GPAtlas🧭 When to suspect
Endometriosis is the growth of endometrial-like tissue outside the uterus, most often on the pelvic peritoneum, ovaries and uterosacral ligaments.
• Ovarian deposits form endometriomas, the "chocolate cyst".
• Endometriosis is a chronic, oestrogen-dependent inflammatory condition.
• It affects roughly 1 in 10 women and people assigned female at birth of reproductive age – around 1.5 million in the UK.
Suspect endometriosis in anyone, including young people aged 17 and under, with one or more of:
• Chronic pelvic pain: pelvic pain for 6 months or longer
• Period-related pain (dysmenorrhoea) affecting daily activities and quality of life
• Deep pain during or after sex (dyspareunia)
• Cyclical or period-related bowel symptoms, especially painful bowel movements (dyschezia)
• Cyclical or period-related urinary symptoms, especially blood in the urine or pain passing urine
• Infertility in association with any of the above
Symptoms may be cyclical at first but can become constant. Fatigue and a significant psychological and social impact are common.
Ask about a first-degree family history of endometriosis, which increases the likelihood.
|
🔑 Key principle – think of it early, believe the symptoms • The defining clinical problem is delayed diagnosis: the average woman waits years – often cited as around 8 years – from first symptom to diagnosis. • In general practice, think of it early, validate the symptoms, and start managing them rather than waiting for a "definitive" test. • A normal examination and a normal ultrasound do not exclude endometriosis. • A working ("suspected") diagnosis is valid, and symptoms should be treated while investigation and referral proceed in parallel. |
| Also consider (differential or coexisting) | Discriminating features |
|---|---|
| Adenomyosis | • Bulky, tender uterus • Heavy and painful periods • Often older or parous • Frequently coexists with endometriosis |
| Pelvic inflammatory disease | • Deep dyspareunia with abnormal discharge, cervical motion tenderness, STI risk factors • May be febrile |
| Irritable bowel syndrome | • Bloating and altered bowel habit related to defaecation • Symptoms not confined to menstruation • Often coexists |
| Bladder pain syndrome or interstitial cystitis | Bladder pain with urinary urgency and frequency but sterile urine (no infection). |
| Ovarian cyst (incl. endometrioma) | • Adnexal mass • Consider acute torsion or rupture if pain is sudden and severe |
| Primary dysmenorrhoea | Pain from menarche, no other features and a normal examination. |
| Pelvic floor or musculoskeletal pain | • Localised, often non-cyclical and positional tenderness • Reproduced on palpation of the pelvic floor |
Source: NICE NG73
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.