Endometriosis in Primary Care: Barriers and Realities

A qualitative interview study reveals how limited pathways and unmet patient expectations challenge GPs treating suspected endometriosis.

Key Points

Highlights:

• Geeneral Practitioners (GPs) struggle to manage suspected endometriosis due to limited resources and unclear referral pathways.
• High patient expectations and symptom complexity often lead to professional insecurity among GPs. 
• Study highlights system-level barriers in delivering timely endometriosis care.

Importance:

• The need for clearer guidelines, referral structures, and stronger GP–specialist collaboration is emphasized.

What's Done Here?

• This is a qualitative interview study of 13 general practitioners across the Faroe Islands.
• Study explored GP perspectives on clinical challenges, patient communication, and referral decision-making. 
• Thematic analysis identified key barriers and strategies in suspected endometriosis management.

Key Results:

• GPs frequently encounter women with pelvic pain and menstrual symptoms but feel uncertain about endometriosis as a diagnosis.
• Referral algorithms are variable, and some GPs report limited access to gynaecology services.
• High patient expectations and long-standing distress create complex consultations.
• GPs rely on holistic, longitudinal care and symptom-focused management while navigating diagnostic uncertainty.
• Diagnostic workup and onward referral are often influenced by resource limitations and system constraints.

Strength and Limitations:

• Illuminating underexplored primary care challenges in endometriosis, the use if rigorous qualitative methodology capturing real-world GP experiences, and providing actionable insights into communication and referral barriers are the strengths of the study.
• Small sample size and its limited nature to the Faroe Islands, affecting generalizability; findings reflecting self-reported experiences rather than observed practice and the absence of incorporation of patient perspectives or specialist viewpoints are the limitations.

From the Editor-in-Chief – EndoNews

"This qualitative study from the Faroe Islands delivers an important and sobering reminder: the earliest delays in endometriosis care often begin long before a woman meets a gynaecologist. They begin in primary care, where GPs try to make sense of complex symptoms, limited local resources, and high patient distress—often without the tools, protocols, or specialist feedback required to navigate this condition effectively.

The interviews reveal a deep professional tension. GPs genuinely want to help their patients, yet many feel clinically underprepared and structurally unsupported. Their uncertainty is not a weakness; it is a reflection of a system that asks them to manage a chronic, heterogeneous, and often invisible disease without consistent guidance or reliable referral pathways. This mismatch between patient expectations and system capacity creates emotional strain for both sides and contributes to the diagnostic inertia so often seen in endometriosis.

What stands out in this paper is the honesty of the GPs’ reflections: the discomfort of feeling unable to offer definitive answers, the frustration of unclear or inconsistent referral processes, and the recognition that some women cycle between providers without progress. These experiences are not unique to the Faroe Islands—they mirror the realities of primary care in many countries where resource constraints, limited access to imaging, and narrow specialist availability delay diagnosis and prolong suffering.

Yet the study also highlights the strengths of primary care: continuity, relational trust, and a holistic understanding of the patient’s life context. These are assets that no tertiary centre can replicate. When aligned with clearer guidelines and stronger collaboration with gynaecology, GP care could substantially shorten delays and improve the quality of the diagnostic journey.

The message from this work is clear. Improving endometriosis outcomes is not only about surgical excellence or advanced imaging; it requires system-level support for primary care, including structured referral pathways, straightforward triage criteria, and co-management strategies that respect the GP’s central role. Without addressing these foundational gaps, we risk perpetuating the very delays we are trying to eliminate.

The authors should be commended for giving voice to the clinicians at the front line of endometriosis detection. Their insights point directly to the changes needed—clear protocols, stronger communication bridges, and a healthcare system that empowers rather than burdens the professionals patients trust most."

Lay Summary

Recognizing and managing endometriosis in primary care is often challenging, especially in healthcare systems with limited specialist access. In the Faroe Islands, general practitioners (GPs) are the first point of contact for women presenting with pelvic pain, heavy periods, and other symptoms that may indicate endometriosis. However, the diagnostic process is not straightforward, and many women experience long delays before receiving a clear explanation for their symptoms.

In this qualitative interview study published in BJGP Open, a group of researchers from Denmark and the UK explored how 13 GPs navigate the clinical and emotional demands of caring for women with suspected endometriosis.

The GPs described feeling stretched between patient expectations for rapid answers and the realities of scarce resources, long referral pathways, and limited communication with gynaecologists. Many reported uncertainty about when to suspect endometriosis, how extensively to investigate in primary care, and when a referral would actually lead to specialist assessment.

Despite these challenges, the GPs emphasized the importance of continuity, holistic care, and careful expectation management. They often relied on building long-term relationships with their patients, addressing pain management, and providing ongoing support while navigating a system with few clear guidelines. The study highlights how structural barriers—rather than lack of clinical interest—contribute to diagnostic delays and patient frustration.

Overall, this research provides valuable insight into the realities of endometriosis care in primary care settings. It underscores the need for clearer referral pathways, stronger collaboration between GPs and specialists, and accessible guidance to help GPs identify and support women with possible endometriosis earlier and more effectively.

Research Source: https://pubmed.ncbi.nlm.nih.gov/41034148/