Referral Pathways

We know first-hand, it may not always be straightforward in knowing where to turn to for help, which is why we have provided a step-by step guide detailing when and how to seek medical advice to help you along your endometriosis journey.

Our Chair of Trustees and Endometriosis specialist, Mr Alfred Cutner, explains 'Referral pathways'.

Watch and wait - Doing nothing if your symptoms are mild and if you’re actively trying to conceive or nearing the menopause.

Pain management - This can vary from heat application to making changes to your diet, holistic therapies, pain medications and modifiers, pelvic health physiotherapy, or a referral to a specialist pain clinic.

Hormone treatments - Hormone therapy treatments to limit, help regulate, or temporarily stop your periods.

Surgery - Surgery to remove the Endometriosis, separate organs adhered together by scar tissue and remove cysts in the ovaries - whilst taking care to avoid causing further damage to the ovary and its function.

Your General Practitioner

If you suspect you might have Endometriosis, it is important to first seek advice from your General Practitioner (GP). Your GP is your first port of call, and they will usually advise you to try pain relief medications, such as paracetamol and NSAID such as ibuprofen or mefenamic acid.

Your GP may also recommend trying hormone therapy treatments, such as the combined contraceptive pill, the Mirena intra-uterine System (IUS), the contraceptive injection, or progesterone pills, to limit, help regulate, or temporarily stop your periods.

Secondary care

If hormone treatments have not worked or if your doctor suspects you might have Endometriosis, it is important you are referred into secondary care. This may be a gynaecologist situated at your local hospital with a specialist interest in managing mild – moderate Endometriosis, or they might be located further afield.

Your gynaecologist will usually carry out a physical examination and arrange several tests. Where appropriate, these tests may include blood tests, an ultrasound scan, MRI, and various other imaging scans. For some people, these tests can be a helpful way to look for ovarian cysts and any visible signs of Endometriosis, and to also help rule out other conditions.

Your gynaecologist may also suggest a laparoscopy to look inside your abdomen and assess the severity or remove the Endometriosis.

Secondary care for adolescents (under 18's)

If you are under the age of 18 and it has become clear hormone treatments have not worked for you, or if your doctor suspects you might have Endometriosis, they will usually refer you to see an adolescent gynaecologist with a specialist interest in Endometriosis.

Similar to those over the age of 18, when referred to gynaecology, your medical team may carry out a physical examination along with several tests. Where appropriate, these tests can include blood tests, an ultrasound scan, MRI, and various other imaging scans.

Your gynaecologist may also suggest a laparoscopy to look inside your abdomen to diagnose and remove the Endometriosis.

Tertiary care

If your gynaecologist suspects you may be suffering with later stages (severe) Endometriosis, this may be suggested by assessing your symptoms combined with imaging scans or confirmed by undergoing surgery. Your gynaecologist should refer you to a specialist Endometriosis centre or clinic.

In tertiary care you should have access to the following specialist doctors - all of which have a specialist interest in Endometriosis:

An Endometriosis nurse
A Gynaecologist
A Urologist
A Colorectal surgeon
A pain management team
Advanced tests and imaging equipment
Fertility services

It's important to know ...

Endometriosis specialist doctors and adolescent gynaecology care services are limited. Some services or centres may not always be local. This should not prevent you from accessing this care.