Page 156 - Diagnostic delay of endometriosis

importance to make sure that the information that is given is age appropriate and aligned to the interest and cognition of the addressed age group.
If I were a pubertal or adolescent girl, I would like to be able to discuss my menstruation issues with my mother or other close relatives and friends. I would ideally compare the duration, severity and symptoms of my menstruation with those of peers, and be guided and supported in my decision to seek medical help. When I would visit my general practitioner, I would prefer a doctor who acknowledged the fact that I weighed my symptoms meticulously before planning a consultation, and be heard about the impact on my personal life. As an adult woman, I want my general practitioner to understand that although I am not keen on getting a gynaecologic examination, I do want to know whether something is wrong with me. And even though I may not get a definite diagnosis, I would like to be informed about the suspicion of having endometriosis before starting an empirical therapy and the effect this may have on my future fertility. I need to know when to return to the doctor in case the treatment doesn’t have the desired effect or if I want to get pregnant, and discuss the pros and cons of having the diagnosis confirmed or ruled out by a specialist. On the other hand, I don’t want to be frightened about possibly having a chronic condition which may or may not interfere with my quality of life or family planning. Having heard about endometriosis at school or at home will probably help putting this into perspective.
If I were a general practitioner
As a general practitioner, I want to be able to distinguish physiology from pathology. I see many patients each day, most of whom have minor or self- limiting health issues. Dysmenorrhea is the most prevalent gynaecologic symptom in women of reproductive age, but is not unequivocally related to a pathologic condition like endometriosis.9, 10 Chronic pelvic pain syndromes are as prevalent in primary care as asthma or back pain.11 Women with pelvic pain may have severe symptoms which negatively affect their quality of life, but the differential diagnosis is wide, and a proportion of these women may not have an underlying condition after all. Frequently, associated symptoms like fatigue, abdominal bloating or periodic constipation are presented as well, which may point to other conditions like irritable bowel syndrome, or even somatisation.12 Like most general practitioners, I had some education about endometriosis at medical school, but it appears to me as if I don’t see many women with this condition at my clinic.
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