When
to suspect endometriosis

Recommendations
on endometriosis symptoms and signs are summarized below.

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Endometriosis
symptoms and signs

 

 

• Suspect
endometriosis in women (including young women aged ?17 years) presenting with
one or more of:

– Chronic
pelvic pain

– Period
related pain (dysmenorrhea) 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.

– Based on
moderate quality evidence from quantitative studies and the experience and
opinion of the Guideline Committee

• Inform
women with suspected or confirmed endometriosis that keeping a pain and symptom
diary can aid discussions. Based on the

experience
and opinion of the Guideline Committee

• Offer an
abdominal and pelvic examination to women with suspected endometriosis to
identify abdominal masses and pelvic signs,

such as
reduced organ mobility and enlargement, tender nodularity in the posterior
vaginal fornix, and visible vaginal endometriotic

lesions.
Based on moderate quality evidence from quantitative studies and the
experience and opinion of the Guideline Committee

 

Adapted from
Diagnosis and
management of endometriosis: summary of NICE guidance

 

Investigating suspected endometriosis

 

Imaging:
ultrasound scanning

•Consider
transvaginal ultrasound:

–      To investigate suspected endometriosis even
if the pelvic

and
abdominal examination is normal

–       If a transvaginal scan is not appropriate
(for example, in women who have never had sexual intercourse), consider a
transabdominal ultrasound scan of the pelvis.

 

Imaging: magnetic resonance imaging (MRI)

•Do not use pelvic MRI as the primary
investigation to diagnose endometriosis in women with symptoms or signs suggestive
of endometriosis. Based on very low quality evidence from quantitative studies
and the experience and opinion of the GC