Endometriosis should be suspected in women presenting with symptoms such as chronic pelvic pain, period-related pain affecting daily activities, deep pain during or after sexual intercourse, cyclical gastrointestinal symptoms like painful bowel movements, cyclical urinary symptoms such as blood in the urine or pain passing urine, and infertility associated with these symptoms NICE CKS.
Women with suspected endometriosis should be asked about any family history of the condition, as this increases the likelihood of endometriosis NICE NG73.
Initial management in primary care includes offering a transvaginal ultrasound scan to all women with suspected endometriosis, even if the pelvic or abdominal examination is normal, to identify ovarian endometriomas and deep endometriosis, and to guide referral and management NICE CKS.
If a transvaginal ultrasound is declined or not suitable, consider a transabdominal ultrasound scan of the pelvis NICE CKS.
Management of pain involves a short trial (e.g., 3 months) of paracetamol and/or NSAIDs for first-line treatment, discussing benefits and risks with the woman NICE CKS.
Hormonal treatments, such as combined oral contraceptive pills or progestogens, can be offered to reduce endometriosis-related pain and do not negatively affect fertility NICE CKS.
Women should be advised on non-pharmacological management, noting that evidence does not support Chinese herbal medicines or supplements for treatment NICE CKS.
If initial treatment is ineffective, not tolerated, or contraindicated, or if symptoms significantly impact daily life, referral to a gynaecology service or specialist endometriosis service should be considered for further investigation and management, including possible laparoscopy NICE CKS.