Endometriosis Diagnosis
How Endometrial Implants Are Diagnosed

Endometriosis Guide

Pelvic Exam for Endometriosis

Endometriosis Diagnosis

Contents

Why It Takes So Long To Diagnose Endometriosis
Step 1: Pelvic Exam
Step 2: Ultrasound & MRI Scan
Step 3: Laparoscopic Exploratory Surgery


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Endometriosis Guide

Why It Takes So Long To Diagnose Endometriosis

As endometriosis has no characteristic symptoms or obvious physical signs, it may be mistaken for other conditions such as:

Pelvic inflammatory disease (PID)
Ovarian cysts
Uterine fibroids
• kidney stones,
Irritable bowel syndrome (IBS),
Ovarian cancer
Ectopic pregnancy.
Or sometimes it is simply dismissed as premenstrual syndrome (PMS cramps).
Often endometriosis is only discovered by chance when testing for another condition or by a routine pelvic exam. In fact, an extensive 2006 study on the subject reported an average delay of 8.5 years in diagnosing endometriosis in women with the condition. Reasons for this delay were cited as:

Women thought the symptoms were normal
Women delayed reporting their symptoms to a doctor because they considered themselves ‘normal’. They thought they were unlucky to have problematic periods rather than suspecting an underlying condition. They felt painful periods were a part of a woman's life and she should be able to cope with it.

Women were told their symptoms were normal
When women finally made the decision to seek help for their endometriosis symptoms, many were told by their family doctor that their symptoms were ‘normal’ and were advised to take analgesic drugs like aspirin to reduce the pain. Others were prescribed oral contraceptives and told it would help control their periods. This advice confused many women into thinking that perhaps the pain was in their head.

The Pill or Temporary Pregnancy Relief
Some women reported temporary relief by taking oral contraceptives. Others experienced temporary relief from painful periods when they became pregnant.

False Scan Results
Nearly all women who responded to the survey received a transvaginal scan to investigate the cause of their pain. While a scan can identify endometriomas (endometriosis cysts on the ovary), it is not good at locating endometriosis in other areas. As a result a negative scan result can be issued, even if endometriosis is present in other areas.

Endometriosis Diagnosis: 3 Steps

Step 1: Pelvic Exam

Unless endometriosis is discovered by chance when testing for another condition, usually the diagnosis process begins with a pelvic exam. This can be carried out by your family doctor or a gynecologist. Before your appointment it is useful to make some notes on the specifics of your pain:

• Does pain occur during/after sexual intercourse?
• Do you have painful bowel movements or any recent changes in this area such as rectal pain, diarrhea or constipation?
• Do you have any pelvic pain? Some women complain of worsening pain during exercise or menstruation.
• When did pain first start occurring?
• What type of pain is it? Jabbing, stabbing, cramping, dull ache or pressure?
• How severe is the pain? Mild, moderate, severe, crippling?
• Is the pain becoming worse?
• How many days a month are you in pain?
• How does pain impact your life, does it prevent you from attending work or school?
• Do you have any problems losing weight?

Suspicious signs which may alert a physician to the presence of endometriosis in a routine pelvic exam include:

• Pelvic nodules and tenderness.
• Masses on the uterine ligaments.
• Ovarian enlargement.
• Painful, pigmented lesions on the back of the vagina wall.
• Lesions on surgical scars.
• Tipped back (retroflexed) uterus that is hard to move.

The initial findings from a pelvic exam, coupled with the woman's complaints, may prompt the doctor to order a magnetic resonance imaging (MRI) or ultrasound scan.

Step 2: Ultrasound & MRI Scan

Imaging tests or scans may be used to identify individual endometrial lesions. The most common types are transvaginal scan and MRI scans. While these scans may be able to identify cysts/lesions on the ovary, they are not able to determine the nature of the cyst, nor distinguish it from any other cyst or condition, such as ovarian cysts. Also, smaller endometriosis cysts or implants may be missed as currently ultrasound machines are not sensitive enough to detect cysts smaller than 2cm in size. Additionally, if endometriosis exists in another part of the body, this will invariably be overlooked. As of today, there is still no test available which can reliably diagnosis the presence of endometriosis without an internal examination (laparoscopy). Neither MRI, CT scans, sonographys nor blood tests can be accurate in this regard. Recently there has been some talk of a new non-invasive test for endometriosis involving detecting nerve fibers in the endometrium of women with endometriosis. This research is still not conclusive or available on the market.

Tip:
Endometriosis Alternative Treatments
For a list of foods to help prevent the re-growth of endometrial implants.

Step 3: Laparoscopic Exploratory Surgery

The diagnosis of endometriosis can only be reliably confirmed by looking inside the pelvic region by an exploratory laparoscopy. This is a minor surgery usually carried out under general anesthesia. First the abdomen is inflated with gas through a small incision near the belly button. Then a small camera device with a light (laparoscope) is inserted through the navel. The surgeon views the internal organs on a TV screen. Also known as keyhole surgery this is one of the least invasive types of surgery available. Yet, even with exploratory surgery the lesions may be mistaken for those associated with another condition such as ovarian cysts or fibroids. For an accurate diagnosis of endometriosis, small biopsy samples should be obtained during the laparoscopy procedure. These biopsies when studied under a microscope may also show the presence of endometrial implants which are still too small for the naked eye to have observed. Read also, what are the stages of endometriosis?

Next: Endometriosis Treatment

  Related Articles on Endometriosis Diagnostics

For more female gynecological issues, see the following:

Can endometriosis be seen on ultrasound?
Causes of endometrosis: List of most likely culprits.

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