Diagnosis
The symptoms of endometriosis are common in other medical conditions. We can not solely rely on the symptoms to diagnose the presence of the disease. This fact is mainly responsible for delays seen, in establishing the diagnosis of endometriosis. However, reporting and discussing your symptoms with your doctor will guide his diagnostic skills towards endometriosis.
The gold standard for the diagnosis of endometriosis is laparoscopy. During the operation, the doctor sees inside the abdomen, through a laparoscope. Endometriotic lesions can be identified and biopsies are taken, to histologically confirm its presence.
The disadvantages of laparoscopy are the cost and the invasiveness of the procedure. The surgeon should be experienced to be able recognize all forms of the disease, to take biopsies from the correct spots and to destroy the endometriotic spots either with a laser or a diathermy.
If the surgeon can not recognize all the intricate appearances of endometriosis, there is the risk of missing the diagnosis.
Physical examination of the patient, is not helpful most of the times, unless there is a large ovarian cyst or visible endometriosis on the cervix or the vagina.
A transvaginal ultrasound is very helpful for the diagnosis of ovarian cysts (endometrioma) or deep infiltrating endometriosis. In the last case, a Magnetic Resonance Imaging MRI can reveal the extend of the disease.
In cases of peritoneal endometriosis neither the transvaginal ultrasound nor the MRI have any indication.
Blood testing for CA-125 is not diagnostic of endometriosis.
The lack of a reliable diagnostic test for endometriosis is very frustrating for doctors and patients alike.