Endometriosis is a chronic, often painful condition in which tissue similar to the lining inside the uterus, called the endometrium, starts to grow outside the uterus. Diagnosing endometriosis can be a complex process, as its symptoms can mimic other conditions.
1. Clinical History and Physical Examination
The first step in the diagnosis is a detailed patient history and physical examination. The patient is typically asked about menstrual cycle patterns, pain symptoms, sexual activity, previous surgeries, and family history of endometriosis or other related conditions. The OB/GYN might feel for cysts or scars behind the uterus during a pelvic exam, though smaller areas of endometriosis are harder to detect.
2. Imaging Studies
While imaging tests cannot definitively diagnose endometriosis, they provide valuable information. An external or transvaginal ultrasound can identify ovarian cysts associated with endometriosis (endometriomas). An MRI offers a detailed view of the organs and can map out the location of endometrial implants.
3. Laparoscopy and Biopsy
Currently, laparoscopy is the gold standard for the definitive diagnosis of endometriosis. During the procedure a surgeon makes a small incision near the navel and inserts a laparoscope, allowing them to view the pelvic organs and look for endometrial implants. They may take small samples of tissue (a biopsy) to be examined under a microscope to confirm the presence of endometriosis. A biopsy is the only definitive way to confirm the diagnosis of endometriosis.
5. Other Tests
The only other way to determine a possible endometriosis diagnosis is a CA-125 blood test. Elevated levels of CA-125, a blood marker, can indicate endometriosis. However, other conditions can also elevate CA-125, so it isn’t specifically diagnostic.
Limitations and Considerations
Symptoms of endometriosis vary from patient to patient. Some women with severe endometriosis might have minimal symptoms, while those with a milder form might experience severe pain. Conditions such as ovarian cysts, pelvic inflammatory disease, and irritable bowel syndrome can mimic endometriosis symptoms. The varying symptoms and overlap with other conditions often lead to a delay in diagnosis. On average, there’s often a significant delay (sometimes years) between the onset of symptoms and a definitive diagnosis. It is important to speak to your healthcare provider about your symptoms as soon as possible and to follow their recommendations for clinical assessment, imaging, and even surgical investigation. Early consultation with an OB/GYN and proper testing are essential for timely identification and management of this condition.
Additional Resources:
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661
Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/4148-endometriosis
Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
RadiologyInfo.org: https://www.radiologyinfo.org/en/info.cfm?pg=pelvismr
American College of Obstetricians and Gynecologists (ACOG): https://www.acog.org/womens-health/faqs/endometriosis
Endometriosis Foundation of America: https://www.endofound.org/endometriosis