Endometriosis in primary medical care

The role of the family doctor in the management of endometriosis is considered in three phases. With the exception of a small minority of cases in which there are superficial endometriotic lesions, it will be difficult for the general practitioner to confirm the diagnosis without referral for laparoscopy or similar gynaecological investigation. In the majority of patients, clinical diagnosis based on symptomatology and physical findings on pelvic examination is not reliable enough to be a sound basis on which to initiate medical therapy. However, the early referral of patients with a suspicious history allows prompter confirmation of endometriosis, if present, and the establishment of a treatment regime, if required. Where medical therapy is instigated, this is usually by the gynaecological team, but, for the convenience of the patient, her surveillance during treatment is conducted jointly with the referring doctor. Compliance with and continuation of therapy will largely depend on the knowledge and skill of the general practitioner in assessing the significance of side-effects of medication. A significant proportion of endometriosis sufferers experience recurrence of their symptoms, and it may be possible for the general practitioner to initiate re-treatment, with the same or alternative medication, prior to a re-evaluation by the gynaecological team.