Endometriosis is a chronic disease frequently encountered in primary care, affecting 5 to 10% of women. Its management is multidisciplinary, with a central role for the general practitioner, who coordinates the care pathway. In 2022 in XXXX, 52% of patients reportedly had recourse to complementary therapy at least once for this indication, including hypnotherapy and acupuncture. These therapies, both recognised by the WHO, have demonstrated benefits in this indication. Nevertheless, there are concerns in XXXX about certain practices considered deviant and the risk of patients abandoning conventional care. However, the care pathways of these women remain largely unexplored.To explore the characteristics and determinants of the care pathway of patients using hypnotherapy and/or acupuncture for endometriosis in XXXX.Qualitative study based on grounded theory using semi-structured interviews with endometriosis patients who had undergone hypnotherapy or acupuncture, until theoretical saturation. A purposive sample was drawn from patient associations and practitioners of each therapy and extended using snowball sampling. Verbatim transcripts were analysed using double coding, leading to the development of an explanatory model.These therapies are used at various stages of patients' pathways as an auxiliary treatment, for different purposes depending on the therapy: diagnosis acceptance, preparation for surgery, pain, emotional and psychological management, etc. Trust in the healthcare professional and the characteristics of the complementary care setting are important determinants of the patient experience, among others. Patients are looking for better coordination of this care pathway by healthcare professionals.This innovative study provides a better understanding of the experiences of women who use hypnotherapy and acupuncture to treat endometriosis in XXXX, helping to identify the factors that influence their decision to use these therapies and how they use them. Uncertainties remain about the actual importance of some characteristics of the care pathway.This study paves the way for a more efficient and coordinated structure for patient care pathways in XXXX, although further studies are needed.

In general practice, women’s pelvic pain represents a frequent, multifactorial and complex issue, often leading to significant diagnostic delays and a major impact on quality of life. Its management requires a global and coordinated approach, involving interprofessional collaboration. In the XXX XX XXX area, this issue is part of a dynamic local context, with a diverse healthcare offer and professionals committed to women’s health, driven by a desire to strengthen interprofessionnal collaboration.To explore the perceptions, experiences and needs of healthcare professionals in the XXX XX XXX area regarding the management of women’s pelvic pain in order to implement a territorial action promoting interprofessional coordination.A qualitative grounded theory study was conducted with 17 healthcare professionals practicing in the XXX XX XXX area, based on semi-structured interviews. The collected data were then integrated into an action-research process, which led to the organization of a multidisciplinary networking event bringing together local healthcare stakeholders.Analysis of the interviews, conducted using cross-coding, revealed three main findings : a lack of specific training of primary care practitioners on women’s pelvic pain; an effective informal network of existing local resources, sometimes still unknown to professionals; a need for direct communication and physical networking between practitioners to improve patient pathways. Professionals expressed feelings of helplessness regarding certain situations and difficulties coordinating care, but above all, a strong motivation to collaborate and to improve the care pathway. The interprofessional event generated genuine enthusiasm : 53 attendees, including heads of OB-GYN departments of two hospitals nearby, and an overall satisfaction in the post-event survey. This confirms the value of creating tangible spaces for meetings and exchanges within the territory.This study highlights that interprofessional cooperation is an appropriate response to the challenges posed by pelvic pain in women. Strengthening training, developing secure communication tools and providing institutional support for local initiatives appear as key levers for sustainably embedding multiprofessional collaboration in primary care.By combining qualitative and action research, this study translated field needs into collective action. Interprofessional collaboration stands out as an adaptative, formative, innovative response to women’s pelvic pain, transforming professional challenges into drivers of change.

Chronic abdominal pain is a frequent and challenging complaint in Family Medicine, often leading to extensive diagnostic testing, repeated specialist referrals, and significant patient distress. Among its under-recognized etiologies is Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), frequently misinterpreted as visceral pathology. Early recognition in Primary Care is essential to prevent unnecessary interventions and to improve patient outcomes.We describe a clinical case assessed in a Primary Care setting. The diagnostic process included a comprehensive history, focused abdominal examination, and evaluation with Carnett’s sign to distinguish abdominal wall pain from visceral pain. The patient underwent multiple imaging studies (CT, PET-CT, MRI) and several specialist evaluations without achieving a definitive diagnosis. A diagnostic-therapeutic local anesthetic and corticosteroid infiltration was subsequently performed. Clinical evolution and symptom response were monitored during follow-up visits in Family Medicine.- Abdominal wall pain should be consistently included in the differential diagnosis of chronic abdominal pain. - Training in Carnett’s sign and focused abdominal examination should be strengthened within Family Medicine. - Early suspicion of ACNES reduces healthcare costs and avoids unnecessary imaging or invasive procedures. - Implementation of screening algorithms may support earlier detection. - Increasing interdisciplinary awareness can shorten diagnostic delays.ACNES remains frequently missed because its diagnosis relies primarily on clinical assessment rather than imaging. This case highlights how thorough physical examination can outperform extensive diagnostic testing when abdominal wall etiologies are considered.Routine consideration of ACNES and the use of simple clinical tools can enhance diagnostic accuracy, reduce unnecessary interventions, and significantly improve patient care in Primary Care settings.

