Diagnosing Endometriosis

What is endometriosis?

A woman’s uterus is lined with endometrial tissue that is shed once a month during the menstrual cycle. Endometriosis is a chronic, painful medical condition that occurs when endometrial-like tissue grows outside the uterine cavity. The ovaries, Fallopian tubes, and the tissue lining the pelvis are commonly involved. Pain associated with endometriosis is usually more severe during menstrual periods as the tissue responds to changing hormones and thickens and bleeds but has no way to exit the body. In severe cases, endometriosis can cause infertility.

How is endometriosis diagnosed?

It can be difficult to distinguish endometriosis from menstrual pain, non-menstrual pelvic pain, or abdominal pain. The diagnostic process typically involves a medical history, physical exam, and imaging procedures. Laparoscopic surgery may also be recommended to provide a definitive diagnosis.

Medical history and physical exam

A medical history involves questions about specific symptoms and their severity and duration. A pelvic exam is part of the physical examination. During the pelvic exam, a health care professional checks for cysts and scar tissue that may indicate endometriosis or other medical conditions. Based on information gathered from the physical exam and medical history, additional tests or even laparoscopic surgery may be recommended to confirm the diagnosis.

Diagnostic tests and procedures

The following tests and procedures may be ordered to confirm a diagnosis of endometriosis:

• Magnetic resonance imaging (MRI)
  An MRI is used to pinpoint where endometrial tissues and cysts are located. This is especially important if surgery is being considered.
• Ultrasounds
  Either an abdominal or transvaginal ultrasound may be ordered to look for cysts associated with endometriosis. However, ultrasounds cannot provide a definitive diagnosis of endometriosis.
• Laparoscopic surgery
  Laparoscopic surgery is the best diagnostic tool for endometriosis, but it’s also the most invasive. During a laparoscopy, a very slim camera is inserted through a tiny cut in the navel in order to view the pelvic area. This can help identify any endometrial tissue outside the uterus. In some cases, endometriosis is diagnosed based on how the tissue looks. In other cases, a tissue biopsy is taken and sent to a lab to confirm an endometriosis diagnosis. If endometrial tissue is located outside the uterus, a diagnosis of endometriosis can be confirmed.

While surgery can definitively diagnose endometriosis and can provide information about the extent of the spread, many individuals prefer to try treatment options before considering this intrusive test.