Endometriosis - Diagnosis

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It typically occurs women who have uterine fibroids, women between the ages of 40 and 50, and women have had children. [For more information on fibroids, see In-Depth Report #73: Uterine fibroids.]

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

• 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:

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

Physical Examination

The doctor 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 doctor 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 doctor 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.