Endometriosis is defined as the presence of endometrial like tissue outside the uterus which induces a chronic inflammatory reaction.  Symptoms of endometriosis include:

  • Severe dysmenorrhoea
  • Deep dyspareunia
  • Chronic pelvic pain
  • Ovulation pain
  • Cyclical or perimenstrual symptoms such as bowel or bladder with or without abnormal bleeding or pain
  • Infertility
  • Chronic fatigue
  • Pain on defaecation


The predictive value of any one symptom or set of symptoms remains uncertain, as each of these symptoms can have other causes and a significant proportion of affected women are asymptomatic. Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because the presentation is so variable and there is considerable overlap with other conditions such as irritable bowel syndrome and pelvic inflammatory disease. As a result, there is often a delay of up to 12 years between symptom onset and a definitive diagnosis.

Refer to Endometriosis Clinic if

·         confirmed or recurrent endometriosis

·         or if symptoms are highly suspicious of endometriosis such assevere period pain, deep dyspareunia, pain opening bowels during periods


Information to include in referral

  • Indication of parity
  • Contraception
  • Confirm symptoms as above and effect on QOL
  • Relevent past medical / surgical history
  • Current regular medication



Please attach a pelvic uss to your referral letter that has been done within 3 months of referral 



Desirable Information

  • Smear history (including last smear & result)the patient will still be seen without this but if you can retrieve it automatically it speeds up the appointment
  • Treatment so far – consider medical oligo / amenorrhoea (eg Tricycle COCP/ Mirena)


Guidance for local General Practitioners on services at RCHT available here



RCOG Green Top Guideline No 24 Oct 2006The Investigation and Management of Endometriosis