Page 53 - Diagnostic delay of endometriosis

Introduction
Endometriosis is defined as the presence of functioning endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction.1 It is a progressive condition affecting women in their reproductive life span. Endometriosis is the most common benign gynaecological disorder, with a reported prevalence of 2–10%, although it is difficult to estimate because laparoscopic visualization, histology, magnetic resonance imaging, or both, are required for definite diagnosis.2,3 In addition, many women experience only mild symptoms or respond well to treatment and do not receive a full diagnostic work-up.
As endometriosis is a progressive disease, which in many patients deteriorates over time, timely diagnosis and treatment are of major importance. The clinical presentation can be highly variable. Classic symptoms of endometriosis include dysmenorrhea, cyclic pelvic pain and dyspareunia. A wide variety of symptoms, however, may be presented, with many of them highly prevalent among young women, non-specific and overlapping with other conditions. This leads to difficulties in identifying those at risk for endometriosis, resulting in many women receiving either delayed or suboptimal care.4,5 A diagnostic delay of up to 10.7 years has been reported, and reflects both a delay in the patient attending primary care and a delay by the GP in reaching a diagnosis.6-9
General practitioners (GPs) and other first-line medical professionals play a pivotal role in identifying patients at an early stage of the disease. To be able to interpret the often cyclic and sometimes aspecific symptoms presented by these women correctly, awareness and knowledge of endometriosis is of major importance. The aim of this study was to explore the level of knowledge of endometriosis among GPs in the Netherlands and to evaluate their diagnostic and treatment strategies. The information gathered in this study will be used to formulate strategies to increase awareness of endometriosis among first- line medical professionals and to develop skills to reduce diagnostic delay.
Materials and methods
Questionnaire
A 51-item questionnaire was developed by AN in cooperation with local GPs, and was tested in a pilot study among 10 GPs (Appendix). Ten questions
Knowledge of, and treament strategies for endometriosis | 51