Women's health toolkit

This Women’s Health Hub is categorised into sections best representing the needs of women at different stages of their lives.

Top tips for managing endometriosis in primary care

Adapted from Top Tips developed by Primary Care Women's Health Forum.

  1. Endometriosis is common, affecting approximately 10% of women of reproductive age. There are as many women with endometriosis as there are with either diabetes, asthma or back pain. The average time to diagnosis is 7.5 years.
  2. Endometriosis usually causes cyclical problems. Using a 3 month menstrual diary found on line or as an app is a good diagnostic tool. This can also be used to determine the pattern of urinary and bowel symptoms.
  3. Endometriosis affects a woman’s physical, psychological and social health and wellbeing.
  4. NICE recommend that an abdominal +/- pelvic and speculum examination is performed. Sexual health screening should also be considered.
  5. An Ultrasound Scan, preferably transvaginally if acceptable, is recommended to exclude endometriomas or adenomyosis. BUT a normal result does not exclude endometriosis or adenomyosis.
  6. Simple analgesia or combined hormonal contraception or desogestrel should be commenced at the first visit. An understanding of imminent fertility requirements assists treatment choices.
  7. On review the use of continuous hormonal treatment (any hormonal contraception) should be commenced to control symptoms if the diagnosis of endometriosis is likely. Signposting to patient information for support i.e. Endometriosis UK is recommended.
  8. Referral to secondary care should be considered if symptoms change, continue, recur or if there are symptoms of bowel or urinary tract involvement or for patient choice.
  9. Early prevention of ovulatory bleeding will reduce the longer-term complications of endometriosis such as reduced fertility and chronic pelvic pain. These issues require management as appropriate with early referral to fertility services for women with endometriosis if conception is delayed.
  10. For women with endometriosis who have required surgical treatment with pelvic clearance (hysterectomy and BSO) use consider use of continuous HRT or tibolone for 12 months before considering changing to oestrogen only HRT.