How is endometriosis diagnosed?

There are a variety of ways to diagnose endometriosis, but usually your doctor will begin by performing a pelvic exam. With a pelvic exam, your doctor can identify any cysts or scars that have developed.

Your doctor could also perform an ultrasound or laparoscopy to produce images of the endometrial buildup. Laparoscopy helps to diagnose endometriosis by providing pictures of displaced endometrial tissue. Laparoscopy involves several small incisions where your doctor can place a small scope. With this scope, your doctor can produce images of the area and identify any displaced endometrial tissue.

Lastly, your doctor might perform a blood test like the cancer antigen 125 (CA 125) to test for a protein that is commonly associated with endometriosis.

Laparoscopy helps to diagnose endometriosis by allowing the doctor to get a view inside the abdominal cavity. This enables the doctor to find the endometrial implants causing endometriosis pain. The doctor can potentially remove them to help with pain and other symptoms. Sometimes, tissue has to be removed and examined under a microscope to confirm it is an endometrial implant.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Endometriosis is a particularly difficult diagnosis, because it will not show up on an ultrasound or other imaging tests. That means that some women literally wait years for a diagnosis. The only definitive test to diagnose endometriosis is a laparoscopy. Your doctor looks at your abdominal organs using a small visualizing tool called a laparoscope.  A physician can view your abdomen through a small incision made near your navel and see the presence and extent of endometrium.

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Diagnosis of endometriosis is made by a combination of tests, including:

  • a careful history of the symptoms and menstrual cycle of the patient
  • a thorough pelvic examination
  • a laparoscopy, during which the abdominal cavity, the ovaries and other structures can be seen.

In couples with infertility, the approach first includes assessment of the male (semen analysis), the fallopian tubes (HSG) and some assessment of ovulatory status. In women with painful periods, inclusion of a laparoscopy is also warranted, since up to 40 percent of couples may have endometriosis diagnosed following this procedure.

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Doctors diagnose endometriosis with a laparoscopy.

Dr. Madeleine M. Castellanos, MD
Psychiatrist (Therapist)

The diagnosis of endometriosis can only be definitively diagnosed by having it directly viewed by laparoscopic surgery. But, it can often be suspected with a high degree of certainty by taking a careful history and good bimanual pelvic exam by the gynecologist. There are, however, women who never experience any symptoms of endometriosis, but find that they have difficulty conceiving. Because the scar tissue can form cysts around the ovaries and can also stick to the fallopian tubes, it can interfere with their movement and their ability to let an ovum pass into the uterus for fertilization. The result is that a large percentage of women with endometriosis cannot get pregnant naturally or have a higher chance of having an ectopic pregnancy (the fertilized egg implants in the fallopian tube instead of the uterus). Women with endometriosis that have been unable to get pregnant naturally may instead opt for IVF (in vitro fertilization) which bypasses the fallopian tubes entirely. If a woman with endometriosis does get pregnant, however, the nine months of suppressed periods can actually eliminate the endometriosis for many.

Gynecologists and reproductive endocrinologists (gynecologists who specialize in infertility and hormonal conditions) have the most experience in evaluating and treating endometriosis.

The condition can be very difficult to diagnose, however, because symptoms vary so widely and may be caused by other conditions.

The ways doctors diagnose the disease include the following:

  • Laparoscopy: Laparoscopy is the gold standard for the diagnosis of endometriosis and is commonly used for both diagnosis and treatment. Performed under general anesthesia, the surgeon inserts a miniature telescope called a laparoscope through a small incision in the navel to view the location, size and extent of abnormalities (such as adhesions) in the pelvic region.
  • Peritoneal tissue biopsy: During the laparoscopy, the doctor may remove a tiny piece of peritoneal tissue (the inner layer of the lining of the abdominal cavity) or other suspicious areas to help establish the diagnosis of endometriosis. This is recommended by the American College of Obstetricians and Gynecologists (ACOG), which notes that only an experienced surgeon familiar with the appearance of endometriosis should rely on visual inspection alone to make the diagnosis. A biopsy, however, is not mandatory to diagnose endometriosis, and a negative biopsy does not rule out the presence of this disease in other areas within the abdomen.
  • Ultrasonography, MRI and CT scan: An ultrasound uses sound waves to visualize the inside of your pelvic region, while a magnetic resonance imaging (MRI) uses magnets and a computed tomography (CT) scan uses radiation. While these tests can occasionally suggest endometriosis, particularly ovarian endometriotic cysts (endometrioma,) or rule out other conditions, none can definitively confirm the condition.
  • Pelvic exam: Your doctor will perform a physical examination, including a pelvic exam, to aid in the evaluation. The examination will not diagnose endometriosis but may allow your doctor to feel nodules, areas of tenderness or masses on the ovaries that may suggest endometriosis.
  • Medical history: A detailed medical history may offer your healthcare provider the earliest clues in making the correct diagnosis.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.