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How is the diagnosis of endometriosis carried out?

By Dra. Elisa Pérez Larrea.
Last Update: 11/16/2021

The diagnosis of endometriosis is often difficult and can be delayed for up to 10 years. The main symptom that should guide the physician to suspect this pathology is pain, typically at the time of menstruation (dysmenorrhea), although in many cases it can appear in other forms such as dyspareunia, dyschezia or chronic pelvic pain. There is also a percentage of patients between 15 and 30% who remain asymptomatic.

A detailed anamnesis, followed by a gynecological examination including speculoscopy and vaginal examination will be the initial steps for diagnosis. As complementary tests, we can use the following:

Transvaginal ultrasound
is the most useful test for the diagnosis of endometriosis, as it can detect endometriomas (endometriosis cysts in the ovaries), as well as signs of adenomyosis. The Doppler study as an additional test can differentiate endometriomas of atypical pattern, improving diagnostic accuracy. In addition, nowadays, high resolution and 3D allow, making a correct preparation, to detect deep endometriosis lesions.
Magnetic resonance imaging (MRI)
It has a sensitivity for ovarian endometriosis similar to transvaginal ultrasound, although its cost is higher. It is a very accurate test for the diagnosis of deep and extragenital endometriosis (intestinal, urinary, pulmonary). MRI allows retroperitoneal study and nerve root involvement. It would be advisable to always perform this test prior to surgical treatment, as it can detect distant endometriosis foci, thus helping to plan surgery.
Analytics with markers
Currently, no valid marker is available for the diagnosis of endometriosis. CA-125 can be seen to have elevated levels in this pathology, but the sensitivity and specificity of this marker is low, so it is not used in the diagnostic protocol for endometriosis.
Laparoscopy
is considered the reference test for the diagnosis of ovarian, peritoneal and deep endometriosis, being the histopathological study of the lesions the gold standard for its diagnosis. However, the use of exploratory laparoscopy is not recommended as a diagnostic technique for endometriosis. In asymptomatic patients, endometriosis may be diagnosed incidentally during a laparoscopy performed for another reason. In symptomatic patients with suspected or diagnosed endometriosis, laparoscopy will be performed only as a treatment for the pathology.
Ecografía abdominal
puede ayudar a descartar endometriosis en otras localizaciones como vejiga, riñones o uréteres.

In particular, laparoscopy should be performed when the woman is menstruating, as it facilitates visualization of the endometrial implants.

Suggested for you: Diagnosis of endometriosis: analytical and imaging tests.

Dra. Elisa Pérez Larrea
Dra. Elisa Pérez Larrea
MD, MSc
Gynecologist
Dr. Elisa Pérez Larrea is a graduate in Medicine and Surgery from the University of Zaragoza and a specialist in Obstetrics and Gynecology from the University of Oviedo. She also has a Master's degree in Human Reproduction from the Complutense University of Madrid.
Licence number: 203311163
Gynecologist. Dr. Elisa Pérez Larrea is a graduate in Medicine and Surgery from the University of Zaragoza and a specialist in Obstetrics and Gynecology from the University of Oviedo. She also has a Master's degree in Human Reproduction from the Complutense University of Madrid. Licence number: 203311163.