Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Endometriosis - Management
When should I suspect endometriosis?

  • Suspect endometriosis in women who present with:
    • Secondary dysmenorrhoea (which may be severe) — usually before or during menstruation.
    • Deep dyspareunia.
    • Chronic pelvic pain.
    • Ovulation-related pain.
    • Cyclical or peri-menstrual bowel or bladder symptoms, with or without abnormal bleeding or pain.
    • Subfertility.
    • Pain on defecation (especially during menses).
    • Painful Caesarean-section scar.
    • Painful micturition (especially during menses). This is very rare.
  • In adolescents, consider endometriosis if pain is unresponsive to the combined oral contraceptive pill and to nonsteroidal anti-inflammatory drugs.
  • Examination is likely to be normal, as most endometriosis is mild or moderate in severity. However, more extensive endometriosis should be suspected if, on a speculum and bimanual pelvic examination:
    • There is localized pelvic tenderness, a fixed retroverted uterus, tenderness of the uterosacral ligaments, or enlargement of the ovaries (due to cystic lesions).
    • There are palpable nodules on the uterosacral ligaments (like a string of beads) or in the pouch of Douglas. Nodules are more likely to be felt during menstruation but pelvic examination at this time is not acceptable to many women.
    • Lesions are visible in the vagina or on the cervix.
  • Consider referring all women with suspected endometriosis, as laparoscopy is usually required to confirm the diagnosis.

© NHS Institute for Innovation and Improvement