Diagnosing Endometriosis

The diagnosis of endometriosis actually comes as a relief to many women. For some, it means there is a name for the pain from which they have suffered for years. For others, it means they now know a possible cause of the infertility they are hoping to overcome.

Suspicion of endometriosis is based on the patient’s history and description of symptoms, as well as the presence of pelvic pain and/or palpable nodules during a physical examination. These findings are only suggestive of the disease.

Diagnostic tests such as ultrasound can be used in the evaluation of a patient with suspected endometriosis. Ultrasound uses sound waves to create an image of tissues and organs. This can help locate a “chocolate cyst” or masses felt during the pelvic exam.

On rare occasions, other imaging studies such as computed tomography scans (CT scans) or magnetic resonance imaging (MRI) can be used to provide additional information that may lead to a diagnosis of endometriosis.

The only way to be sure that endometriosis is present is to perform a biopsy (removal of a sample of tissue) and examine the tissue under a microscope in a laboratory. A biopsy can be taken during a laparoscopy, which is a procedure that allows a physician to look inside the pelvis and abdomen. An instrument called a laparoscope is inserted into a small incision next to the navel and the abdomen is inflated. A camera and light attached to the laparoscope allows doctors to search directly for abnormalities, scarring or any evidence of endometriosis. However, in the majority of cases, the diagnosis is made by the visual appearance of the implants of endometriosis at the time of surgery.

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