15/05/09

How to diagnose endometriosis?



Although endometriosis is the most commonly diagnosed uterine disorder, it is often misdiagnosed or missed altogether.

Approach to Diagnosing Endometriosis

Endometriosis frequently begins to develop in adolescence, but it is not typically diagnosed until a woman is in her midtwenties or early thirties. There are a number of reasons for this:

  • First, the symptoms vary widely, and sometimes do not occur at all. Some women, then, do not know they have endometriosis until they fail to become pregnant and seek help for infertility.
  • Also, pain in the pelvic or abdominal area can be caused by so many conditions that it is often difficult to pin down the precise cause [see Ruling out Conditions with Similar Symptoms below].


Endometriosis should be highly suspected in women with severe menstrual cramps who also have infertiliy.

LAPAROSCOPY, AN INVASIVE DIAGNOSTIC PROCEDURE, IS THE ONLY DEFINITIVE METHOD FOR DIAGNOSING ENDOMETRIOSIS.



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. 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 surgeon uses these devices to view the uterus, ovaries, tubes, and peritoneum (lining of the pelvis). (see atlas for laparoscopic views of endometriosis)
  • 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. [See the Surgical Treatments for Endometriosis?]


The procedure is used for detecting and staging endometriosis to determine its severity. [ See Staging of Endometriosis.]

Imaging Techniques

An ultrasound is performed in cases where other conditions are suspected, such as uterine fibroids, ovarian cysts, or ectopic pregnancy. This non-invasive imaging technique can detect endometriomas, or cysts that are usually located on the ovaries and filled with thick dark blood. Ultrasound can also pick up larger cysts, but will miss smaller cysts, or small and shallow endometrial implants on the surface of ovaries, or on the peritoneum (lining of the pelvis).



Once a diagnosis is made, more sophisticated imaging techniques, such as computed tomography (CT) scanning or magnetic resonance imaging (MRI), may be used to obtain a more accurate image of severe endometriosis, but these techniques are expensive and are not useful in reaching a diagnosis of endometriosis.

Biologic Markers for Endometriosis

Investigators are studying certain chemicals detected in blood tests that may prove to help diagnose endometriosis and so avoid invasive diagnostic procedures in many women. Among the most studied to date is CA-125, which is elevated in women severe endometriosis.

Higher levels of CA-125 occur in many other diseases, however, including ovarian cancer, so results using this test alone do not provide enough information for a definitive diagnosis of endometriosis

Ruling out other conditions with pelvic pain

Many conditions cause pelvic pain. In many cases, the cause is unknown and it often resolves on its own.. Some causes of pelvic pain can be serious and should be ruled out during a work-up for endometriosis.

Primary Dysmenorrhea.

Primary dysmenorrhea is recurrent pelvic pain associated with menstruation whose cause is unknown.

Adenomyosis.

A condition called adenomyosis occurs when nodules (knots) of endometrial tissue develop within the deep muscle layers of the uterus. This disorder is often classified with endometriosis, but it actually is a different disease. Adenomyosis is a significant cause of severe pelvic pain and menstrual irregularities. Advanced imaging techniques using ultrasound and magnetic resonance imaging scans may be able to detect it.It typically occurs women who have uterine fibroids and in women between the ages of 40 and 50, and who have had children.

Other Causes of Pelvic Pain.

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.
  • 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

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