Page 77 - Diagnostic delay of endometriosis

related to the menstrual cycle, they find it difficult to differentiate between physiological discomfort and pathological conditions like endometriosis. Moreover, consultations for abdominal complaints pose the difficulty of a wide differential diagnosis, which is mostly pointed to defecation and dietary patterns instead of a possible concurrence of complaints with the menstrual cycle.
“When I got the invitation [for the interview] I thought I hardly ever see endometriosis. But it’s like when you buy a new car; all of a sudden you see a lot of them... Last week I got the results of a woman who had a laparoscopy because of endometriosis. A young adult who suffered from severe abdominal pain for many years. I thought she had a problem with her intestines, referred her to the gastroenterologist...”[FG4, GP2, female]
The quality of the history taking may define the nature and extent of the physical examination. This can lead to omitting a gynaecological examination if symptoms are not addressed correctly. A prior serious case in their practice or recent training appeared to facilitate awareness of endometriosis. Although some of the respondents were familiar with typical signs of endometriosis in basic gynaecological examinations, like the characteristic blue nodules in the posterior fornix, most GPs stated they consider their own knowledge and skills insufficient for diagnosing endometriosis.
“If you are more aware of the condition you can ask more detailed questions, and then you can have a suspicion.”[FG2, GP1, male]
Even when the GPs consider endometriosis, referral for further diagnostics is not always beneficial in their opinion. The GPs felt that definite diagnosis may induce a burden of disease or “stigma” to some women. Especially for young or adolescent women, for whom the GPs considered a gynaecological examination too invasive given the low probability of a pathological condition in their opinion, the willingness to refer to a gynaecologist was low.
“Moderator: For example a young girl, 16 years old, who comes to your office with complaints about her menstruation, would you tell her, you consider endometriosis when you prescribe her the pill? GP3: I wouldn’t even think of it. GP2: No, me neither. I would think it just bothers her more than others. Or she just wants the pill, that’s fine. GP3: Or PMS. Just try taking the pill. I would never say to anyone ‘well you might have endometriosis, try this’. GP2: No way.”[FG4, GP2, female and GP3, male]
Barriers and facilitators to the timely diagnosis of endometriosis | 75