Endometriosis is a common chronic condition affecting 10% of women of reproductive age worldwide and is a leading cause of chronic pelvic pain (CPP). In Australia, approximately 14% of women are diagnosed with endometriosis by age 44–49, and women can experience delays in diagnosis of 8 years. General Practitioners (GPs), as the first point of contact in the healthcare system, are seeing increased numbers of patients with endometriosis. GPs may face challenges in diagnosing and managing endometriosis and CPP due to the varied symptom presentation in patients and limited support resources. In response, the Australian Government funded the development of an Endometriosis Management Plan (EMP) to support the diagnosis and management of endometriosis and CPP in primary care settings.To identify: (i) the key components for developing and implementing an EMP to support GPs and patients in the diagnosis and management of endometriosis and CPP; and (ii) the outcomes the EMP should aim to achieve.A co-design workshop was conducted online in October 2023, using the Experience Based Co-design methodology to bring together patients with lived experience of endometriosis or CPP, GPs, and representatives from endometriosis and CPP stakeholder organisations. Participants were recruited through convenience, purposive, and snowball sampling. The workshop was audio-recorded and transcribed verbatim. Data were analysed inductively using reflexive thematic analysis.Forty-three participants across Australia attended the half-day workshop, including patients, GPs, representatives from endometriosis and pelvic pain organisations and project governance members. Four themes and nine subthemes were generated which broadly highlighted the EMP’s potential to support GPs in making a preliminary diagnosis, enabling a holistic and patient-centred approach to symptom management, promoting multidisciplinary collaboration by streamlining referral pathways, supporting capacity building among GPs and enhancing patient self-management through improved knowledge and awareness.The co-design process enabled meaningful stakeholder engagement and collaboration, guiding the development of a context-specific, evidence-based EMP, that integrates the latest endometriosis clinical guidelines in an online tool.The EMP is designed to support GPs and patients experiencing endometriosis and CPP symptoms, and enhance endometriosis and CPP healthcare in Australian primary care settings. The EMP will be released nationally in May 2026.

Endometriosis is a chronic inflammatory disease that affects one in ten women of reproductive age and directly impacts the daily lives of those who suffer from it.The aim of this study was to determine the positive impact of multidimensional care - including the physical, psychological, socioeconomic, sexual and family dimensions - on quality of life.This is a cross-sectional study done with women who suffer from endometriosis thanks to a form that was sent to general practitioners, for them to display it in the waiting area of their office, to pharmacies located in the XXX and to online patients associations. Inclusion criteria were women aged over 18 years with a diagnosis of endometriosis (superficial or deep) confirmed by a healthcare professional. A descriptive univariate analysis was first conducted, followed by a multivariate analysis using statistical tests including ANOVA, Student’s t-test, Pearson’s correlation, and Chi-square tests. Results were considered statistically significant when the p-value was less than 0.05. The study was approved by an ethics committee.One hundred and fifty-two women were included. Endometriosis had an impact on social, professional and family life for respectively, 90,1%, 88,8% and 53,9% of the surveyed women. For half of them, the financial cost impeded access to adequate medical care. The patients, who received comprehensive care from their general practitioners, showed a significant improvement in quality of life, despite the low referral rates: 39.1% for pain management, 21.7% for financial support, 19.7% for work-related healthcare, and 16.4% for support networks.This study is original due to its quantitative approach, larger sample size, and focus on multidimensional management of endometriosis. Limitations include voluntary participation, online questionnaires, and self-reported data, which may introduce selection and reporting biases. Nevertheless, the study reinforces the importance of comprehensive care.A global approach including a psychological, socioeconomic and professional support appears essential to improve the patients’ quality of life. To achieve this, it may be useful to create a directory gathering all the associations, the regional care sectors and the referring specialists to improve the orientation of the patients.

