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Endometriosis missed repeatedly

Women with endometriosis are enduring nine years of delay before being diagnosed with their illness, a study has found.

Researchers at the University of Surrey found a third of women with the condition consulted their GP six or more times before being picked up, with 39% referred to gynaecologists at least twice. GPs were urged not to assume that ultrasound alone could rule out the condition.Primary care experts said endometriosis was difficult to diagnose but admitted women were often 'just dismissed' when they consulted their GP. Study author Dr Karen Ballard, senior lecturer at the University of Surrey postgraduate medical school, said: 'Women are often told that it's period pain and they have to put up with it. But GPs should be thinking that if a woman is coming back time and time again there might be something else wrong with them.'The retrospective analysis of 118 primary care records found GPs frequently referred women for ultrasound but that the procedure only identified 10% of cases. The prevalence of endometriosis in women over the age of 16 was 1.44%, with a small proportion also having at least one negative laparoscopy before diagnosis, the study found.The average wait from first presentation with symptoms to diagnosis was nine years.Dr Ballard said GPs could wrongly interpret a negative ultrasound result as meaning a patient did not have endometriosis. Following a negative result, patients should be prescribed the contraceptive pill and if that alleviated symptoms there was a 'high suggestion' they did have the condition (see box right).GPs should also take a detailed history from women, including whether they suffered pain at other times during their menstrual cycle or during sexual intercourse, she advised.Dr Martyn Walling, a GP in Boston, Lincolnshire, and member of the Primary Care Gynaecology Group, said: 'It is a miserable condition and the women can be dismissed and then keep coming back. A lot of gynaecology is not done that well in general practice.'Dr Walling said the study highlighted the need for more gynaecology specialists in primary care, and practice-based commissioning could be 'well placed' to deliver this.The study was published in this month's British Journal of General Practice.

• For guidelines,

Diagnosis tips

• Take a detailed history including when the pain started, when it occurs during the menstrual cycle and whether sexual intercourse is painful• Be aware symptoms other than sub-fertility could indicate endometriosis, including pelvic pain and dysmenorrhoea• Refer for ultrasound, but remember this only identifies 10% of cases• Prescribe hormonal treatment: alleviation of symptoms a strong indication of endometriosis• Refer for laparoscopy, but be aware of false negative results

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