Professional Documents
Culture Documents
April 2013
Introduction
This document is to inform local General Practitioners (GPs) of local services for women
with endometriosis.
Patients with severe endometriosis present with chronic lower abdomino-pelvic pain.
They may have any, or all, of the following:
deep dyspareunia
Symptoms tend to be cycle related initially, but become persistent as scarring and
teathering develops around the active endometriosis. Often patients are on multiple
analgesics and their lives are blighted by pain. They are usually young; 18-40 years,
and may have associated subfertility. Typically patients will have had many hospital
referrals and may have had multiple attempts at treatment, or cycle control. The chronic
nature of the pain and lack of solution often results in low mood and depression. Bowel
symptoms may be attributed to Irritable Bowel Syndrome and referral to a medical
gastroenterologist may further delay reaching the diagnosis.
Mild pelvic pain which is cyclical may be due to mild endometriosis and can be managed
by medical control of the ovarian cycle (COCP) without the need for further investigation.
Similarly painful periods may be due to adenomyosis and be adequately controlled by a
Mirena without need for further investigation. These interventions can be initiated and
managed in Primary care. However persistent and severe symptoms require
investigation and treatment in hospital.
Severe endometriosis, especially in young women who want to conceive, is particularly
challenging for general gynaecologists to treat and is best managed by gynaecologists
who specialise in endometriosis.
National guidance from the Royal College of Obstetricians and Gynaecologists (Green
top guideline GT24 RCOG 2006) has established that severe disease should be treated
by endometriosis specialist teams. It also advises that when endometriosis is identified,
all endometriotic lesions should be removed. This is independent of whether a
hysterectomy and/or oophorectomy is undertaken. Such excisional surgery is best
undertaken by laparoscopic surgery as it provides detailed views of areas hard to access
at open surgery. As a consequence of these requirements, a dedicated endometriosis
service was set up in 2009: the Cornwall Endometriosis Centre.
Governance Information
Document Title
Date Issued:
April 2013
April 2013
March 2016
Contact details:
01872 252730
Suggested Keywords:
Endometriosis
GPs
Target Audience
PCT
CFT
Date revised:
April 2013
Initial Issue
Changes Made by
Dominic Byrne