Page 158 - Diagnostic delay of endometriosis

holy grail for a timely diagnosis of endometriosis, but has some pitfalls as well. As a general practitioner, it is one of my responsibilities to prevent excessive interference with naturally occurring phenomena, unnecessarily turning women into patients. Overdiagnosis, overtreatment and the transformation of everyday complaints into abnormalities can lead to medicalisation. It can create anxiety, stigmatization, increased costs and side effects as a result of unnecessary treatment.18, 19
However, every woman presenting with pelvic pain or symptoms related to the menstrual cycle merits an adequate appraisal and acknowledgement of her concerns. Consideration on the likelihood of an underlying pathological condition like endometriosis should be done with great care in order to prevent disease progression and subfertility. The development of a national multidisciplinary clinical guideline directed at pelvic pain and problematic menstruation, appropriate for general practitioners, will support the timely consideration of endometriosis and promote early referral to a gynaecologist for those who are at increased risk of endometriosis or subfertility. In women with mild symptoms without a desire for pregnancy, one should consider to start empirical therapy before the routine use of extensive diagnostic procedures. Subfertility and symptoms or signs indicating advanced disease require immediate referral. The choice between empirical treatment and advanced diagnostics or referral should ideally be made together with the patient. Incorporating patient preferences successfully into clinical strategies relies on improved knowledge of both women and medical professionals, and may be supported by the use of a decision aid, as advocated by an expert panel as described in this thesis.20, 21 Nevertheless, providing the general population and medical professionals with enough information to raise awareness without unnecessary medicalisation will remain a huge challenge.
If I were a gynaecologist
As a gynaecologist, I want to inform my patients on the chance of having endometriosis, explain the pros and cons of each step in the diagnostic process and offer them the most suitable treatment for their specific symptoms or subfertility. Personalized medicine and shared decision making are key elements of my daily clinical care.21 To be able to provide good quality diagnostics and treatment at a secondary care level, I was trained at medical school and during my specialty training in obstetrics and gynaecology. As a gynaecologist, I stay up to date by attending conferences and post-
156 | Chapter 8