ReviewBMJ open2026
Use of symptom-reporting tools to support endometriosis identification and management in primary care: a realist synthesis.
Review in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesEndometriosis affects 5-10% of women of reproductive age and is associated with chronic pain, infertility and reduced quality of life. Symptom Reporting Tools (SRTs) may support identification and management in primary care, but evidence is limited. This review investigates what works, for whom, in what contexts and why, when using SRTs for endometriosis in primary care.
designA realist synthesis was used to develop programme theories on how SRTs were intended to work for women and healthcare practitioners. DATA SOURCES: A purposive and iterative search was conducted across eight databases (Google Scholar, Press Reader, PubMed, Web of Science, LibrarySearch, APA PsycINFO via Ovid, Overton and Scopus) between January and April 2024 and updated in October 2025. ELIGIBILITY CRITERIA: Studies were included if they focused on women, primary care professionals or SRT developers, and addressed symptom tracking, shared decision-making and diagnostic delays. Studies from low- and middle-income countries, non-English language or lacking SRT content were excluded. DATA EXTRACTION AND SYNTHESIS: Initial programme theories of how SRTs were intended to work for women and healthcare practitioners were developed, tested and refined with stakeholder and patient and public involvement and engagement.
resultsThis review included 102 studies: 83 informing initial theory development and 19 were used to refine these theories, covering a total of 22 266 participants aged between 13 and 70 years. Most studies included in the synthesis were cross-sectional (n=15). Evidence showed that independent SRT use could enhance symptom awareness, health literacy, self-management and quality of life. During appointments, SRTs might support communication and personalised treatment, potentially leading to more timely diagnosis and improved outcomes. However, without guidance, SRT use could also cause distress and disempowerment. Challenges included symptom variability and limited awareness of endometriosis and SRTs in primary care. Few studies explored the experiences of those unaware their symptoms could indicate endometriosis.
conclusionOur findings highlight how and why using SRTs could support endometriosis identification and care in primary care. Evidence on their role in timely diagnosis and shared decision-making was limited. Implications for practice and further research were identified. PROSPERO REGISTRATION NUMBER: CRD42024518266.
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