How do healthcare providers diagnose endometriosis?

Surgery is currently the only way to confirm a diagnosis of endometriosis.

The most common surgery is called laparoscopy.

In this procedure:

  • The surgeon uses an instrument to inflate the abdomen slightly with a harmless gas.
  • After making a small cut in the abdomen, the surgeon uses a small viewing instrument with a light, called a laparoscope, to look at the reproductive organs, intestines, and other surfaces to see if there is any endometriosis.
  • If patches of tissue are present, the surgeon examines them to determine whether they are endometriosis and, if so, at what stage they might be.
  • In some cases, the surgeon will also do a biopsy, which involves taking a small tissue sample and studying it under a microscope, to confirm the diagnosis.1
  • The most common surgery is a laparoscopy, but sometimes a laparotomy—a surgical procedure involving a larger incision—is used to make a diagnosis.

Healthcare providers may also use imaging methods to produce a “picture” of the inside of the body. Imaging allows them to locate larger endometriosis areas, such as nodules or cysts. The two most common imaging tests are ultrasound, which uses sound waves to make the picture, and magnetic resonance imaging (MRI), which uses magnets and radio waves to make the picture. These types of imaging do not help diagnose small lesions or adhesions.1

Your healthcare provider will perform a laparoscopy only after learning your full medical history and giving you a complete physical and pelvic exam. This information and exam, in addition to the results of an ultrasound or MRI, will help you and your healthcare provider make more informed decisions about treatment.

Researchers are also seeking less invasive ways to diagnose endometriosis and determine how severe it is. NICHD-funded researchers in the National Centers for Translational Research in Reproduction and Infertility created a “diagnostic classifier” for endometriosis based on the presence of particular genes. The classifier was 90% to 100% accurate. Once the classifier is validated, a simple biopsy in the doctor’s office may be a nonsurgical way to diagnose endometriosis in most women.2

Citations

  1. American College of Obstetricians and Gynecologists. (2010, reaffirmed 2018). Management of endometriosis. Practice Bulletin No. 114. Washington, DC. Retrieved February 11, 2020, from https://insights.ovid.com/article/00006250-201007000-00041 external link
  2. Tamaresis, J. S., Irwin, J. C., Goldfien, G. A., Rabban, J. T., Burney, R. O., Nezhat, C., et al. (2014). Molecular classification of endometriosis and disease stage using high-dimensional genomic data. Endocrinology, 155(12), 4986–4999. Retrieved February 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239429/
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