Episode 12 - The importance of diagnosing endometriosis early - Dr Danielle Robson
Recognising endometriosis earlier: a guide for GPs
Period pain is easy to normalise, particularly when a patient has lived with it for years. Some people organise their work, study and social life around symptoms without recognising how much those symptoms affect them. Others have few obvious signs and first seek help when they have difficulty conceiving. Both experiences deserve a thoughtful assessment.
In this episode of Fertility in General Practice, Dr Ali Hodgkinson speaks with fertility specialist and gynaecologist Dr Danielle Robson about recognising endometriosis and supporting timely care. Their discussion explores symptom history, imaging, fertility planning and the importance of matching referral to the patient's priorities.
Ask what symptoms mean in everyday life
A useful history goes beyond asking whether periods are painful. Dr Robson encourages attention to what patients do to manage symptoms and what they miss because of them. Regularly needing pain relief or planning life around a period may reveal a burden that a brief description does not capture.
The episode also discusses pain with intercourse and bowel or bladder symptoms associated with menstruation. Patients do not always present with a neat, recognisable pattern. They may describe general abdominal discomfort or symptoms that overlap with other conditions. Listening carefully and exploring timing can help build a clearer picture without assuming every symptom has the same cause.
Using a symptom diary
A symptom diary is one practical tool discussed in the episode. Recording symptoms alongside the menstrual cycle can help patients describe patterns that are difficult to recall during a short consultation.
For a GP, this can support a more detailed history and a more informative referral. It also gives patients a way to explain the effect on their life in their own terms. A diary should support assessment, not become a reason to delay care when symptoms or other findings need earlier review.
Understanding what imaging can and cannot show
Dr Robson discusses pelvic imaging, including specialist ultrasound assessment for deep endometriosis. Imaging can contribute valuable information, but a scan that does not identify endometriosis does not necessarily exclude it.
That distinction matters when patients feel their symptoms have been dismissed after a normal result. The next step should take account of the history, examination, investigations and response to treatment. Decisions about further imaging, clinical assessment or surgery belong within an individual management discussion, rather than a blanket rule that every patient needs the same test or procedure.
Keep fertility goals in the conversation
The episode explores how reproductive plans influence referral. A patient mainly seeking pain relief may have different immediate needs from someone actively trying to conceive. When fertility is the priority, assessment should consider the broader picture, including other potential contributors and the circumstances of a partner where relevant.
Surgery may be useful for selected patients, but it is not automatically the first step for everyone with suspected endometriosis and fertility difficulties. Procedures involving the ovaries need particular care because ovarian reserve may be affected. Dr Robson emphasises the value of expertise that considers both symptom management and the patient's reproductive goals.
Care is broader than an operation
Endometriosis care can involve medical treatment, pain management, allied health support and fertility treatment, depending on the individual. The discussion recognises that persistent pain and delayed answers can affect emotional wellbeing as well as physical health.
A coordinated approach helps avoid framing the problem as a choice between doing nothing and having surgery. Patients need clear explanations about the purpose of each option, how it fits their current goals and when the plan should be reviewed. GPs are well placed to maintain that continuity while specialist assessment is underway.
Making the referral useful
A referral can include the symptom pattern, its effect on daily life, treatments already tried, imaging reports, previous surgery and fertility history. Recording the patient's main concern helps the specialist understand what matters most at the first appointment.
For patients, early acknowledgement that symptoms deserve attention can be important in its own right. It does not require promising a diagnosis or a particular outcome. It means taking concerns seriously, explaining the next steps and keeping the conversation open when initial tests do not provide a complete answer.
Listen to the episode
Listen to Dr Danielle Robson and Dr Ali Hodgkinson discuss practical ways to recognise endometriosis concerns, support informed referral and bring fertility planning into the conversation. The episode offers a patient-centred perspective on a condition that can present in very different ways.
About Dr Danielle Robson
Dr Danielle Robson is a CREI-accredited fertility specialist and gynaecologist practising at Genea's Sydney CBD and Manly clinics. She holds a Master of Reproductive Medicine and has trained in obstetrics and gynaecology at major Australian teaching hospitals. She is also involved in medical education, including training junior doctors. Her approach combines evidence-based management with time to listen, clear explanations and ongoing support.
.png "Genea logo"){kind=logo}
.png)
