Understanding the diagnostic process of endometriosis in primary care: An interview study with general practitioners in Denmark using clinical vignettes

Introduction: Endometriosis is a chronic, systemic condition affecting 5–10% of individuals assigned female at birth. Due to its non-specific symptoms, diagnosis is often delayed. Objectives: This study aims to explore diagnostic challenges and decision-making processes that general practitioners (GPs) encounter when managing patients with symptoms suggestive of endometriosis in Denmark. Methods: A qualitative research approach was employed, incorporating the co-production of three fictional clinical vignettes representing diverse endometriosis presentations. Semi-structured interviews were conducted with 27 practicing GPs (7 males and 20 females) from urban and rural areas. Participants had a mean age of 50 years (range 41–66) and clinical experience ranging from newly qualified to 27 years. Interviews involved engagement with the vignettes, and data were analysed using thematic analysis. Results: Findings reveal the challenge of the non-specific nature of symptoms, the role of cyclical symptom patterns in diagnosis, the influence of diagnostic hierarchies, patient-centred care approaches, the bio-psycho-social perspective in management, the persistent stigma surrounding gynaecological symptoms, and GPs limited trust in general gynaecologists. GPs were more likely to suspect endometriosis when symptoms followed a cyclical pattern, whereas gastrointestinal presentations were less commonly linked to the condition. While many GPs adopted a patient-centred, shared decision-making approach, some still adhered to mind-body dualism in their clinical reasoning. Conclusion: Diagnosing endometriosis in primary care is challenging due to non-specific symptoms, diagnostic hierarchies, and stigma. Encouraging GPs to routinely inquire about the cyclical nature of symptoms may serve as a valuable diagnostic tool, particularly in cases involving gastrointestinal complaints.