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Guideline of the month: management of endometriosis

The guideline

Endometriosis can be a chronic condition with a significant psychological, physical, social and sexual impact, and for the first time NICE has released a guideline on diagnosing and managing the disease.

Key points for GPs

  • Women living with endometriosis may have complex needs that require long-term support. Offer treatment according to the woman’s preferences, priorities and symptoms rather than the stage of her disease, as staging systems for endometriosis tend not to be well defined.
  • Don’t exclude endometriosis as a possible diagnosis if pelvic examination, ultrasound or MRI are normal. Refer for further assessment if symptoms persist or clinical suspicion continues.
  • Refer women to a specialist endometriosis centre if they have suspected or confirmed deep endometriosis involving the bladder, ureter or bowel.

Practical issues

  • Where symptoms persist, GPs are advised to refer to secondary care even if initial investigations seem normal. This could mean many more women being referred for investigation.
  • The guideline also recommends women who have deep endometriosis be referred to a specialist endometriosis centre. There are 51 accredited centres in the UK according to the British Society of Gynaecological Endoscopy, and unequal geographic distribution may make referral difficult.

Expert comment

GPSI in women’s health in Bradford and RCGP clinical champion for women’s health Dr Anne Connolly said: ‘The guideline should transform the lives of women living with this complex chronic condition. Women suffer symptoms for an average of seven years before diagnosis and this delay not only causes short-term pain but also increases the likelihood of long-term consequences, such as sub-fertility.

’The guideline should raise awareness of the psychological, social and sexual support that suffers need, and help us give women greater control of their decisions and management.’

The guideline

NICE. NG73: Endometriosis: diagnosis and management. London; NICE: 2017