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Main article: Endometriosis Overview
Updated: 30-July-2024
Diagnosis of Endometriosis
Diagnosis of endometriosis is a slow multi-step process. Please see a doctor experienced with endometriosis like symptoms regardless of age to avoid delays in diagnosis. It is not uncommon to diagnose girls as young as 12 with endometriosis.
Source: Millischer A E, et al. (2022)
Dismissal of symptoms by doctors contributes to reduced self-esteem and depression.
Source: Bontempo A C, et al. (2021)
The doctor will then ask about your symptoms and signs before recommending some of the following tests for a clinical diagnosis:
- Pelvic exam
- Ultrasound
- Magnetic Resonance Imaging (MRI)
- Laparoscopy
A thorough pelvic examination includes vulvar inspection, speculum vaginal examination and a digital vaginal examination. This exam has a diagnostic accuracy of 0.76 (71% sensitivity. 69% specificity) which makes it a useful first step towards diagnosis of endometriosis whilst ruling out other conditions (e.g. myofascial syndrome). However this exam may not be suitable for everyone due to religion, previous sexual abuse, adolescent, virgin, excessive pain etc.
Source: Dabi Y, et al. (2024)
In any case, the 2022 ESHRE 2022 Guidelines allow medical professionals to confirm the presence of endometriosis by visual imaging alone. Although the exact accuracy of ultrasound and magnetic resonance imaging (MRI) for endometriosis varies according to the location. Ultrasound is a reliable diagnostic tool for ovarian endometriomas and rectal endometriosis. Ultrasound can also detect superficial endometriosis 50% of the time through the vagina. However MRI, with its large field of view, will usually find endometriosis in other locations. Therefore experts suggest the combination of a pelvic exam, ultrasound and MRI as the most accurate approach to diagnosing severe endometriosis, also known as deep infiltrating endometriosis.
It’s important to also check for other conditions (e.g. polyps) during imaging which are known to affect fertility.
Source: Hu Y, et al. (2023)
However, definitive diagnosis of endometriosis is only possible following laparoscopic examination, especially in cases of superficial peritoneal endometriosis. During this procedure, a small section (biopsy) of the lesion (or even ascitic fluid) is extracted and sent to the lab for analysis. Endometriosis is then confirmed if at least 2 of the following is found in the histopathologic evaluation; endometrial glands, endometrial stroma and / or hemosiderin-laden macrophages.
