Friday 11 April 2008
Diagnosing endometriosis
Issue 07: 7 Apr 2008
Source: Fertility and Sterility 2008;in press
New study findings suggest that women and girls with symptoms of endometriosis who see a gynecologist first tend to have a shorter and better experience before being diagnosed, compared with those who see a generalist or other specialist first.
Researchers from the National Institutes of Health, in Bethesda, USA, and from centers in Washington and Milwaukee, USA, conducted a study to determine whether the first physician seen and whether or not symptoms began in adolescence have an effect on the diagnostic experience of endometriosis (in terms of time to diagnosis, number of physicians seen, and overall satisfaction).
They analyzed self-reported survey data gathered from the responses to a 10-page questionnaire developed by the Endometriosis Association and sent to about 10,000 of the group’s members in North America. A total of 4,745 members returned the survey; the current analysis was restricted to the 4,334 members (mean age 36.2 years) who reported a surgically confirmed diagnosis of endometriosis and who also answered all relevant questions.
Overall, 50.3 percent of the survey respondents reported first seeing a gynecologist about their symptoms, 45.1 percent saw a generalist first, and 4.6 percent saw another type of physicians first. For the purposes of the study, obstetrician/gynecologists and reproductive endocrinologists were classified as gynecologists.
Almost all of the respondents (98.4 percent) said pelvic pain was one of their lifetime symptoms of endometriosis: 83.8 percent had menstrual pain, 75.7 percent had ovulatory pain, 72.2 percent had non-menstrual pain, and 67.2 percent had all three types. In addition, 58.5 percent of women reported heavy bleeding, and 69.4 percent had infertility.
The overall mean time from onset of symptoms to first seeking medical attention was 4.6 years. The mean time from seeking medical attention to receiving a diagnosis of endometriosis was 4.7 years.
The researchers found that just over two–thirds of women (67.1 percent) reported that their symptoms began during adolescence. These women were significantly more likely to report first seeing a generalist, compared with women who first developed symptoms as adults. They also waited three times as long after the onset of symptoms before seeking medical attention (mean 6 years, compared with 2 years for women with symptom onset in adulthood).
Women who saw a generalist first took the longest to receive a diagnosis, compared with those who saw a gynecologist or other specialist. Women who saw a gynecologist first tended to see significantly fewer physicians overall, compared with other women. Overall, 41.3 percent of the 4,334 women surveyed saw 1-2 physicians before diagnosis, 35.2 percent saw 3-4 physicians, 18.3 percent saw 5-9 physicians, and 5.2 percent saw 10 or more.
In terms of satisfaction with medical care, 59.6 percent of women overall said they were not taken seriously, while 50.9 percent said they found physicians helpful.
Significantly more women who saw a generalist first said they were not taken seriously (65.8 percent), compared with women who saw a gynecologist or other specialist first (54.5 percent and 53.5 percent, respectively). Similarly, women who saw a gynecologist first were significantly more likely to report finding physicians helpful (55.8 percent), compared with women who saw a generalist or other physician (45.4 percent and 50.8 percent, respectively).
However, 63 percent of women said they were told that nothing was wrong by at least one physician at some point while seeking a diagnosis: gynecologists made this remark more frequently than generalists and other specialists (68.9 percent versus 52.9 percent and 13.4 percent respectively).
Writing in the journal Fertility and Sterility, the researchers say the study findings support their initial hypothesis that women and girls who see a gynecologist first for symptoms of endometriosis are more likely to have a shorter time to diagnosis, see fewer physicians, and report a better experience with their physicians during the time before being diagnosed.
But they add that the findings “shed new light on the types of challenges women and girls face while seeking medical care for endometriosis, and potentially identify areas of improvement from the physician’s perspective, as well as from the patient’s.”
source:
http://www.orgyn.com/en//webzine/200...asp?svarqvp2=0
Diagnosing endometriosis 
