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Risks and benefits of early diagnosis (II): At the referral level
Accurateandreliablediagnosing procedures
Increase the quality of care among the most severe patients
Necessitate the definition of referral centers
Increase of time to have appropriate pain treatment Increasing the surgery rate
Innapropriate management of the less severe patients Long- term benefits unclear
Uncertaintity on the QOL
Diagnostic strategy for women with symptoms suggestive of endometriosis: the HAS 2017 proposal
Patient level
Primary care level
GP, Gynecologist, midwife
Not wishing f
Alleviating
DIE
Complaint for chronic pelvic pain symptoms (dysmenorrhea, dyspareunia, non-menstrual pelvic pain)
No
Dysmenorrhea without location indicating pain symptoms
Assessment of pain symptoms (intensity and impact on QOL)
 Look for symptoms suggestive of endometriosis: severe dysmenorrhea (> 7, frequent absenteeism, resistance to level 1 analgesics), infertility
 Look for location indicating pain symptoms of DIE: deep dyspareunia, painful defecation increasing with menses, low urinary tract signs
or pregnancy
ymptoms? No 2nd and
Digital vaginal and speculum examination (if possible) First-line TVUS
Location indicating pain symptoms of DIE, infertility, or visualisation of an endometrioma at TVUS?
wishing for pregnancy, inf ou refusal f
 Look for DIE
ertility, impossibility or or COP
 COP
s
3rd line exams for diagnosing
Yes
Yes
Stop diagnosis procedure Continuation of contraception
Secondary care level
Adaptated from Bourdel et al 2018
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PRECONGRESS COURSE 03 I BARCELONA, SPAIN – 1 JULY 2018 31