Endometriosis in secondary care

As a hospital gynaecologist I may not be the best person to comment on your article¹ but these are my thoughts. Symptoms that could be due to endometriosis are extremely common in both primary care and the hospital gynaecology clinic. With the exception of women who are currently trying to conceive, it is perfectly reasonable to treat these symptoms hormonally. The earlier Royal College of Obstetricians and Gynaecologists guideline as well as the more recent European guideline you quote, both recommend treating symptoms with either the combined contraceptive pill, an ovulation suppressing progesterone-only pill, or the Mirena^® interauterine system. Women referred to hospital because of the supposed importance of early diagnosis may be disappointed to be offered precisely those treatments if they attend a consultant clinic.