At-a-glance (pattern recognition)
- Classic symptoms: cyclical pelvic pain, severe dysmenorrhoea, deep dyspareunia, cyclical bowel/bladder symptoms, and chronic pelvic pain.
- Don’t dismiss “normal” exams: endometriosis may exist despite a normal pelvic exam and/or normal basic tests.
- First-line: analgesia + hormonal treatment can be started empirically where appropriate, alongside clear follow-up and referral criteria.
- Fertility matters: ask early about pregnancy plans and tailor hormonal therapy choices accordingly.
Primary care management (pragmatic)
- Analgesia: NSAIDs (if appropriate) + paracetamol; consider neuropathic pain features if chronic pain dominates.
- Hormonal options: combined hormonal contraception or progestogen-based options can reduce symptoms for many (align with contraindications and preferences).
- Assess impact: function, work absence, mood, sleep, sexual function; consider comorbid IBS-like symptoms but avoid premature closure.
- Safety-net: document review timeframe and escalation triggers (persistent symptoms, red flags, fertility concerns).
When to refer / investigate
- Refer for imaging/specialist assessment: significant symptoms despite empirical treatment, suspected deep endometriosis, ovarian endometrioma concerns, or diagnostic uncertainty affecting function.
- Fertility pathway: earlier referral if subfertility is present or pregnancy is desired and symptoms are significant.
- Red flags: follow relevant pathways for unexplained weight loss, abnormal bleeding, or suspected malignancy (rare but important).
Frequently asked questions
Can I start treatment before a definitive diagnosis?
Yes. Empirical pain and hormonal management is often appropriate while arranging referral or investigations, provided pregnancy is excluded where relevant and there is clear follow-up.
What symptom cluster should make me think “endometriosis” quickly?
Severe dysmenorrhoea with cyclical pelvic pain, dyspareunia, and cyclical bowel/bladder symptoms is a high-yield cluster, especially when persistent and function-limiting.
When should I expedite referral?
Marked functional impairment, persistent symptoms despite first-line therapy, suspected deep disease, or fertility goals that require specialist input.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.