Endometriosis is not straight-forward to diagnose. The European Society of Human Reproduction and Embryology (ESHRE) guidelines state that definitive diagnosis of most forms of endometriosis requires visual inspection of the pelvis using laparoscopy.
Work to identify a reliable biomarker of the condition that could be measured in the blood or urine has to date been unsuccessful. There is optimism that the use of transvaginal ultrasounds might replace the more invasive, surgical techniques currently in use. However, the equipment and level of expertise required, have so far limited their use.
Most doctors will follow a step-by-step approach when it comes to making an endometriosis diagnosis.
1) Pelvic exam. Some endometrial lesions may be palpable through the abdomen.
2) Ultrasound/MRI. These imaging techniques may identify abnormal masses, although they will not usually be able to discern the exact composition of any lesions.
3) Blood test. Until a reliable marker is found, blood tests are used predominantly to rule out other conditions.
4) Treatment. For those unwilling to undergo surgery, treating with some of the medications known to improve endometriosis symptoms, might give circumstantial support to a diagnosis.
5) Laparoscopy. The current ‘gold standard’ for diagnosis. A cut is made in the abdomen and the doctor uses a camera to explore the inside of the pelvic cavity in detail. During this process visible lesions can be removed and tissue biopsies can be taken for further testing.
The main thing is to find an approachable doctor, who will talk you through each step of the diagnostic process.
- Kennedy, S, et al. “ESHRE Guideline for the Diagnosis and Treatment of Endometriosis.” Human Reproduction, vol. 20, no. 10, Oct. 2005, pp. 2698–2704., doi:10.1093/humrep/dei135 .
- “The Path to Diagnosis May Not Always Be Simple.” SPEAKENDO.com, AbbVie, www.speakendo.com/about-endometriosis/testing.