Is there a test to diagnose endometriosis?
Obstetrician-gynecologists (OB-GYNs) are the type of doctors that commonly treat endometriosis.
Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations. Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along with the ligaments that attach to the pelvic wall. At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
Unfortunately, neither the symptoms nor the physical examinations can be relied upon to conclusively establish the diagnosis of endometriosis. Imaging studies, such as ultrasound, can help rule out other pelvic diseases and may suggest the presence of endometriosis in the vaginal and bladder areas, but they cannot reliably diagnose endometriosis. For an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as a tissue biopsy of the implants are necessary.
As a result, the only definitive method for diagnosing endometriosis is surgical. This requires either laparoscopy or laparotomy (opening the abdomen using a large incision).
Laparoscopy is the most common surgical procedure commonly employees used for the diagnosis of endometriosis. This is a minor surgical procedure performed under general anesthesia, or in some cases under local anesthesia. It is usually performed as an outpatient procedure (the patient does not stay in the facility overnight). Laparoscopy is performed by first inflating the abdominal cavity with carbon dioxide through a small incision in the navel. A thin, tubular viewing instrument (laparoscope) is then inserted into the inflated abdominal cavity to inspect the abdomen and pelvis. Endometrial implants can then be directly seen.
During laparoscopy, biopsies (removal of tiny tissue samples for examination under a microscope) can also be performed to obtain a tissue diagnosis. Sometimes random biopsies obtained during laparoscopy will show microscopic endometriosis, even though no implants are visualized.
Pelvic ultrasound and laparoscopy are also important in excluding malignancies (such as ovarian cancer) which can cause many of the same symptoms that mimic endometriosis symptoms.