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Endometriosis - Management
When should I refer?
- If there is a palpable abdominal or pelvic mass on examination that is not obviously uterine fibroids, or not of gastrointestinal or urological origin:
- Refer urgently for a scan.
- If the scan is suggestive of cancer or an urgent ultrasound is not available, refer urgently to a gynaecologist.
- If endometriosis is suspected (especially if symptoms are severe or there is difficulty conceiving), consider referral to a gynaecologist to confirm the diagnosis by laparoscopy, and for medical or surgical management.
- If the woman has been successfully treated for endometriosis, but the symptoms have returned, seek advice or refer to gynaecologist for consideration of further hormonal treatment or surgery.
- If there are suspected complications in a woman with known endometriosis (such as rupture of an endometriotic cyst, or symptoms of bowel obstruction), consider urgent admission.
- Seek specialist advice regarding prescribing hormone replacement therapy (HRT) or tibolone:
- As add-back treatment for women receiving gonadotrophin-releasing hormone analogues.
- For women who have menopausal symptoms and are not currently prescribed hormonal treatment for endometriosis.
- For young women who have had a bilateral oophorectomy.
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