Literature DB >> 17550672

Management of endometriosis in general practice: the pathway to diagnosis.

Zoë Pugsley1, Karen Ballard.   

Abstract

BACKGROUND: The prevalence of endometriosis is estimated to be around 10%. Diagnosis is through visualisation of the lesions, mostly via laparoscopy. Studies reveal that there is an average delay in the diagnosis of endometriosis of between 8 and 12 years. Little is known about the reasons for delays in diagnosis women's experiences of primary care prior to diagnosis. AIM: To investigate women's experiences of endometriosis from first presentation to diagnosis. DESIGN OF STUDY: Retrospective analysis of data collected from primary care records in four general practices.
SETTING: General practice in south-east England.
METHOD: Women with a Read Code diagnosis of endometriosis were recruited to the study. Details of consultations, investigations, and referrals related to endometriosis were recorded from the notes. Data were analysed using descriptive statistics.
RESULTS: The prevalence of endometriosis in women aged over 16 years was 1.44%. A third of women had consulted their GP six or more times before being diagnosed. Ultrasound was frequently requested by GPs, but was helpful in diagnosing endometriosis in only 10.6% of women who underwent a scan. Thirty-nine per cent of women were referred to gynaecologists two or more times before a positive diagnosis was made. The median time from first presentation with symptoms to diagnosis was 9.0 years (interquartile range = 4.5-13.5 years).
CONCLUSION: Repeated consultations and negative investigations contribute to a median delay of 9.0 years before diagnosis of endometriosis. Further research into GPs' interpretation of symptoms and patients' experiences of negative investigations and consultations may lead to a more positive outcome for women with this condition.

Entities:  

Mesh:

Year:  2007        PMID: 17550672      PMCID: PMC2078174     

Source DB:  PubMed          Journal:  Br J Gen Pract        ISSN: 0960-1643            Impact factor:   5.386


  15 in total

Review 1.  Endometriosis: epidemiology and aetiological factors.

Authors:  Paola Viganò; Fabio Parazzini; Edgardo Somigliana; Paolo Vercellini
Journal:  Best Pract Res Clin Obstet Gynaecol       Date:  2004-04       Impact factor: 5.237

2.  The community prevalence of chronic pelvic pain in women and associated illness behaviour.

Authors:  K T Zondervan; P L Yudkin; M P Vessey; C P Jenkinson; M G Dawes; D H Barlow; S H Kennedy
Journal:  Br J Gen Pract       Date:  2001-07       Impact factor: 5.386

Review 3.  Endometriosis.

Authors:  D L Olive; L B Schwartz
Journal:  N Engl J Med       Date:  1993-06-17       Impact factor: 91.245

4.  Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women.

Authors:  M S Arruda; C A Petta; M S Abrão; C L Benetti-Pinto
Journal:  Hum Reprod       Date:  2003-04       Impact factor: 6.918

5.  Patients' consent preferences for research uses of information in electronic medical records: interview and survey data.

Authors:  Donald J Willison; Karim Keshavjee; Kalpana Nair; Charlie Goldsmith; Anne M Holbrook
Journal:  BMJ       Date:  2003-02-15

6.  What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis.

Authors:  Karen Ballard; Karen Lowton; Jeremy Wright
Journal:  Fertil Steril       Date:  2006-11       Impact factor: 7.329

7.  Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates.

Authors:  S D Mathias; M Kuppermann; R F Liberman; R C Lipschutz; J F Steege
Journal:  Obstet Gynecol       Date:  1996-03       Impact factor: 7.661

8.  Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study.

Authors:  Paul Little; Martina Dorward; Greg Warner; Katharine Stephens; Jane Senior; Michael Moore
Journal:  BMJ       Date:  2004-02-13

9.  Diagnostic delay in women with pain and endometriosis.

Authors:  Gunhild Kalleberg Husby; Ragnhild Skipnes Haugen; Mette Haase Moen
Journal:  Acta Obstet Gynecol Scand       Date:  2003-07       Impact factor: 3.636

Review 10.  Is insulin resistance an essential component of PCOS?: The endometriosis syndromes: a clinical classification in the presence of aetiological confusion and therapeutic anarchy.

