How is Endometriosis Diagnosed?

The diagnosis of endometriosis cannot be made from symptoms alone since some women with endometriosis have no symptoms at all, and many women with pelvic pain do not have endometriosis. However, it may be suspected if a woman is having difficulty getting pregnant, or she has pelvic pain, painful periods, or pain during intercourse. A family history of endometriosis in a close relative is also suggestive. A woman who has an affected close relative is more likely to have endometriosis and more likely to have severe disease.

Physical examination – A physical examination can be helpful, particularly in making diagnoses other than endometriosis that may cause pelvic pain, but it is not an accurate way to diagnose endometriosis. The doctor may or may not be able to feel tender spots of endometriosis or an enlarged ovary. If the exam is performed at the time of menses it sometimes can be especially helpful. Findings at the physcial exam may be helpful in directing further tests and evaluations, as well as treatment.

Laparoscopy – The diagnosis of endometriosis is generally considered uncertain until proven by laparoscopy. Laparoscopy, is an operation, during which a thin telescope, called a laparoscope, is inserted through a small incision and the patient’s abdomen is distended with carbon dioxide gas to make the organs easier to see. It may be done under local or general anesthesia. When it is performed under local anesthesia, a technique called pain mapping may be done. This is a relatively new procedure that allows the patient and her surgeon to localize areas of endometriosis, or other disease, that directly cause the pelvic pain. By moving the laparoscope around the abdomen, the surgeon can check the condition of the abdominal organs and see the endometrial implants, if care and thoroughness are used. Skill and familiarity with endometriosis are important, as it has many different appearances and may be missed by the inexperienced or inattentive physician.

If endometriosis is seen at laparoscopy, it is usually possible to destroy it by burning it with electrical or laser energy, or by cutting it out with traditional surgical techniques using a surgical knife and scissors. The location of the endometriosis will influence which techniques are used. It is helpful if a small piece of endometriosis can be removed for microscopic examination at this time, called a biopsy. Confirmation of the diagnosis by biopsy is very helpful, as even the most experienced surgeon is sometimes fooled by lesions that look like endometriosis, but are not. It is important that women without endometriosis not be labeled as having it. Although a woman may be treated as if she has endometriosis without surgical confirmation, it is not good practice to diagnose endometriosis without surgical confirmation.

Other diagnostic techniques – There has been intense research directed towards finding blood tests to diagnose and stage endometriosis, but as yet such tests are not available. Ultrasound, computerized tomography (CT scan) or magnetic resonance imaging (MRI) can be used to get more information about the extent of the endometriosis in severe cases. These techniques can identify cysts in the ovaries and are usually done in the hospital radiology (X-ray) department or in a specially equipped doctor’s office. They cannot be used to make a definite diagnosis of endometriosis as yet, but some research with MRI has been promising.

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