In my mind, I see endometriosis as a bit of a diagnostic quagmire. When somebody who has chronic pelvic pain and dysmenorrhea comes in, there's a workup and you do an ultrasound. Already, as you said, this can be a problem, because it depends on who's doing the ultrasound or the MRI. Even that may not be reliable. However, say you do an ultrasound, MRI or laparoscopy, and they have endometriosis. How do you know that's the cause of the pain? You've told us some people can have quite severe endometriosis and have no pain at all.
Again, I'm admitting my bias from the population I used to see. It seems to me it wasn't that unusual to see a woman with chronic pelvic pain who'd been diagnosed as having endometriosis or an irritable bowel, or they were NYD. They'd seen a gynecologist. They'd had an ablation and nothing changed. You wonder whether it was endometriosis at all.
Were those people under-treated? Is it being over-diagnosed when you have ultrasonic or laparoscopic evidence of endometriosis, but in fact that isn't the cause of pain? Can you talk a bit about diagnostic ability, and the false positives and negatives?