How is Endometriosis Diagnosed?

 

What is Endometriosis? | Causes of Endometriosis | Symptoms | How is it Diagnosed? | Treatments for Endometriosis

Overview:

It is estimated that endometriosis affects approximately 1 in 10 individuals who menstruate worldwide. It typically affects individuals during their reproductive years between the ages of 15 to 49, and the risk of developing endometriosis increases with age. Although it is very rare, endometriosis has also been described in very young individuals, in individuals who have already reached menopause, and in some men who take large doses of oestrogen.

While many menstruating individuals experience the more common symptoms of endometriosis, a large proportion of people with the condition either have no symptoms or experience atypical symptoms, making it difficult for doctors to suspect endometriosis and causing a delay in diagnosis.

A diagnosis of endometriosis often takes up to 7 – 10 years from the onset of symptoms. This is due to a combination of a lack of awareness and inexperience of doctors in primary care, the normalization of endometriosis pain as “part of being a woman”, and the lack of a straightforward and precise method of diagnosis.

In light of the difficulty in diagnosing endometriosis, early detection is key to reducing the long-term impacts of endometriosis on patients’ health and improving their quality of life. Early detection also helps with symptom management and preventing infertility.

Steps to Diagnosing Endometriosis

 
 
 
 

1)   History and Physical Examination

A careful history and examination by a trained physician can suggest the presence of the disease. Stage 1 or mild endometriosis usually cannot be felt on examination, however in more advanced stages, when there are nodules or cysts, endometriosis can be detected during a gynecological assessment.

 
 
 

 

 

2) Imaging Endometriosis

a) Ultrasound

Ultrasound is typically used to image pelvic structures because it is excellent at visualizing the uterus and ovaries and is sensitive to structural changes in these organs. Ultrasound is also non-invasive and more cost-effective, making it available in more clinics and other healthcare settings.

Using ultrasound to assess endometriosis does require some advanced and very specific training; not all ultrasonographers have the specialized training required to be able to detect endometriosis. Ultrasound can identify endometriosis in cases where there are endometriotic cysts (endometriomas) on one or both ovaries, nodules of deep infiltrating endometriosis, and when the condition has caused adhesions or scarring. However, most superficial endometriotic lesions are not visible on ultrasound.

 

b) Magnetic Resonance Imaging (MRI)

Another useful visualization tool for endometriosis is MRI. Like ultrasound, it does not show superficial lesions but can be very useful in the assessments of more severe forms of endometriosis. MRI is effective in showing ovarian cysts or nodules affecting the vagina, rectum, or bladder. It is also useful to diagnose endometriosis outside of the pelvis such as in the lungs or diaphragm.

MRI also requires extensive training and experience for the technologist and is still currently more expensive and less available than ultrasound.

 

 

 

3)   BLOOD TESTS

Much research into a simple, non-invasive blood test has been done for endometriosis.  Unfortunately, to date, there is no reliable blood test established to diagnose endometriosis.

Research has indicated that the protein, CA 125, is found in greater concentration in tumour cells than in other cells of the body, and individuals with ovarian cancer often show high levels of CA 125 in the blood. Some individuals with endometriosis also display high levels of CA 125 in their blood, however, the test is not specific or reliable enough to provide an endometriosis diagnosis and therefore is not routinely used.

 
 

4)   LAPAROSCOPY

The gold standard for a definitive diagnosis of endometriosis is still by laparoscopy, also known as keyhole surgery, where a camera is inserted into the abdomen through a small incision in the umbilicus (or navel).

Endometriotic lesions can then be seen by the surgeon, samples can be taken and sent through to pathology. Biopsy (histopathologic evidence) is still the most definitive confirmation of the condition.

The advantage of a laparoscopy is that it is not only diagnostic but can also become part of the treatment for endometriosis. All lesions seen during the procedure can be excised, thereby reducing symptoms experienced by the patient. Please see the laparoscopy and endometriosis treatment pages for more detail.

A laparoscopy is not always mandatory for endometriosis diagnosis. This is true when is it considered okay to not have a definitive diagnosis in specific situations such as:

  • When symptoms are not very severe and do not have a significant impact on the individual’s quality of life.

  • The symptoms respond well to medical treatment.

  • The individual is able to conceive without treatment or is not trying to conceive.

  • A good quality ultrasound does not show ovarian cysts or deep infiltrating endometriotic nodules.