Endometriosis is primarily diagnosed through a combination of symptom assessment, physical examination, imaging tests, and definitively by a surgical procedure called laparoscopy with biopsy.
Initial Assessment and Physical Exam
Doctors start with a review of symptoms and a physical (pelvic) exam to check for unusual changes like cysts, nodules, or painful spots in the pelvic area. However, small areas of endometriosis can be missed if no cysts have formed.
Imaging Tests
- Ultrasound (including transvaginal ultrasound): Helps detect cysts linked to endometriosis, such as endometriomas, but cannot definitively diagnose the condition.
- Magnetic Resonance Imaging (MRI): Used mainly for detailed mapping of endometriosis growths, aiding surgical planning but not definitive diagnosis.
- These imaging tests support diagnosis but do not confirm it.
Definitive Diagnosis: Laparoscopy with Biopsy
The gold standard to confirm endometriosis is laparoscopy, a minimally invasive surgery where a camera (laparoscope) is inserted through a small cut near the navel to visually inspect the pelvis for endometrial lesions. Tissue samples (biopsies) can be taken for lab confirmation. The surgeon may simultaneously remove or treat visible lesions.
Additional Notes
- Diagnosis can take years because symptoms overlap with other conditions.
- Some women may be treated based on clinical suspicion without laparoscopy depending on symptoms and treatment goals.
- The physical exam may include vaginal or rectal exams to detect deeper lesions in some cases.
In summary, initial evaluation involves symptom review, physical exam, and imaging, but laparoscopy with biopsy remains the only definitive way to diagnose endometriosis. This procedure also offers potential for treatment during the same surgery. This comprehensive approach is the current standard for diagnosis of endometriosis.
