Simple test could transform time to endometriosis diagnosis

A simple 5-minute test addressing major endometriosis diagnostic delays and treatment, has been developed by University of Queensland researchers.

The Simplified Adolescent Factors for Endometriosis (SAFE) score uses a questionnaire to identify at-risk patients and fast track specialist referrals for further investigation.

Professor Gita Mishra AO, Centre Director of UQ’s Australian Women and Girls’ Health Research Centre, said the test could prevent years of waiting for a diagnosis.

“The test uses 6 questions to detect girls or young women at risk of endometriosis and in need of further assessment,” Professor Mishra said.

“Identifying which patients should be referred and treated is challenging and improving how patients are diagnosed is a major priority.

“By detecting endometriosis earlier – ideally in adolescents as soon as they begin their periods – we hope the tool will reduce the average 6-8-year diagnostic delay so we can start treatment as early as possible.’’

Endometriosis is an often-crippling condition where tissue, similar to the inner lining of the uterus, grows outside of it.

The condition has no cure and affects up to 11 per cent of Australian women of reproductive age.

Using the questionnaire, young women are asked if they experience pelvic pain often, if they’ve sought treatment for pelvic pain, taken painkillers for pelvic pain, experienced heavy menstrual bleeding or painful periods, and have a family history of endometriosis.

The SAFE score works on a point‑based system and would help guide referrals in primary care.

The more risk factors identified, the higher a woman’s score and the greater likelihood of the condition.

The tool was designed using data from more than 9000 women from the Australian Longitudinal Study on Women’s Health, with researchers identifying risk factors for endometriosis.

“This simple tool can be used in women of any age, but we have carefully chosen age-appropriate questions to target adolescents,” Professor Mishra said.

“Long delays in diagnosis can be due to unclear symptoms, lack of awareness, misdiagnosis, and normalisation of menstrual pain which impacts quality of life.

“The condition often involves surgery to confirm diagnosis, although experts are working to change this so the condition can be picked up through ultrasound or MRI.

“We need to be able to detect endometriosis early because our research found most women were diagnosed in their late twenties, often when they are trying to fall pregnant.

“Early diagnosis is critical because it can change treatment of fertility issues later on.

“The usual treatment route is ovulation induction, but this is not as effective as IVF for women with endometriosis.’’

Next steps will evaluate the tool in clinical settings, assess its practicality in Brisbane GP, endometriosis and pelvic pain clinics, and explore if an app can be developed.

March is Endometriosis Awareness Month, signified internationally by the colour yellow.

The research is published in eClinicalMedicine.