Authors:  Ray Garry
Journal:  Hum Reprod       Date:  2004-01-29       Impact factor: 6.918

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  13 in total

1.  Pointers to earlier diagnosis of endometriosis: a nested case-control study using primary care electronic health records.

Authors:  Christopher Burton; Lisa Iversen; Sohinee Bhattacharya; Dolapo Ayansina; Lucky Saraswat; Derek Sleeman
Journal:  Br J Gen Pract       Date:  2017-11-06       Impact factor: 5.386

2.  Delay in diagnosis of endometriosis: a case report of catamenial pneumothorax.

Authors:  Marije G Hierink; Felix Poppelaars; Ellen R Klinkert; Hester van der Vaart; J Marinus van der Ploeg
Journal:  Br J Gen Pract       Date:  2019-11-28       Impact factor: 5.386

3.  Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries.

Authors:  Kelechi E Nnoaham; Lone Hummelshoj; Premila Webster; Thomas d'Hooghe; Fiorenzo de Cicco Nardone; Carlo de Cicco Nardone; Crispin Jenkinson; Stephen H Kennedy; Krina T Zondervan
Journal:  Fertil Steril       Date:  2011-06-30       Impact factor: 7.329

4.  MULTI-CENTRE STUDIES OF THE GLOBAL IMPACT OF ENDOMETRIOSIS AND THE PREDICTIVE VALUE OF ASSOCIATED SYMPTOMS.

Authors:  Kelechi E Nnoaham; Sivahami Sivananthan; Lone Hummelshoj; Crispin Jenkinson; Premila Webster; Stephen H Kennedy; Krina T Zondervan
Journal:  J Endometr       Date:  2009

5.  Total laparoscopic hysterectomy with obliterated anterior cul-de-sac.

Authors:  M Sami Walid; Richard L Heaton
Journal:  Ger Med Sci       Date:  2010-02-10

6.  Patients' report on how endometriosis affects health, work, and daily life.

Authors:  Jessica Fourquet; Xin Gao; Diego Zavala; Juan C Orengo; Sonia Abac; Abigail Ruiz; Joaquín Laboy; Idhaliz Flores
Journal:  Fertil Steril       Date:  2010-05-01       Impact factor: 7.329

7.  Barriers and facilitators to the timely diagnosis of endometriosis in primary care in the Netherlands.

Authors:  Moniek van der Zanden; Doreth A M Teunissen; Inger W van der Woord; Didi D M Braat; Willianne L D M Nelen; Annemiek W Nap
Journal:  Fam Pract       Date:  2020-02-19       Impact factor: 2.267

8.  Navigating possible endometriosis in primary care: a qualitative study of GP perspectives.

Authors:  Sharon Dixon; Abigail McNiven; Amelia Talbot; Lisa Hinton
Journal:  Br J Gen Pract       Date:  2021-08-26       Impact factor: 6.302

9.  Burden of Endometriosis: Infertility, Comorbidities, and Healthcare Resource Utilization.

Authors:  Vered H Eisenberg; Dean H Decter; Gabriel Chodick; Varda Shalev; Clara Weil
Journal:  J Clin Med       Date:  2022-02-21       Impact factor: 4.241

10.  Localization of claudin-2 and claudin-3 in eutopic and ectopic endometrium is highly similar.

Authors:  Alena Hoerscher; Fabian Horné; Raimund Dietze; Eniko Berkes; Frank Oehmke; Hans-Rudolf Tinneberg; Ivo Meinhold-Heerlein; Lutz Konrad
Journal:  Arch Gynecol Obstet       Date:  2020-03-05       Impact factor: 2.344

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