Diagnosis of Endometriosis

Endometriosis is a common condition that affects women. It is a painful disorder in which tissue that normally line the inside of your uterus — the endometrium — is present outside the uterus. If your symptoms are suggestive of endometriosis the doctor will recommend tests to confirm the diagnosis.

History and physical examination: The doctor will take a detailed history and try to rule out other conditions that can cause pelvic pain. Your doctor will ask you to describe your symptoms, such as the location of your pain, relation to menstrual cycle and when it occurs and other questions such as:

• do you have heavy bleeding during menstrual cycle?
• is there any spotting in between periods?
• has the severity of pain become worse over time?
• do you have pain after sexual intercourse?

Tests which may be done to check for endometriosis include:

Pelvic exam: In this exam the doctor inserts two fingers in the vagina to feel (palpate) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. In women who have small areas of endometriosis the doctor may not feel anything abnormal unless they've caused a cyst to form.

Ultrasound: This is a painless and non-invasive test. It uses high-frequency sound waves which cannot be heard by human ears to obtain information about structures inside the body. The pattern of the echoes produced when the sound waves are reflected from the internal structure creates a picture called a sonogram. The radiologist can differentiate normal and abnormal pattern on organs inside the body on this picture. In women with endometriosis vaginal ultrasound may be done. In this test a wand-shaped scanner (transducer) is inserted into your vagina to look for abnormalities in the pelvic area. Ultrasound of the pelvis can be done via the abdomen as well. In this a small scanner is moved across your abdomen. In both the tests image of your reproductive organs is formed. In this image it is not possible to diagnose endometriosis but it can help to identify cysts associated with endometriosis (endometriomas).

Laparoscopy: This is the definitive test for diagnosis of endometriosis. During this test a laparoscope is inserted from the abdominal wall to look inside your abdomen (direct visualization) for signs of endometrial implants. It is a minor surgical procedure for which you will be given a general anaesthesia before the procedure begins. A tiny incision is made near the navel, to insert the laparoscope inside the abdomen. By moving the laparoscope around, the doctor can see pelvic and other abdominal organs, and can look for signs of endometrial tissue outside the uterus. It gives the doctor detailed information about the location, extent and size of the endometrial implants. This information is useful as it helps your doctor to plan treatment.