GPs should offer a transvaginal ultrasound to all patients with suspected endometriosis, NICE has said.
The investigation is now recommended even if pelvic or abdominal examination is normal, the draft partial update to 2017 guidance said.
This will help identify endometriomas and deep endometriosis involving the bowel, bladder or ureter, identify or rule out other pathology and guide management options and appropriate referral, the guidelines committee said.
While the recommendation reflects current best practice and so is unlikely to lead to a large increase in transvaginal ultrasound in primary care, earlier scans may reduce the need for further tests after referral for some women, it added.
GPs should also consider family history when considering a possible diagnosis of endometriosis.
Taking into account the fact that a history of the condition in a first-degree relative can increase the likelihood of endometriosis could lead to earlier diagnosis, the draft update published today says.
NICE has also made some changes to the recommended patient pathway to speed up diagnosis including that initial pharmacological treatment, ultrasound and referral can all be done at the same time rather than as a stepwise process.
It means sections on referral and diagnosis have been merged and reordered to ‘make the patient pathway clear’.
The changes have been made to ‘emphasise that initial pharmacological treatment, a non-specialist ultrasound and referral do not need to happen sequentially and can happen in parallel so that the overall pathway of care is more timely,’ the document notes.
‘Earlier diagnosis of endometriosis (particularly endometriomas) is likely to lead to earlier treatment and reduce serious disease and subsequent costs,’ NICE said.
But the possibility of endometriosis should not be excluded if the abdominal or pelvic examination are normal and referral may still be necessary the guidelines reiterated.
Laparoscopy may still be considered in the case of normal ultrasound or MRI results, the recommendations added.
The Government launched its Women’s Health Strategy in 2022 to tackle the ‘gender health gap’ with a survey launched the following year.
Earlier this year it said the priorities for the strategy in 2024 would be better care for menstrual and gynaecological conditions including endometriosis.
This would include producing guidance for healthcare professionals, continuing to improve information and support for women and promoting easier access to contraception, the Government said.
Women’s health hubs will also be expanded further to reduce inequalities in access to care for menstrual problems, contraception, pelvic pain, and menopause under the plans.
READERS' COMMENTS [4]
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My Grandma needs some egg sucking lessons as well. Not that I have ever had a patient diagnosed with endometriosis with US apart perhaps from one or two endometriomas.
I’ve always felt somewhat confused whether I was supposed to just take a symptomatic approach to menstrual symptoms vs when to investigate? Because primary care management of menstrual symptoms seems to me to be the same whatever the diagnosis: Consider tranexamic acid / NSAID / COCP / LARC and refer if none of these are helpful.
Perhaps the new guidelines will bring enlightenment.
Agree with both comments above. We are already doing USS for patients with pelvic pain, severe, dysmenorrhoea, dyspareunia etc. but often these scans don’t show endometriosis. Clearly diagnosis for many patients is delayed but the limiting factor for us is being able to refer for diagnostic investigations – pelvic MRI/laparoscopy, due inability to refer for scans, lack of scanners, radiographers, radiologists, and overwhelmed gynae services.
Gynae patients with unexplained symptoms need a pelvic Ultrasound – shocker.
NICE isn’t exactly re-inventing the wheel here.