Suspect endometriosis in chronic pelvic pain

NICE has released new guidance calling for doctors to suspect endometriosis in women presenting with chronic pelvic pain.

It states that on average women wait 7.5 years between first seeing a doctor and getting a confirmed diagnosis of endometriosis and this leads to prolonged pain and a progressed condition which is more difficult to treat. Endometriosis affects approximately one in 10 women of reproductive age in the UK.

The NICE guideline aims to reduce diagnostic delays and advises doctors to suspect endometriosis in women (including young women aged 17 and under) presenting with one or more of the following symptoms or signs:

• chronic pelvic pain • period-related pain (dysmenorrhoea) affecting daily activities and quality of life
• deep pain during or after sexual intercourse
• period-related or cyclical gastrointestinal symptoms, in particular, painful bowel movements
• period-related or cyclical urinary symptoms, in particular, blood in the urine or pain passing urine
• infertility in association with one or more of the above.

The guideline states that doctors should consider referring women to a gynaecology service for an ultrasound or gynaecology opinion if they have severe, persistent or recurrent symptoms of endometriosis or initial management is not effective, not tolerated or is contraindicated.

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."