“A very bad period or pelvic pain is not necessarily normal”


The first national clinical guidelines for endometriosis aim to help clinicians diagnose and treat the disease earlier.

More than 830,000 women and girls in Australia are affected by endometriosis.

One in nine women and girls in Australia are affected by endometriosis, a chronic – and often debilitating – inflammatory disease.

Yet, although it is relatively common, the diagnosis can take between seven and 12 years old.

But there is new hope with the release of the Australian debut clinical practice guidelines for the diagnosis and management of endometriosis.

Commissioned by the federal government as part of the National Endometriosis Action Plan, the guidelines are based on the latest scientific evidence.

Moderated by the Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), the work was developed by the Multidisciplinary Expert Working Group on Endometriosis (EEWG), chaired by Professor RANZCOG Jason Abbott and comprising the general professor Danielle Mazza.

“Endometriosis consumer groups have rightly pointed out that there is an unacceptable delay between women seeking care for their symptoms and initiating diagnosis and management,” said Prof Mazza. gp news.

“They really wanted this to be fixed, and for there to be better education for women and girls as well, those really bad periods or pelvic pain isn’t necessarily normal and doesn’t need to be endured. “

Endometriosis involves cells similar to those lining the endometrium that develop in other parts of the body, such as the pelvis and, in some cases, other tissues and organs, causing a range of symptoms ranging from pelvic pain with infertility.

The condition explained 34,200 hospitalizations in Australia in 2016-17, with 95% of presentations involving at least one procedure.

While general practitioners are often the first port of call for patients, Professor Mazza “would hesitate to say” that women with symptoms of endometriosis are turned away. Rather, she believes that the delay in diagnosis may at least in part be the result of treating symptoms without a diagnosis.

“I think the problem for general medicine is [that endometriosis] is a multi-faceted problem because first of all, there may be a delay in women and girls… to come forward, showing symptoms, ”said Prof Mazza.

“And often GPs can offer care, like girls starting contraception for period-related difficulties, and many of the contraceptive products we use can also be used to treat endometriosis.

“So the symptoms may go away or be treated without a diagnosis ever necessarily being made, and that’s not a problem – if women are asymptomatic because they are using hormones, then that’s okay?” is a good thing.

“But it’s when they give up these hormones and want to get pregnant that their endometriosis can come back, or there can be scars from previous endometriosis.”

Prof Mazza says the guidelines are a step in the right direction and can help GPs become more aware of symptoms to look for, including:

  • persistent pelvic pain
  • dysmenorrhea affecting daily activities and quality of life
  • deep pain during or after sex
  • menstrual or cyclical gastrointestinal symptoms
  • menstrual or cyclical urinary symptoms
  • infertility in association with one or more of the above.

“One of the very simple things, first of all, is how to handle period pain and how to handle heavy bleeding in women,” Professor Mazza said. “We have the tools in general practice to do it and the recommendations of the directives on this subject, there are no new breakthroughs in this area.

“The simple measures we have are the non-steroidal anti-inflammatory drugs for pain and hormonal treatments that we are all very familiar with in general medicine, namely the pill, Mirena, IUD, Depo [Provera], Implanon – all those hormonal products that can help treat endometriosis. ‘

If a GP suspects that a patient has endometriosis, Prof Mazza suggests asking her to keep a symptom diary, as well as offering abdominal and pelvic exams and information about the disease.

However, she says it’s important to be aware that a normal abdominal or pelvic exam, ultrasound, CT scan or MRI “does not rule out the possibility of endometriosis.”

“So continue to encourage the woman to come back if her symptoms are not resolved, then an appropriate referral can take place,” Prof Mazza said.

It was recently revealed in the latest ABC article Australia talks about national health survey that 36% of women, compared to just 16% of men, believe their health problems were ruled out by a general practitioner, including problems such as unexplained pelvic pain.

To better understand women’s experiences with endometriosis in particular, Prof Mazza says further investment in research is needed.

“There has to be, as with everything, an improvement in the evidence base of general medicine and the recommendations that are provided,” she said.

“But most of the research has focused on how to treat endometriosis in hospital or specialist settings. So we don’t really have a clear picture of how many women come into general practice, what is currently offered to them as frontline management, whether they are investigated and how they are investigated – or where referrals occur.

“Personally, I would like to see if the MRFF [Medical Research Future Fund] would like to do another round of funding on endometriosis, there should be an emphasis on primary care aspects because that is where women come in first.

In addition to addressing the detection, diagnosis and treatment of endometriosis, the new clinical practice guideline also includes adenomyosis, a related condition where cells similar to the lining of the uterus are present in the muscle wall. .

To facilitate the implementation of the directive, the RANZCOG confirmed that other tools specific to general practitioners will be developed.

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