Endometriosis is diagnosed primarily through a combination of clinical evaluation and surgical confirmation.

Diagnostic Process

1. Clinical Evaluation

• A healthcare provider will start by taking a detailed history of symptoms such as pelvic pain, painful periods, and infertility, and perform a pelvic exam to feel for abnormalities like cysts, nodules, or scars

• Imaging tests such as ultrasound (especially transvaginal ultrasound) and magnetic resonance imaging (MRI) may be used to detect larger endometriosis lesions like ovarian cysts (endometriomas) or deep infiltrating nodules

• However, imaging cannot reliably detect small or superficial lesions or pelvic adhesions, so a normal scan does not rule out endometriosis

2. Definitive Diagnosis: Laparoscopy

• The only definitive way to diagnose endometriosis is through laparoscopy, a minimally invasive surgery performed under general anesthesia

• During laparoscopy, a surgeon makes a small incision near the navel and inserts a laparoscope (a thin camera) to visually inspect the pelvic organs for endometrial tissue outside the uterus.
• Suspicious lesions can be biopsied during the procedure for microscopic confirmation by a pathologist, which is required for a definitive diagnosis

• Laparoscopy also allows for simultaneous treatment, such as removal or destruction of endometriotic tissue

Summary

Diagnostic Method| Role in Diagnosis| Limitations
---|---|---
Pelvic Exam| Initial assessment for abnormalities| Cannot detect small or deep lesions
Ultrasound (transvaginal)| Identifies ovarian cysts and deep nodules| Cannot detect superficial lesions or adhesions
MRI| Detailed imaging for complex or deep lesions| Expensive, less available, misses superficial lesions
Laparoscopy| Gold standard; direct visualization and biopsy| Invasive surgery, requires anesthesia

In conclusion, while symptoms, pelvic exams, and imaging help guide suspicion, laparoscopy with biopsy remains the only definitive method to diagnose endometriosis