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Endometriosis — DRCOG MCQ

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HardGynaecologyEndometriosisDRCOG

A 25-year-old woman has severe dysmenorrhoea, deep dyspareunia and pain opening her bowels during menstruation. Pelvic examination is normal and STI tests are negative. Symptoms have persisted despite NSAIDs. When should this patient be referred?

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Correct answer: E — Refer to gynaecology for suspected endometriosis

The best answer is “Refer to gynaecology for suspected endometriosis”. Cyclical pelvic pain with deep dyspareunia and dyschezia suggests endometriosis even when pelvic examination is normal, and referral is appropriate when symptoms persist. Repeated antibiotics are not appropriate with negative STI tests and cyclical symptoms. The pearl is that a normal examination does not exclude endometriosis. Antenatal decisions combine gestation, maternal stability, fetal risk and whether care can safely remain in the community. Screening, diagnostic testing and urgent assessment are not interchangeable. The UK pathway should be followed with clear safety-netting whenever symptoms may evolve before the next routine appointment.

Reference: NICE NG201: Antenatal care: https://www.nice.org.uk/guidance/ng201/chapter/recommendations