For Your Patients: How Will Your Doctor Diagnose Endometriosis?

Endometriosis is now considered a whole-body inflammatory disease that can affect many parts of the body beyond the pelvic area and reproductive organs. Still, doctors initially rely on classic menstrual and pelvic symptoms to begin the diagnosis of this debilitating condition and move to timely treatment to improve your quality of life.

Among the most indicative symptoms are:

• Severe menstrual pain that progressively worsens over the years

• Pelvic pain at other times of the month

• Pain during sexual relations

• Bladder and bowel pain that is cyclical

• Difficulty becoming pregnant

Pelvic Exam

For this examination, the doctor manually palpates the interior of your pelvis to check for any anatomical abnormality or injury that might be causing pain. The exam also involves feeling for adhesions and cysts on the reproductive organs as well as scarring around the uterus that might be due to inflamed endometriotic deposits.

While the exam can't precisely identify tissue as endometriosis, it can raise a physician's suspicion that you have endometriosis. It can also help rule out other causes of pelvic pain such as fibroids, ovarian cysts, and pelvic inflammatory disease.

Some doctors may feel that your symptoms and pelvic exam provide enough evidence of endometriosis to go straight to a trial of medical hormone therapy to ease symptoms without further testing. Others may want to investigate further with imaging studies.

Ultrasound Imaging

This test uses high-frequency sound waves to visualize the interior of the pelvis.

In ultrasonography, a slim, wand-like device called a transducer is pressed against the exterior of the abdomen or inserted into the vagina to map and image the reproductive organs.

Standard ultrasound imaging won't definitively diagnose endometriosis the way surgery can, but it can detect large lesions such as cysts formed by endometriotic tissue (endometriomas). These growths can form in and on the ovaries and in addition to causing pain, can interfere with conception and may contribute to infertility.

And while ultrasound can't locate tiny clumps of endometriotic tissue, it can find tissue that has penetrated deep into pelvic organs. This form of imaging can help guide surgery if you need that later. Depending on whether ultrasound does or does not locate a mass of interest, your doctor may want more precise information, which can be provided by magnetic resonance imaging (MRI).

MRI

In this test a magnetic field, pulsed radio waves, and a computer create more detailed images of the organs and the state of soft issues within your body. Although MRI is not routinely used to diagnose endometriosis, it can provide more specific information about the location and size of endometriotic implants.

Before MRI, you'll be given a chemical contrast agent in order to show potential trouble spots, You'll be placed inside a large cylinder that acts as a giant magnet. The magnet lines up tiny particles in your body to map your internal organs. No radioactive x-rays are involved.

Laparoscopic Surgery

Laparoscopy, followed by a laboratory assessment of tissue removed from the pelvic area, is the only truly definitive way to diagnose endometriosis. Few diagnoses, however, will require this invasive test, which does necessitate general anesthesia. A surgeon makes a small incision near your navel and inserts a fine tube (a laparoscope) containing a tiny camera to locate and evaluate endometrial tissue.

The laparoscope offers further details on the size and extent of the implants and helps in a process called staging to determine how severe the disease is. But for some women, the pain from a very small amount of endometriosis can be worse than that from extensive disease, so staging is considered more of a research procedure nowadays.

In some cases the surgeon may remove endometriotic tissue at the time of the laparoscopy, but this may grow back if not controlled by medication. Extracted sample tissue is sent to the pathology lab to confirm the diagnosis of endometriosis in a process known as biopsy.

The goal of diagnosis is to quickly rule out other causes of symptoms and be able to start treatment so you can get back to being pain-free as soon as possible.

Read Part 1 of this series: What Is Endometriosis?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.