In recent years, societal and medical awareness of female-specific conditions has increased across Europe. In the Netherlands, media and patient advocacy groups have called for improved recognition and diagnostic accuracy for conditions such as endometriosis. Dysmenorrhea, one of the most common gynaecological complaints, remains underdiagnosed and undertreated in primary care, resulting in reduced quality of life and considerable societal costs. This guideline represents the first national initiative to provide evidence-based recommendations for diagnosing and managing of dysmenorrhea in general practice. As part of its implementation, an NHG option grid is being developed to enhance shared decision-making for women with dysmenorrhea.To develop and present a comprehensive, evidence-based guideline for general practitioners addressing both primary and secondary dysmenorrhea, focusing on improving diagnostic processes, treatment options, and patient involvement in care decisions.A multidisciplinary team of general practitioners, a guideline epidemiologist and a gynaecologist developed the guideline through systematic literature review, expert consensus, and alignment with existing European guidelines on endometriosis (ESHRE 2022, NICE 2024), covering both primary and secondary dysmenorrhea. Key diagnostic and therapeutic challenges in primary care were addressed. For the option grid, mixed-method research with two surveys and two focus groups is conducted to ensure usability and patient-centred design.The guideline provides: - Enhanced focus on secondary dysmenorrhea causes, particularly endometriosis and adenomyosis. - Recommendations on transvaginal ultrasound: while limited for ruling out endometriosis or adenomyosis, it may aid in diagnosing other causes such as fibroids. - Clarification that imaging is not required before initiating empirical treatment. - Treatment options for both primary and secondary dysmenorrhea, emphasizing shared decision-making. No first-line preference is given between analgesics and hormonal contraception; patient values and preferences guide the choice. An option grid is under development to facilitate this process.This guideline addresses a critical gap in Dutch primary care and is aligned with broader public health efforts to advance women's health. It promotes earlier recognition and management of dysmenorrhea, potentially reducing diagnostic delay and improving outcomes.The NHG Guideline on Dysmenorrhea offers practical, patient-centred recommendations for general practitioners. Its implementation may enhance care quality and contribute to better health outcomes for women.

XXX guidelines recommend progestin-releasing long-acting reversible contraception (LARC), including levonorgestrel-releasing intrauterine devices (LNG-IUS) and etonogestrel implants, as first-line treatments for endometriosis in primary care.This systematic review and meta-analysis aimed to determine the efficacy of LARC as a treatment for endometriosis, and investigate differences by sub-populations with endometriosis.The study was registered prospectively. Medline, Embase and CENTRAL databases were searched from January 1990 to January 8 2025. Eligible studies were published randomised and clinical controlled trials (RCTs and CCTs) comparing progestin-releasing LARC (with or without laparoscopy) with pharmacological, surgical, placebo or expectant management treatments for endometriosis. Studies rated as ‘high-risk’ of bias for random sequence generation were excluded. Two reviewers independently screened the studies, extracted outcome data and assessed the quality of included studies using the Cochrane Risk of Bias 2 tool. Data was synthesised using fixed-effects model meta-analyses and narrative syntheses. Certainty of the evidence was assessed using GRADE.Of the 770 studies identified, ten RCTs were included, with 499 participants. Sample sizes ranged from 22 to 103 participants. Eight studies had ‘high-risk’ of bias. The treatment benefit of LNG-IUS with laparoscopy was greater than expectant management post-laparoscopy for dysmenorrhoea (MD -2.07 [95%CI -3.29, -0.85]; very-low certainty evidence), dyspareunia (MD -1.39 [95%CI -3.22, 0.45]; very-low certainty evidence) and noncyclic pelvic pain at 12 months (two trials), and less than leuprolide acetate for endometriosis-related pain at 6 months when used without laparoscopy (MD 0.17 [95% CI -0.4, 0.74]; moderate certainty evidence, two trials). LARC offered comparable quality of life benefits, safety, treatment satisfaction and efficacy for dysmenorrhoea and persistent pelvic pain to other hormonal treatments for endometriosis; very-low to moderate certainty evidence. The data was unsuitable for investigating sub-population differences.The efficacy of LNG-IUS with laparoscopy was superior to laparoscopy alone, and the efficacy of progestin-releasing LARC was comparable to other hormonal treatments for endometriosis. However, the certainty of evidence was reduced by the imprecision and quality of included studies.There is a need for robust, well-powered RCTs for LARC treatment for endometriosis. These findings validate LARC’s use as efficacious, safe and acceptable hormonal treatments for endometriosis in primary care.