Page 159 - Diagnostic delay of endometriosis

academic education courses concerning endometriosis. A high quality national clinical guideline, including an overview of the most recent literature and recommendations for diagnosis and treatment, will support my clinical strategies in daily practice. Special attention should be paid to perform adequate and complete diagnostic tests. The basic gynaecologic examination should be done with great care since it may point to anatomic areas which need to be evaluated in more detail by ultrasound or other imaging techniques. In my opinion, the trans vaginal ultrasound should ideally be performed by the gynaecologist herself, since this facilitates the correlation of particular symptoms or site specific tenderness to endometriotic lesions. Based on the results of the history and clinical examination, the extent of endometriosis can be assessed with reasonable accuracy.22, 23 At this point, it is important to decide whether medical or fertility treatment is started or expanded, or more elaborate imaging (MRI) or diagnostic laparoscopy is indicated. This decision can be supported by discussing the complexity of the individual case within a regional network, in which both secondary and tertiary care clinics specialized in treating advanced endometriosis in a multidisciplinary team participate. Collaboration between clinics with varying degrees of expertise will promote the timely diagnosis and complete staging of endometriosis and allows for the appropriate treatment with as minimal number of surgeries as possible.24, 25 Especially in young women, it is wise to be cautious with (repeated) surgical interventions for endometrioma as this may have detrimental effects on their ovarian reserve. As a gynaecologist, I expect a rise in the number of referrals from general practitioners and other medical specialists, resulting from recent and future efforts to increase awareness on endometriosis.20, 26 These women should receive appropriate care at the appropriate institution. Women responding well to basic medical treatment can be further managed by their own general practitioner, which should receive a detailed overview of performed diagnostics and therapy, completed with specific advice on further actions in case of symptom recurrence or desire for pregnancy. Women with more advanced disease prompting specialist care should be treated in a center of expertise.
If I were a patient representative
Patient interest groups have traditionally provided a supporting role for patients, but their activities are constantly developing and evolving. Their core task is to supply comprehensive information for instance on paper, websites and social media and arrange for contacts with other patients to
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