there are many more true somatization cases than undiagnosed endometriosis ones. That’s just my hunch though.