Researchers have discovered a variety of contributing reasons after reviewing qualitative studies over the previous 20 years, including a persisting stigma around periods, society’s normalisation of menstruation discomfort, and a lack of medical knowledge concerning the issue.
Endometriosis, which affects 10 per cent of women globally and 1.5 million women in the UK alone, is caused by endometrial (womb) tissue growing outside the womb. It's extremely painful, exhausting, interferes with daily life and can lead to infertility if untreated.
The researchers found that women in the studies often weren't sure if their pain was unusual or severe enough to seek treatment. When they did, some found that their GP was doubtful or dismissive of their symptoms. GPs in two of the studies themselves admitted that they found it difficult to differentiate problematic pain from ordinary menstrual symptoms.
Dr. Sophie Davenport, who led the research and is now a doctor in the NHS, says, “Society has traditionally normalised period pain, so we need to rethink what constitutes 'non-normal' periods. If symptoms are affecting daily life, where the woman is not going to work or school, or unable to carry on social life, that's a clear sign that medical intervention is needed.”
Dr. Davenport says, "Given the numbers of women affected, we think there should be additional, mandatory training about menstrual conditions during medical school. At present, as little as 4 weeks out of 5 years of medical training may be spent on gynaecology; and during that time, endometriosis may barely be mentioned. Given that 1.5 million women in the UK are affected, we think it's time to prioritise this.”
Even if suspected, the definitive method of diagnosis has been by laparoscopy under general anaesthetic, so some practitioners have been reluctant to order such an invasive procedure. However, recent ESHRE guidelines now recommend a two-step approach in which treatment is started more quickly, based on clinical suspicion and MRI/ultrasound imaging, rather than waiting for laparoscopic findings.
Supervising author Dr. Dan Green, Senior Teaching Fellow at Aston University's College of Health and Life Sciences, adds. “It will be interesting to see if these new ESHRE guidelines affect the existing time to diagnosis and can improve patients' experiences in future.”