Women's health GP

Question 1

Endometriosis NICE guideline 2017 -

what is the key message?

Answer 1

Endometriosis can be difficult to diagnose and is often diagnosed late - up to 4-10 years in some studies.

This results in decreased quality of life and disease progression.

www.nice.org.uk/guidance/ng73

Question 2

What symptoms and signs should make you suspect endometriosis in women (including women <17 years)?

Answer 2

• chronic pelvic pain
• period related pain (dysmenorrhoea) affecting daily activities and quality of life
• deep pain during or after sexual intercourse
• period related or cyclical gastrointestinal symptoms like painful bowel movements
• period related or cyclical painful urinary symptoms like dysuria or haematuria
• infertility in association with one of the above

Question 3

Next steps if endometriosis suspected?

Answer 3

Pain and symptom diary

Abdominal and pelvic examination: abdominal mass, reduced organ mobility and enlargement, tender nodularity posterior vaginal fornix, visible vaginal lesions

Ultrasound, if possible transvaginal: endometrioma or deep endometriosis lesions on bladder, bowel or ureter

Note, however, that a normal examination and Ultrasound do not rule out endometriosis.

Question 4

Initial management of endometriosis?

Answer 4

Analgesia: Paracetamol and/or NSAIDs 3 mo trial

Hormonal treatments: a CHC or progestogen for women with suspected, confirmed or recurrent endometriosis. They have no adverse effect on future fertility.

If trying to conceive: refer.

If treatment not effective, not tolerated or contraindicated: refer.

Question 5

When to refer women with suspected endometriosis?

Answer 5

Severe, persistent or recurrent symptoms of endometriosis

Pelvic signs of endometriosis

Initial management not effective, not tolerated or contraindicated

Also consider referring women <17 who have symptoms or signs of endometriosis