Endometriosis: time to think differently (and together)

General practice holds expertise in complex system and implementation research, and in navigating and holding uncertainty. The experience of improving early cancer diagnostics and pathway development work, and using primary care population evidence speaks to the potential power of this approach.11,12 GPs have experience of managing undifferentiated symptomatic presentations across multiple conditions where diagnosis can be complex. GPs can share their wisdom and learning from this, but need spaces and opportunities where this can happen. Collaborations between those with lived experience and clinicians along the whole pathway are needed to characterise points of opportunity for improvement along complex care journeys. We urgently need evidence and resources developed within and for primary care populations, and education that aligns with the reality of general practice.

1. Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. BMJ 2022; 379: e070750. 2. Endometriosis UK. Years of being “dismissed, ignored and belittled”: Endometriosis UK urges improvement to deteriorating diagnosis times. London: Endometriosis UK, 2024. 3. Department of Health and Social Care (DHSC). Women’s Health Strategy for England. London: DHSC, 2022. 4. Scottish Government. Women’s Health Plan: a plan for 2021–2024. Edinburgh: Scottish Government, 2021. 5. The Health Committee (Denmark). The Health Committee holds a consultation on endometriosis. Christiansborg: Danish Parliament, 2023. 6. Bougie O, Yap MI, Sikora L, et al. Influence of race/ethnicity on prevalence and presentation of endometriosis: a systematic review and meta-analysis. BJOG 2019; 126(9): 1104–1115. 7. Medina-Perucha L, Pistillo A, Raventós B, et al. Endometriosis prevalence and incidence trends in a large population-based study in Catalonia (Spain) from 2009 to 2018. Womens Health (Lond) 2022; 18: 17455057221130566. 8. Dixon S, McNiven A, Talbot A, et al. Navigating possible endometriosis in primary care: a qualitative study of GP perspectives. Br J Gen Pract 2021; DOI: https://doi.org/10.3399/BJGP.2021.0030. 9. Fearn H. ‘Gaslit by doctors’: UK women with endometriosis told it is ‘all in their head’. The Guardian 2024; 21 Jan: https://www.theguardian.com/society/2024/ jan/21/gaslit-by-doctors-uk-women-with-endometriosis-told-it-is-all-in-their- head (accessed 11 Apr 2024). 10. Toye F, MacLellan J, Dixon S, McNiven A. Understanding primary care perspectives on supporting women’s health needs: a qualitative study. Br J Gen Pract 2023; DOI: https://doi.org/10.3399/BJGP.2023.0141. 11. Black GB, Lyratzopoulos G, Vincent CA, et al. Early diagnosis of cancer: systems approach to support clinicians in primary care. BMJ 2023; 380: e071225. 12. Hamilton W. Cancer diagnosis in primary care. Br J Gen Pract 2010; DOI: https:// doi.org/10.3399/bjgp10X483175. Editorials Sharon Dixon, (ORCID: 0000-0002-7469-6093) GP and National Institute for Health and Care Research (NIHR) Doctoral Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Rebecca Mawson, (ORCID: 0000-0001-6377-6197) NIHR Clinical Lecturer in Primary Care, School of Medicine and Population Health, University of Sheffield, Sheffield, UK. Ulrik Bak Kirk, (ORCID: 0000-0003-1683-2189) PhD Fellow; Chief Consultant and FEMaLe (Finding Endometriosis using Machine Learning) Coordinator, Research Unit for General Practice and Department of Public Health, Aarhus University, Aarhus, Denmark. Andrew W Horne, (ORCID: 0000-0002-9656-493X) Professor of Gynaecology and Reproductive Sciences, Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK. Funding This article was funded as part of Sharon Dixon’s NIHR Doctoral research fellowship reference: NIHR301787). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Provenance Commissioned; not externally peer reviewed. Competing interests Andrew Horne’s institution (University of Edinburgh) has received payment for consultancy and grant funding from Roche Diagnostics to assist in the early development of a blood diagnostic biomarker for endometriosis, and further received payment for consultancy fees from Gesynta and Joii. Andrew Horne has received payment for a presentation from Theramex. Ulrik Bak Kirk’s institution (Aarhus University) has received grant funding from the European Union’s Horizon 2020 research and innovation program to coordinate the project Finding Endometriosis using Machine Learning (reference: FEMaLe/101017562). The remaining authors have declared no competing interests. DOI: https://doi.org/10.3399/bjgp24X737085 CORRESPONDENCE Sharon Dixon Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK. Email: [email protected]