522 Circuit Breaking: Pathways of Treatment Seeking for Women With Endometriosis in Australia Lenore Manderson Narelle Warren Milica Markovic Monash University, Caufield East, Victoria, Australia Pain resulting from endometriosis is experienced as both a chronic, ongoing condition and an acute episode at time of menstruation, often occurring in association with diarrhea, vomiting, nausea, heavy bleeding, and other reactions. Women expect pain with menstruation, however, and even if they experience major disruptions as a result, they find it difficult to distinguish normal from pathological discomfort. Drawing on qualitative research conducted from 2004 to 2006, we describe the “circuit breakers” that lead Australian women to seek medical advice. These include outside intercession, major disruptions to everyday life, changes in embodied experience, and difficulties in conception and pregnancy. Women’s ideas of menstrual pain as “normal” are shared by doctors, resulting in further delays before a definitive diagnosis of endometriosis is made. During this time, women move between doctors and in and out of med- ical care, which they described through particular narrative styles to highlight the complexity of help seeking. We explore the ways in which ideas of gender, informed by women’s embodiment but also the quality of their reporting of symptoms, influence their interactions with health professionals. Keywords: chronic illness; pain; women’s health; decision making; grounded theory; health care professionals C ontemporary social beliefs influence both medical practice and patients’ interpretations of symptoms and illness. These beliefs often explain diagnostic delays associated with patients’ and health profession- als’ non-recognition and/or dismissal of warning signs and symptoms, supplementing the structural and cir- cumstantial factors that shape access to health care. Although much contemporary research focuses on patterns of treatment seeking, self-care, diagnosis, and treatment in relation to infectious disease and child health, researchers have also drawn attention to the delays that occur in cases of chronic—particularly contested— health conditions (Clarke & James, 2003; Dumit, 2006; Glenton, 2003; Lipson, 2001; Markovic, Manderson, & Quinn, 2004; Nettleton, 2006). Endometriosis, the focus of this article, is a con- dition of unknown etiology in which uterine lining (endometrial tissue) grows outside of the uterus, most commonly in the pelvic and abdominal cavities (Farquhar, 2007; Henderson & Wood, 2000; Jackson & Telner, 2006). Although the prevalence of endometrio- sis in Australia is unknown, estimates suggest that approximately 10% of women experience the condition (Henderson & Wood, 2000). Diagnosis of endometrio- sis occurs through visual diagnosis, determined during laparoscopy (Farquhar, 2007; Pugsley & Ballard, 2007). In many cases, although not all, the condition is resolved by menopause (Jackson & Telner, 2006), but women who experience extended periods of pain are rarely happy to delay treatment until this time. Even so, treat- ment-seeking and diagnostic delays are common (Cox, Henderson, Anderson, Cagliarini, & Ski, 2003; Cox, Ski, Wood, & Sheahan, 2003; Grace, 1995a, 1995b). Women who are eventually diagnosed with endometriosis frequently experience delays of between 6.7 years and 11.7 years from the onset of their symp- toms to diagnosis (European data as described by Husby, Haugen, & Moen, 2003; Pugsley & Ballard, 2007). In Australia, women experience an average delay Qualitative Health Research Volume 18 Number 4 April 2008 522-534 © 2008 Sage Publications 10.1177/1049732308315432 http://qhr.sagepub.com hosted at http://online.sagepub.com Authors’ Note: Correspondence concerning this article should be sent to: Lenore Manderson, School of Psychology, Psychiatry and Psychosocial Sciences, Monash University, Level 4, Building F, 900 Dandenong Road, Caufield East, Victoria 3145, Australia. at Monash University on March 25, 2016 qhr.sagepub.com Downloaded from