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Suspect endometriosis in women with chronic pelvic pain, advises NICE guidance

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Health professionals should “suspect endometriosis” in women presenting with chronic pelvic pain, according to latest clinical guidance on the condition.

The National Institute for Health and Care Excellence has published its first guideline intended to speed up and improve the diagnosis and treatment of women with endometriosis.

“The condition is difficult to diagnose as symptoms vary and are often unspecific”

Mark Baker

Delayed diagnosis is a significant problem for women with endometriosis, said the institute. It noted that, on average women waited 7.5 years between first seeing a GP and getting a confirmed diagnosis of endometriosis.

For many, it could lead to prolonged pain and a progressed condition, which is more difficult to treat, it warned.

The NICE guideline aims to reduce diagnostic delays by highlighting the symptoms of endometriosis to clinicians, notably pelvic pain, painful periods, and subfertility.

Key messages include that health professionals should be aware that endometriosis can be a long-term condition, and can have a “significant physical, sexual, psychological and social impact”. Women may have complex needs and require long-term support, highlighted the institute.

“The new NICE guidance provides a welcome opportunity to raise the bar in endometriosis care”

Emma Cox

Clinicians should also take the woman’s symptoms, preferences and priorities into consideration when assessing treatment options, said NICE.

In addition, they should not exclude a diagnosis of endometriosis, even if the abdominal or pelvic examination, ultrasound or MRI are normal.

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,” he said. “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,” said Professor Baker.

The independent committee that drew up the guidance for NICE also found that current practice of care for women with endometriosis varied in different parts of the country.

“Helping affected women manage their symptoms is imperative”

Caroline Overton

Dr Caroline Overton, a consultant gynaecologist and chair of the guideline committee, said: “There is no cure for endometriosis, so helping affected women manage their symptoms is imperative.

“This guideline highlights the different programmes of care available to help reduce the burden of this disease on women’s lives,” she said. “As one of the most common gynaecological diseases in the UK, it is vital that endometriosis is more widely recognised now.”

Endometriosis affects around one in 10 women of reproductive age in the UK. It develops when cells normally found in the womb are present elsewhere in the body such as the bladder or bowel.

Emma Cox, chief executive at Endometriosis UK, said: “The new NICE guidance provides a welcome opportunity to raise the bar in endometriosis care by increasing awareness, and setting standards of skills, knowledge and experience for healthcare professionals.”

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