Consider endometriosis even after normal test, NICE guidance urges GPs

GPs should not exclude the possibility of endometriosis in women with persistent symptoms even if initial tests and examination come back normal, according to the latest NICE guidance.

NICE has published its first guideline on endometriosis, which aims to speed up diagnosis and treatment of the condition, thought to affect one in 10 women of reproductive age in the UK.

Women wait an average 7.5 years between first seeing a doctor with symptoms and getting a confirmed diagnosis, it said.

The guideline says GPs should suspect endometriosis in women – including young women aged 17 and under – presenting with one or more symptoms such as chronic pelvic pain, period-related pain, infertility and pain during or after sex.

Women with suspected endometriosis should be offered an abdominal and pelvic examination to identify abdominal masses and pelvic signs.

Endometriosis diagnosis

They should be referred for an ultrasound or gynaecology opinion if this uncovers signs of endometriosis, if they have severe or recurrent symptoms of the condition or if initial treatment is ineffective.

It warns that GPs should not exclude the possibility of endometriosis if examination, ultrasound or MRI come back normal, and referral for further assessment should be considered ‘if clinical suspicion remains or symptoms persist’.

Professor Mark Baker, director of the centre for guidelines at NICE, said: ‘Delayed diagnosis is a significant problem for many women with endometriosis leading them to years of unnecessary distress and suffering.

‘The condition is difficult to diagnose as symptoms vary and are often unspecific. However, once it has been diagnosed, there are effective treatments available that can ease women’s symptoms. This guideline will help healthcare professionals detect endometriosis early, to close the symptom to diagnosis gap and to ensure more timely treatment.’

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