• Diagnosis of Endometriosis

    The doctor will ask you about your symptoms, take a medical and family history, and perform a pelvic exam. If your family history, medical history, and/or medical examination support the possibility of endometriosis your doctor may want to do additional studies to determine whether you have endometriosis.
    There are differing approaches. The "old school" approach advocates a certain diagnosis and classification of the severity of endometriosis before giving any therapy for possible endometriosis. In contrast, those practicing the "new school" approach advocate a therapeutic trial in patients who are deemed likely to have endometriosis, without requiring surgical confirmation. The latter is most often used when the patient’s primary symptom is pain, and there is no immediate desire for fertility.
    If your doctor suspects you have endometriosis, he or she may perform the following tests:
    Ultrasound—Transvaginal ultrasound appears to be a useful test both to make and to exclude the diagnosis of an ovarian endometrioma (growth of endometriosis and old blood within the ovary).
    Laparoscopy —A laparoscope is a small telescope that is inserted into your abdomen through small cuts made on your lower abdomen. This brings light into the abdomen and the doctor can then see inside. A very small video camera can project images from inside your abdomen onto a video screen. This process allows for the detection of endometrial tissue outside of the uterus. The size, number, and location of this tissue can then be determined. This is a minor surgical procedure done on an outpatient basis under anesthesia.
    Biopsy —A biopsy is a small sample of tissue that is taken to test for the presence of a disease. Tissue samples are taken when laparoscopy is performed. These tissue samples are then viewed under the microscope for features associated with endometriosis.

    References

    American Academy of Family Physicians website. Available at: http://www.aafp.org . Accessed March 2, 2006.

    The American College of Obstetricians and Gynecologists. The Management of Endometriosis . Practice Bulletin No. 114. July 2010.

    Gabbe, SG et al. Obstetrics: Normal and Problem Pregnancies . 5th ed. London: Churchill Livingstone, 2007.

    Griffith’s 5-Minute Clinical Consult . New York, NY: Lippincott Williams and Wilkins; 1999.

    Katz VL et al. Comprehensive Gynecology . 5th ed. St. Louis, MO: Mosby; 2007.

    Kistner’s Gynecology and Women’s Health . 7th ed. St. Louis, MO: Mosby-Year Book; 1999.

    Howard FM. An evidence-based medicine approach to the treatment of endometriosis-associated chronic pelvic pain: placebo-controlled studies. J Am Assoc Gynecol Laparoscopists . 2000;7(4):477-488.

    Farquhar C, Sutton C. The evidence for the management of endometriosis. Curr Opinion in Obstetr & Gynecol . 1998;10(4):321-332.

    Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound in Obstetr & Gynecol . 2002;20(6):630-634.

    National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/ . Accessed March 1, 2006.

    National Library of Medicine website. Available at: http://www.nlm.nih.gov/ . Accessed March 2, 2006.

    National Women’s Health Resource Center website. Available at: http://www.healthywomen.org/ . Accessed March 1, 2006.

    Rakel RE, Bope ET. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

    Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG . 2004;111(11):1204-1212.

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