Diagnosis

The diagnosis of endometriosis may be suspected because of one or more of the symptoms but there is a considerable overlap of symptoms with other conditions such as irritable bowel syndrome and pelvic inflammatory disease. As a result there is often a delay between symptom onset and diagnosis.

 

  • Vaginal examination is usually normal although at times nodules can be felt within the vagina in the region of the uterosacral ligaments. Deep nodules are most reliably detected when a vaginal examination is performed during a period.
  • In some women, infertility may be the only symptom. The patient is often the best person to judge whether endometriosis is present or not. Once the nature of the symptoms are understood, or the disease has occurred previously, the accuracy of the patient making the diagnosis is high
  • The disease often commences in the teens. Unfortunately, diagnosis in young women is often delayed because of difficulty in distinguishing endometriosis from the more common type of menstrual pain due to prostaglandin excess,
  • Transvaginal ultrasound (TVS) may be helpful to diagnose ovarian endometriomas
  • CT and MRI imaging are of limited value
  • CA125 blood test is of virtually no value as it is very non-specific and can be elevated for lots of reasons.

For a definitive diagnosis of endometriosis visual inspection of the pelvis at laparoscopy is the gold standard investigation. Some of the affected tissue is removed and examined under a microscope. This is called histological examination. Positive histology will confirm the diagnosis, however, negative histology does not exclude it.

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