Page 96 - Diagnostic delay of endometriosis

Table 2. Familiarity, agreement and adherence to key recommendations
Recommendation
Consider the diagnosis of endometriosis in the presence of gynaecological symptoms such as: dysmenorrhea, non-cyclical pelvic pain, deep dyspareunia, infertility and fatigue in the presence of any of the above
Consider the diagnosis of endometriosis
in women of reproductive age with non- gynaecological cyclical symptoms (dyschezia, dysuria, hematuria rectal bleeding and shoulder pain)
Perform transvaginal sonography to diagnose or to exclude an ovarian endometrioma
Assess ureter, bladder and bowel involvement by additional imaging if there is a suspicion based on history or physical examination of deep endometriosis, in preparation for further management
Counsel women with symptoms presumed
to be due to endometriosis thoroughly, and empirically treat them with adequate analgesia, combined hormonal contraceptives or progestagens
Prescribe hormonal treatment (hormonal contraceptives, progestagens, antiprogestagens or GnRH agonists) as one of the options, as it reduces endometriosis- associated pain
Take patient preferences, side effects, efficacy, costs and availability into consideration
when choosing hormonal treatment for endometriosis-associated pain
Prescribe hormonal add-back therapy to coincide with the start of GnRH agonist therapy, to prevent bone loss and hypoestrogenic symptoms during treatment
Familiar Agrees Adheres with with to
67 66 63 (100%) (99%) (94%)
66 66 61 (99%) (99%) (91%)
66 67 67 (99%) (100%) (100%)
65 64 52 (97%) (96%) (78%)
66 65 59 (99%) (97%) (88%)
66 66 62 (99%) (99%) (93%)
64 64 61 (96%) (96%) (91%)
60 55 45 (90%) (82%) (67%)
table continues
94 | Chapter 6