Endometriosis is a disease of the female reproductive system. It occurs when endometrium (the lining of the uterus) starts to grow outside the uterus. The endometrial tissue swells and sheds with the menstrual cycle. However, the tissues that have implanted elsewhere cannot be released through the uterus as with normal endometrial shedding. This causes symptoms such as pelvic pain and infertility. 

There are several methods that can be used to diagnose endometriosis, but because the symptoms are similar to those of many other conditions, most patients will have spoken to several physicians before being diagnosed.

Patient history

Some cases of endometriosis may have a genetic link, so physicians will discuss the medical history of the patient and her family to determine whether any of their relatives have been diagnosed with endometriosis.

Pelvic exam

During a pelvic exam, the doctor manually feels (palpates) the pelvis for abnormalities, such as cysts on reproductive organs or scars behind the uterus. However, it is not always possible to feel small areas of endometriosis unless a cyst has formed.

Imaging

There are several imaging techniques that can be used to diagnose endometriosis.

An ultrasound uses high-frequency sound waves to visualize the inside of the body. A wand-like device is used to capture the images. This device may be pressed against the abdomen or inserted into the vagina (a transvaginal ultrasound) to get an image of the reproductive organs. Ultrasounds may not definitively determine whether a patient has endometriosis but may be able to visualize cysts associated with endometriosis.

Computed tomography (CT) scans use an injected dye and an X-ray machine linked to a computer to get higher resolution images of the whole body. CT scans may be able to identify cysts or areas of implanted endometrial tissue outside the uterus.

Magnetic resonance imaging (MRI) is an imaging technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues within the body and can identify cysts caused by endometriosis. For some women, an MRI also may help with surgical planning, giving the surgeon detailed information about the location and size of endometrial implants that may need to be removed.

Surgery

Surgical procedures are used both to diagnose and treat endometriosis and are considered the surest method of confirming endometriosis. Laparoscopy is a surgical technique in which a small incision is made so that a small, telescope-like device can be inserted into the abdomen to look for endometrial lesions. The lesions, if found, may be biopsied — a small sample of the lesion is cut out and the tissue is examined on a slide to determine if it contains endometrial tissue.

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