Two of the big symptoms of endometriosis that can tip patients and doctors off to start looking for a diagnosis are debilitating pain and infertility. Endometriosis can be present, and can even be serious, without showing either of these two symptoms, but other symptoms of endometriosis can feel enough like a part of normal daily life that they won’t necessarily be investigated.
Symptoms provide a place for doctors to start looking for a diagnosis, and if a healthcare provider suspects a mild case of endometriosis, they may even assume a diagnosis, and begin to treat endometriosis, but the only definitive way to diagnose endometriosis is through a laparoscopy, which is a minimally invasive surgery.
Methods of detection
Laparoscopy has been described as the “gold standard” for diagnosing endometriosis, but limiting surgery when possible is generally agreed to be ideal. This means that a few other means of making a reasonable assumption of a diagnosis can be used in cases where endometriosis seems likely.
- Process of elimination: In getting ready to diagnose endometriosis, a healthcare provider might start by ruling out other possibilities for illnesses by running blood tests or testing vaginal cultures for infection, and by taking an ultrasound or MRI. The conditions being tested for in these ways might not be as common as endometriosis, which is a fairly common condition, but they’re easier and less invasive to test for, so it often makes sense to check for them first.
- Broad strokes: By doing a pelvic exam, where a healthcare provider uses their hands to check the pelvic area for abnormalities, the healthcare provider can often feel the cysts that can be caused by endometriosis, or scarring behind the uterus, which can also be a sign of endometriosis. Pelvic exams often can’t pick up smaller areas of endometriosis, though, and since not all cases of endometriosis cause cysts, this way of testing can’t rule endometriosis out by not finding anything. More than that, cysts can be caused by other conditions aside from endometriosis. This means that a pelvic exam doesn’t lead to any kind of definitive diagnosis, though it can come close enough for a healthcare provider to decide to treat as if for endometriosis and keep a close eye on the condition in the meantime.
- The only one: In the end, though, a laparoscopy is considered to be the definitive test for endometriosis. In a laparoscopy, a small incision near the belly-button allows a small probe to enter the abdomen, look around, and sometimes even take a biopsy of the tissue in the pelvis. Laparoscopy can give an idea of how much endometriosis is present and where, which can help to determine the course of treatment.
The future?
Even though laparoscopy is a fairly non-invasive surgery as surgical procedures go, needing surgery for a diagnosis isn’t ideal. In 2009, researchers published findings in the journal Human Reproduction that suggested that, instead of through surgery, endometriosis could be diagnosed by taking a biopsy and testing it for nerve fibers.
Since that time, other studies have questioned whether the presence of nerve fibers says anything definitive about an endometriosis diagnosis. Still, new ways to diagnose and to better understand endometriosis are being studied and investigated every day.
Sources
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Albert L. Hsu, Izabella Khachikyan, Pamela Stratton. “Invasive and non-invasive methods for the diagnosing of endometriosis.” Clin Obstet Gynecol. 53(2): 413–419. September 2010. Web.
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European Society for Human Reproduction and Embryology. “Quick And Accurate Way Of Diagnosing Endometriosis.” ScienceDaily. ScienceDaily, 19 August 2009. Web.
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Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull M. “Imaging tests for the non-invasive diagnosis of endometriosis.” Cochrane. Cochrane, February 26 2016. Web.
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C. Leslie, T. Ma, B. McElhinney, R. Leake, CJ Stewart. “Is the detection of endometrial nerve fibers useful in the diagnosis of endometriosis?” Int J Gynecol.32(2):149-55. Web. March 2013.
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“Endometriosis: A Guide for Friends, Siblings, and Significant Others.” youngwomenshealth. Boston Children’s Hospital, July 30 2014. Web.
