Page 58 - Diagnostic delay of endometriosis

before starting treatment. Moreover, it might also reflect bias as the GPs know the questionnaire was initiated by gynaecologists.
When asked about specific signs and symptoms suggestive of endometriosis, the GPs refer to a broad spectrum of complaints (Figure 2). Most GPs mention cyclic symptoms and dysmenorrhea as the main trigger for their suspicion. These are generally regarded as classic endometriosis symptoms. This indicates that GPs suspect endometriosis mainly based on the correct symptoms. If endometriosis is suspected, adequate actions including pain relief, hormonal treatment or referral to a gynaecologist are undertaken by most GPs.
The finding that, according to GPs, they encounter 2.8 patients with endometriosis in their practice a year indicates that the first diagnostic impression at presentation of symptoms is not aimed at endometriosis. The prevalence of endometriosis is estimated at 2–10%; the exact incidence is unknown. Each of the GPs in the study is expected to encounter between 7.4 and 36.8 women with endometriosis a year based on the average practice population of women aged 15–50 years (23.3% of total population, 2258 patients for fulltime practice) corrected for the average full time equivalent of 0.7.12,13 The results of this study show that many women who present with symptoms of endometriosis are not recognized as such by their GP. This leads to an unnecessary delay in diagnosis and treatment.
The present study has some limitations. First, the GPs who completed the questionnaire represent only a part of the total population of GPs in the region, which may lead to bias. There is a manifest difference in response rate between the GPs at the education meeting and those who were recruited by email. The GPs at the education meeting may have completed the questionnaire as an act of courtesy to the organizers of the meeting. The GPs who completed the questionnaire by email may have had an above average interest in gynaecological pathology. We did not explore characteristics of non-responding GPs; however, the demographics of the responding GPs by means of age, sex and years of working experience show a common pattern. Furthermore, some of the questions relate to GPs’ own perception of information; for example the number of encountered endometriosis patients or the women’s own appreciation of complaints or source of information. This may lead to bias as these issues are difficult to recall.
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