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RAG rating
n/a
Document type
Clinical pathways
Place
South and West Hertfordshire
Output type
Clinical Pathways
Pathway
Chronic Pelvic Pain Endometriosis Pathway

Chronic Pelvic Pain Endometriosis


Pathway Publish Date: October 2024
Pathway Next Review Date: October 2026
 
 Endometriosis is characterized by the growth of endometrium-like tissue outside the uterus.
  • Endometriotic deposits are most commonly distributed in the pelvis; on the ovaries, peritoneum, uterosacral ligaments, and pouch of Douglas. Extra-pelvic deposits, such as in the bowel and pleural cavity, are rare.
  • Endometriosis is associated with menstruation. The hormonal changes in the menstrual cycle induce bleeding, chronic inflammation, and scar tissue formation. 
  • The exact cause of endometriosis is unknown. It is thought that endometriosis develops as a result of a combination of several factors, including retrograde menstruation, personal genetics, metaplasia, and environmental factors. 
  • Endometriosis is one of the most common gynaecological disorders in women of reproductive age. About 1 in 10 women of reproductive age in the UK have endometriosis.
  • Endometriosis can be a chronic disease affecting women throughout their reproductive lives (and sometimes beyond). For most women, symptoms can be controlled with hormonal treatment, however, some women may have complex needs and require long-term support.
  • Endometriosis should be suspected in women presenting with one or more of the following symptoms or signs:
    • Chronic pelvic pain (defined as a minimum of 6 months of cyclical or continuous pain).
    • Period-related pain (dysmenorrhoea) affecting daily activities and quality of life.
    • Deep pain during or after sexual intercourse.
    • Period-related or cyclical gastrointestinal symptoms, in particular painful bowel movements.
    • Period-related or cyclical urinary symptoms, particularly blood in the urine or pain passing urine.
    • Infertility in association with one or more of the above.
  • If endometriosis is suspected, a thorough history and examination should be undertaken to:
    • Identify risk factors (such as early menarche, nulliparity, or family history of endometriosis).
    • Exclude differential diagnoses (such as other gynaecological conditions, irritable bowel syndrome, or pelvic inflammatory disease).
    • Identify complications (such as fertility problems or depression).
  • If endometriosis is suspected, a transvaginal ultrasound scan should be arranged to exclude other pathology, identify endometriomas and deep endometriosis, and to guide referral and management.

For further information please see pathway.  

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