The PCWHF has produced this resource to support you in diagnosing and managing endometriosis in primary care.
- There will be as many women in your surgery with endometriosis as there are with either diabetes, asthma or back pain.
- A 3-month menstrual diary found online or downloaded as an app is a good diagnostic tool (also note cyclical bowel/urinary).
- Appreciate the impact of symptoms on her psychological and social wellbeing.
- Perform abdominal +/- pelvic and speculum examination and sexual health screening as appropriate.
- USS is recommended to exclude endometriomas (warn patient that transvaginal (TV) scan is best) BUT a normal result does not exclude endometriosis.
- Commence simple analgesia or combined oral contraceptive/desogestrel at first visit (choice of treatment dependent on imminent fertility requirements).
- On review, recommend continuous hormonal treatment and signpost to Endometriosis UK for patient support.
- Consider referral to secondary care if symptoms change or continue, or for patient choice.
- Longer term concerns include managing fertility issues and chronic pain management where indicated.
- Following surgical treatment (pelvic clearance) consider use of continuous HRT ortibolone for 12 months before changing to oestrogen only.
Reviewed June 2020.