Page 45 - Diagnostic delay of endometriosis

about their opinion about interventions to reduce the delay, the participants in our study mainly suggested improvements in knowledge and awareness and being taken seriously by medical professionals. They did not mention increasing efforts to expand scientific and medical knowledge, or focus on new diagnostic tests, but stressed the importance of being acknowledged in their symptoms and worries. Although the importance of developing an accurate non-invasive diagnostic test for endometriosis is obvious, in the meanwhile, it may be time to focus more on the clinical and personal aspects of reaching a diagnosis. Several studies suggested a switch from surgical to clinical diagnosis of endometriosis31-33, a strategy that may reduce time between start of symptoms and adequate treatment even in the absence of a definite diagnosis. Focussing more on the person instead of the lesion creates opportunities for general practitioners to be more confident in their own diagnostic skills, and start empiric treatment in a timely matter. Adequate education to provide general practitioners with more knowledge about specific signs, symptoms and clinical findings possibly related to endometriosis and indications for referral is warranted to increase awareness on the condition and ensure specialist care when needed. Implementing this strategy may decrease reluctance in general practitioners for referral because of fear of inappropriate invasive testing as seen in one of our previous studies.34 It is of great importance to make sure that when empiric treatment is started, the presumed diagnosis of endometriosis is communicated with the patient, a standardized therapeutic algorithm is followed in which hormonal therapy is given continuously instead of intermittently, and short term evaluation of the intervention is effectuated. In case of treatment failure or infertility, referral to a gynaecologist for specialist care (including expert medical treatment, advanced imaging, diagnostic or therapeutic laparoscopy and artificial reproductive techniques) is warranted. The development of a guideline, which is suitable for both general practitioners and gynaecologists or other medical specialists who encounter women in their reproductive life span with abdominal complaints, may support the feasibility of such a strategy. In addition, increasing awareness in the general population, in particular adolescent girls and women is of major importance to reduce patients’ delay. Efforts have been made to identify the gaps in knowledge about endometriosis and preferences for information transmission in young women,35 and several countries including the United States and Australia have developed outreach programs to expand knowledge in adolescents.36The Dutch patient interest group on endometriosis recently reported on a possible increase in awareness on endometriosis in women, resulting in a
Strengths and weaknesses in the diagnostic process | 43