Keepin' it regular: Talk to patients about periods and other tips from new clinical review on endometriosis

A new Canadian systematic review provides diagnostic and treatment information on the most prevalent but poorly understood gynecological conditions: endometriosis. The authors of the review note that early diagnosis and treatment of the condition are essential. Although laparoscopy and histological confirmation is the gold standard of diagnosis, most guidelines recommend that family physicians diagnose it based on symptoms, physical examination and imaging. This non-surgical diagnosis means a patient can receive treatment more quickly. “Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” authors Drs. Catherine Allaire, Mohamed Bedaiwy and Paul Young wrote in the review. All three authors are from the departments of obstetrics and gynecology at the University of British Columbia and the B.C Women’s Hospital and Health Centre’s Centre for Pelvic Pain and Endometriosis. “Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” they wrote. The authors suggest family physicians should routinely ask patients about their menstrual cycle and symptoms associated with endometriosis. This is to overcome stigma often associated with discussing gynecological symptoms, and to combat the tendency in society to normalize women’s pain. Read: Report finds taboos in women's health can limit access to knowledge and care The review provides a decision tree for the diagnosis and first-line management of endometriosis. Diagnosis of endometriosis could include the presence of classic symptoms of the condition, including severe dysmenorrhea, chronic pelvic pain and a history of fertility problems. First-line imaging is transvaginal ultrasound and MRI can be used to diagnose deep endometriosis, the review states. There are a number of treatment options for symptomatic endometriosis, including hormonal therapies that surpress ovulation and menstruation and surgical treatment. The authors note that the hormonal treatments supported by clinical guidelines are similar in their efficacy but all have different costs and adverse effect profiles. GnRH agonists and antagonists are considered second-line treatment. Read: Endometriosis: How advocacy, awareness and algorithms could shorten the long wait for diagnosis and treatment The review addresses the complex nature of pain in endometriosis, including the development of other chronic pain conditions that co-exist with it. These include vulvodynia, irritable bowel syndrome, painful bladder syndrome, migraine, back pain, fibromyalgia and chronic fatigue syndrome. “Evidence suggests that early treatment of endometriosis and associated pain may decrease the risk of development of chronic pain, which further supports the importance of early assessment and intervention,” the authors wrote. The review suggests a patient should be referred to a gynecologist if they show signs and symptoms of deep endometriosis or have an endometrioma. Patients who are trying to conceive or those with peritoneal endometriosis who don’t respond to first-line treatment should also see a gynecologist. For patients who receive incomplete relief from treatment and develop chronic pain, primary care physicians can play a central role in coordinating multidisciplinary care, the review, published in the CMAJ, read. Its publication coincides with endometriosis awareness month. A number of landmarks across Canada will be lit up in yellow during March to recognize the condition—a list is featured on the Endometriosis Network Canada website. “Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” the authors wrote. A patient’s experience with endometriosis is published alongside the review in the same CMAJ issue. Read: A new way to diagnose endometriosis quickly

Keepin' it regular: Talk to patients about periods and other tips from new clinical review on endometriosis

Register for free access or login.

Related Topics