Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care.
Zondervan KT., Yudkin PL., Vessey MP., Dawes MG., Barlow DH., Kennedy SH.
OBJECTIVES: To describe duration of symptoms and patterns of diagnosis and referral in women with chronic pelvic pain. DESIGN: Retrospective cohort analysis of the MediPlus UK Primary Care Database. SETTING: One hundred and thirty-six general practices in the UK. STUDY GROUP: A cohort of 5051 incident cases of chronic pelvic pain. METHODS: The cohort was followed up from the start of their symptoms in 1992 until the end of the chronic pelvic pain episode or the end of 1995. MAIN OUTCOME MEASURES: Duration of symptoms, frequency of diagnoses and referral rates. RESULTS: A third of women had symptoms persisting for more than two years. Duration of symptoms increased significantly with age (P < 0.001) from a median of 13.7 months in 13-20 year olds to 20.2 months in women over the age of 60. Irritable bowel syndrome and cystitis were the most common diagnoses at all ages. Twenty-eight percent of women never received a diagnosis during three to four years of follow up after first consultation, and 60% of women had no evidence of a specialist referral. Women aged 21-50 and women whose final diagnosis was endometriosis received the largest number of diagnoses and had the highest referral rates. CONCLUSIONS: The numbers and types of diagnosis given to a woman with chronic pelvic pain and the likelihood of specialist referral depend on her age, as well as on the duration of symptoms. Women seen in secondary care for chronic pelvic pain are a highly selected group and are likely to represent only the tip of the iceberg.