GPs to offer ultrasound to all patients with suspected endometriosis, confirms NICE

NICE has issued updated recommendations on endometriosis which it said would speed up diagnosis and provide clearer guidance on referral.

The revision of the 2017 guidelines now states GPs should offer a transvaginal ultrasound to all patients with suspected endometriosis. 

It should be done even if pelvic or abdominal examination is normal, NICE said.

This will help identify ovarian endometriomas and deep endometriosis, including that involving the bowel, bladder or ureter, spot or rule out other pathology which may be causing symptoms and guide management and referral decisions.

But GPs should recognise that endometriosis is still a possibility if the abdominal or pelvic examination and ultrasound scan are normal and referral may still be needed.

Patients with symptoms of endometriosis should be referred to secondary care where initial treatment is not effective, tolerated or is contraindicated and it is having a detrimental impact on their daily lives.

Those with persistent or recurrent symptoms would also be eligible for referral as well as those who have pelvic signs, but deep endometriosis is not suspected.

Young women under the age of 17 should be referred to a paediatric and adolescent gynaecology team or specialist endometriosis centre, NICE said.

GPs should ask about family history of the condition as having a first-degree relative with it increases the likelihood of endometriosis, the committee noted.

It is estimated that around 1.5 million women of reproductive age in the UK have endometriosis.

But recent reports from both the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and Endometriosis UK have highlighted problems with the time it takes to diagnose the condition. 

According to Endometriosis UK, the average length of time to diagnosis is eight to 10 years with delays leading to prolonged suffering, ill health, and risks to fertility.

NICE said the update would provide greater clarity regarding the pathway of care for women with suspected endometriosis.

Professor Jonathan Benger, chief medical officer and interim director of the Centre for Guidelines at NICE, said: ‘This guideline will help healthcare professionals detect endometriosis early, to close the symptom to diagnosis gap and ensure more timely treatment.’

He added: ‘We recognise that capacity in endometriosis clinics remains an issue, and that waiting times to be seen in secondary care can sometimes be lengthy.

‘However, NICE also recognises the serious problems which people with suspected endometriosis face in accessing the care they need and the consequences of delayed diagnosis and treatment. This update aims to help tackle these problems by clarifying what high quality care for women with suspected endometriosis should be.’

Women’s health minister Baroness Merron said: ‘Endometriosis can be debilitating and women with this condition have been failed for far too long.

‘This Government is determined to overhaul women’s healthcare and these changes will help patients receive an accurate and timely diagnosis, benefitting over a million women affected.

‘Our 10-Year Health Plan, backed by a £22.6bn increase in day-to-day health spending, will help cut waiting lists in gynaecology and get women the support they need.’