GPs should suspect endometriosis in women with chronic pelvic pain

CREDIT: This story was first seen in OnMedica

The National Institute for Health and Care Excellence (NICE) has published its first guideline to speed up the diagnosis and treatment of women with endometriosis, reports.

NICE said that on average women wait 7.5 years between first seeing a doctor and getting a confirmed diagnosis of endometriosis, which for many leads to prolonged pain and a progressed condition that is more difficult to treat. It said its guideline aims to reduce diagnostic delays by highlighting to doctors the symptoms of endometriosis – such as pelvic pain, dysmenorrhoea, and subfertility – and to provide clear advice on what action to take when women with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available.

NICE said doctors should suspect endometriosis in women (including young women aged 17 and under) presenting with at least one of:

  • chronic pelvic pain
  • dysmenorrhoea affecting daily activities and quality of life
  • deep pain during or after sexual intercourse
  • period-related or cyclical gastrointestinal symptoms, in particular, painful bowel movements
  • period-related or cyclical urinary symptoms, in particular, blood in the urine or pain passing urine
  • infertility in association with one or more of the above.

The guidance advises doctors to tell women with suspected or confirmed endometriosis that keeping a pain and symptom diary can aid discussions, and offer an abdominal and pelvic examination to women with suspected endometriosis to identify abdominal masses and pelvic signs – or, if a pelvic examination is not appropriate, offer an abdominal examination to exclude abdominal masses. If women have severe, persistent or recurrent symptoms of endometriosis, or have pelvic signs of endometriosis , or if initial management is not effective, not tolerated or is contraindicated, GPs should consider referring them to a gynaecology service for an ultrasound or gynaecology opinion.

NICE also recommends that a managed clinical network should be set up for women with suspected or confirmed endometriosis, consisting of community services (including GPs, practice nurses, school nurses and sexual health services), gynaecology services and specialist endometriosis services (endometriosis centres). It advises that these services should:

  • provide coordinated care for women with suspected or confirmed endometriosis; and
  • have processes in place for prompt diagnosis and treatment of endometriosis, because delays can affect quality of life and result in disease progression.
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President of the Royal College of Obstetricians and Gynaecologists, Professor Lesley Regan, said that although endometriosis is very common, affecting between two and ten of every 100 women, because they experience considerably varied symptoms it is very difficult to diagnose and can be confused with fibroids, irritable bowel syndrome, pelvic inflammatory disease or other conditions with similar symptoms. She commented: “Unfortunately, there is no simple, non-invasive test for endometriosis and the exact cause of the condition is unknown. While there is no cure, there are many treatment options available to help ease the symptoms.

“As investigations can be lengthy, it takes many women up to 7.5 years to receive a confirmed diagnosis of endometriosis, and the RCOG welcomes measures to speed up this process. The condition can be very difficult to deal with, both physically and emotionally, and delayed diagnosis can lead to unnecessary pain and suffering.”

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