Endometriosis - Diagnosis

It typically occurs women who have uterine fibroids and in women between the ages of 40 and 50, and who have had children.

Fibroid tumors may not need to be removed if they are not causing pain, bleeding excessively, or growing rapidly.

There is some evidence that newer IUDs called levonorgestrel-releasing intrauterine systems (LNG-IUS) may be useful in treating them. A procedure called uterine artery embolization may also be helpful.

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Other Causes of Pelvic Pain. Many conditions cause pelvic pain that may or may not be related to menstruation (called dysmenorrhea). Some causes of pelvic pain can be serious and should be ruled out.

Conditions other than endometriosis that cause dysmenorrhea include the following:

Uterine fibroids
Pelvic inflammatory disease (which is a result of infections in the pelvic area)
Miscarriage
Ectopic pregnancy

Click the icon to see an image of an ectopic pregnancy.

Pelvic cancer (rare)
Uterine polyps
The use of an intrauterine device (IUD) for contraception

Conditions that may mimic symptoms of endometriosis but which are unrelated to problems in the reproductive organs include the following:

Severe kidney or urinary tract infections
Celiac disease
Appendicitis
Interstitial cystitis
Inflammatory bowel disease
Diverticulitis
Irritable bowel syndrome

Physical Examination

The physician may be able to feel tender masses or nodules during a pelvic examination, but these signs can indicate many conditions and do not necessarily mean endometriosis is present.

Diagnostic Procedures

Laparoscopy. Diagnostic laparoscopy, an invasive surgical procedure, is currently the only definitive method for diagnosing endometriosis. Laparoscopy normally requires a general anesthetic, although the patient can go home the same day.

Click the icon to see an image of laparoscopy.

The procedure is as follows:

The surgeon makes tiny abdominal incisions through which a fiber optic tube, equipped with small camera lenses, is inserted. The physician uses these devices to view the uterus, ovaries, tubes, and peritoneum (lining of the pelvis) on a video monitor.
Carbon dioxide gas is injected into the abdomen, distending it and pushing the bowel away so that the physician has a wider view.
A blue dye may be flushed through the fallopian tubes to determine blockage; if there is an obstruction, the dye will not flow through the tube.
If the surgeon needs to remove small endometrial cysts or other lesions during the procedure (operative laparoscopy), tiny surgical instruments are passed through a tube.