Diagnosis of Endrometriosis

The Gold Standard of diagnosis is excision of endometriosis tissue via laparoscopy. But laparoscopy requires anesthesia and is an expensive procedure therefore a diagnosis must be established before laparoscopy is implemented as a one-stop see and treat measure. Therefore it must be done by people who specialise in endometriosis excision.

Clinical History :

Endometriosis is highly suspected if the patient complains of dysmenorrhoea (Painful periods), dyspareunia (Painful sexual intercourse), abnormal bleeding and subfertility.

Special attention must be paid to symptoms like nosebleeds, hematochezia (blood in stools) and blood in urine among others which would lead one to a suspicion of extra-genital endometriosis.

Clinical Examination:

A vaginal and rectal exam is ideally performed to feel for nodularity and mobility of the uterus. If any nodularity is noted then one will suspect deep endometriosis.

Adnexal masses on palapation may be suggestive of endometriomas.

In young girls a vaginal exam may not be possible, so a rectal exam may be performed in select cases.

Ultrasonography:

Transvaginal ultrasound is the best non invasive method to diagnose endometriosis. It may reveal cysts, rectovaginal nodules and adherent ovaries. It may not reveal much peritoneal disease. In younger girls who are not sexually active a transrectal approach is much better for diagnosing endometriosis than a transabdominal one.

MRI:

Useful in detecting rectovaginal disease but not much better than a well performed ultrasound.

Gynecologists should ideally perform their own ultrasound rather than relying on a sonologist who doesn’t focus solely on endometriosis.

Laparoscopy:

As mentioned before laparoscopy is the gold standard for diagnosis of endometriosis. The advanced optics and modern imaging modalities with HD, 4K, 3D and Near-Infra Red Imaging systems improve visual acuity in identifying lesions as never before. The corollary to this is that the surgeon should know what to look for. Subtle endometriosis lesions may be missed if he/she hasn’t seen them before.