RACGP endorses RANZCOG living guideline for endometriosis

Despite growing awareness around conditions such as endometriosis and adenomyosis, it still takes up to eight years on average for patients to receive a diagnosis.
 
But the Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ (RANZCOG) Australian Living Evidence Guideline: Endometriosis is being hailed as an important step towards girls and women affected by these conditions receiving the understanding and treatment they need.
 
Recently endorsed by the RACGP, the guideline includes the latest scientific evidence to assist with the detection, diagnosis and management of endometriosis and adenomyosis, including a quick reference guide and flowchart designed specifically to support primary care providers.
 
Professor Danielle Mazza, Head of the Department of General Practice at Monash University, was a member of the guideline development group. She told newsGP the its primary care focus is very much deliberate.
 
‘So much of endometriosis care happens in general practice, particularly around diagnosis and initial management, and for most women that will be enough,’ she said.
 
‘But if women do need gynaecological care, then GPs also have a very big role in managing the condition on an ongoing basis throughout a woman’s life.
 
‘This is particularly around conceptualising it as a chronic disease and also engaging in multidisciplinary team-based care, hopefully with the assistance of chronic disease management planning.’
 
Launched in May, the living guideline replaces the first Australian Clinical Practice Guideline for the Diagnosis and Management of Endometriosis, developed by RANZCOG in 2021.
 
Produced by a team of experts, including input from people with lived experience, Professor Mazza says there are three key messages that emerge from the guideline for GPs, the first being: ‘start treatment early’ by empowering doctors to use the knowledge and tools they have at their disposal.
 
‘One of the things that this guideline challenges is that you don’t need to wait for a diagnosis confirmed by laparoscopy to institute management,’ she said.
 
‘This guideline is encouraging GPs to treat symptoms in women, as they present, because we have very effective tools at our fingertips.
 
‘We’ve got very good guidance and recommendations about exactly what analgesia to use. We are also adept at prescribing hormonal contraceptive products, and these are part of the first line management.’
 
The guideline also encourages the use of ultrasound to help obtain a diagnosis.
 
‘You don’t need to wait for a laparoscopy; the quality of ultrasounds has gone up markedly and remarkably, and they are a useful tool in the diagnosis of endometriosis,’ Professor Mazza said.
 
‘And use multidisciplinary care to manage women where there are a range of symptoms including pelvic pain and mental health burdens arising from the chronicity of the condition.’
 
Given the time it takes on average to receive a diagnosis, many women report feeling dismissed by their doctor. Professor Mazza says this is some she has seen in practise and believes it highlights a need for better education across the board.
 
‘Patients often say they feel dismissed because they were just offered the pill or told to get pregnant – and that’s not necessarily because they’re being dismissed, but rather that they perhaps need better explanations as to why going on the pill or why getting pregnant might actually change the symptom profile that they have,’ she explained.
 
‘So, spend a lot of time in educating what endometriosis is, how it works and how the hormonal contraception works at managing this.’
 
To assist GPs with this, the guideline also includes new patient-facing resources to help patients understand the conditions and navigate their care journey.
 
With the Federal Government’s five-year National Action Plan for Endometriosis nearing an end, the next steps on where investment will be directed have yet to be clarified. But Professor Mazza says one thing is clear.
 
‘It’s very important that the Government continues to focus on endometriosis because it is a very highly prevalent condition with the risk of poor outcomes for women – and the investment has to remain in research in the general practice setting where the majority of early management occurs,’ she said.
 
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