Diagnosing endometriosis in primary care: clinical update

Jennifer L Johnston, Helen Reid, David Hunter
The British journal of general practice : the journal of the Royal College of General Practitioners · 2015 · vol. 65(631) , pp. 101–102 · doi:10.3399/bjgp15x683665 · PMID:25624305 · W2038454385
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This clinical update highlights the challenges in primary care for diagnosing endometriosis, including symptom diversity, low suspicion, and awareness gaps, leading to significant delays for affected women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This clinical update paper from British Journal of General Practice discusses diagnosing endometriosis in primary care, focusing on symptom recognition, diagnostic delay causes, and practical history, examination, and referral considerations. It highlights that women often experience a 7–10 year diagnostic delay despite frequent healthcare contacts, and notes key presentations such as dysmenorrhoea, dyspareunia, chronic pelvic pain, and cyclical bowel or bladder symptoms, while emphasizing that symptom severity does not reliably map to disease extent. A major limitation is that it is not an original diagnostic study but instead a synthesis of primary-care–relevant guidance and pitfalls, explicitly stating that primary care tests like ultrasound and CA-125 are not reliable and that referral should not be delayed by empirical symptom management. This paper is centrally about endometriosis — it provides a primary-care clinical update on how to recognize, evaluate, and refer for suspected endometriosis.

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Abstract

Prompt diagnosis of endometriosis is a clinical imperative for general practice. Women with endometriosis typically face a diagnostic delay of 7–10 years, despite more frequent GP and accident and emergency attendances than women without the disease.1,2 Endometriosis has a relatively high prevalence (up to 10% of women in the general UK population and up to 50% of infertile women) and causes high morbidity in terms of both pain and infertility.2 Despite this, the condition remains poorly recognised in practice, meaning that patients must often navigate misdiagnosis and suboptimal care. While there have been recent significant advances in the evidence regarding pathogenesis and management, this literature is largely directed towards a secondary care audience. We present key issues below from a primary care perspective. Diversity of presenting symptoms, overlap with benign conditions, and a low index of suspicion in both primary and secondary care all contribute to women with endometriosis falling between the cracks. Other contributors include cultural attitudes normalising painful menstruation, a lack of clinician awareness of updated guidelines on distinguishing normal from pathological, and concern over the invasive nature of laparoscopy.1,2 Paradoxically, while women …

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Disease Management Endometriosis Primary Health Care Diagnosis, Differential Endometriosis Female Humans Primary Health Care

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (5)

Cited by (24)

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