What is involved in an endometriosis diagnosis?

Endometriosis is a chronic health condition that can significantly impact the quality of life of any women affected.

Here to provide a detailed insight into endometriosis, including diagnosis and treatment, is Mr Alfred Cutner, highly experienced consultant gynaecologist in London.

Is it difficult to diagnose endometriosis? Why/why not?

The first thing that a specialist must do when a woman presents with symptoms of endometriosis is to try and determine a possible diagnosis for those signs. If a woman has endometriosis, she will typically present with: painful periods; pain in the bowels; pain during urination; pain during sex; fertility issues.

After this, an abdominal examination is done to feel for any masses in the tummy. If a woman already has had sex, then an internal examination is also done to look for a womb that is not very mobile, or for endometriosis nodules.

Following this stage, appropriate investigations are ordered, which are either a vaginal ultrasound scan or an MRI scan, if the ultrasound is not possible. These scans should always be carried out by a specialist who is an expert at both performing and reporting the procedures. It is important to know, however, that even if both scans suggest endometriosis, there is a chance that this might be a misdiagnosis.

The only way to completely confirm a diagnosis of endometriosis is by performing a laparoscopy, a keyhole procedure that allows a specialist to look inside of the tummy and the pelvis for endometriosis tissue. However, this is an operation that carries certain risks and benefits which need to be discussed, to determine whether the procedure is justified.

Can the symptoms of endometriosis be confused for any other conditions?

All of the pelvic organs are located in close proximity to each other. This means that symptoms of pelvic organ disorders can sometimes be confused with symptoms of endometriosis.

Take for example, functional bowel disorders, which cause pain at the opening of the bowels. The bowel is sensitive to the hormonal cycle and thus, bowel pain can sometimes coincide with period pain. As a result, patients can believe that their pain is related to endometriosis, when in fact, it is due to a functional bowel disorder. The same thing can occur with painful bladder syndrome and with pain during intercourse.

The other issue to take into account is that pain is also a learnt phenomenon, whereby it is very hard to unlearn pain once pain has been felt. This means that if patients get pain in one area, this can cause pain to arise in another area. Thus, endometriosis can sometimes be confused with both colorectal and urogynaecological conditions.

How is a definitive diagnosis of endometriosis made?

The gold standard for diagnosing endometriosis in the pelvis is through a laparoscopy. In some cases, this is also supported by a positive histology, which is the microscopic study of cells and tissues that signify diseases.

What implications does an endometriosis diagnosis have for women? Can it affect fertility?

An endometriosis diagnosis can impact women in two ways.

Firstly, a diagnosis can help to put a name to the condition, allowing women to address their symptoms appropriately and work out a way to move forward.

Secondly, a diagnosis can be a factor in women’s fertility. Although, generally, there is a direct correlation between the progression of the condition and the severity of symptoms, this is not always the case. This means that some women can have very severe endometriosis but have no symptoms or fertility issues, while others can have mild endometriosis but have significant symptoms and fertility issues. An endometriosis diagnosis can be helpful in these scenarios by allowing a couple to move forward and perhaps consider IVF, if that is more appropriate.

Does endometriosis always require treatment?

There are relative indications and absolute indications with treatment for endometriosis (particularly surgical treatment).

If endometriosis symptoms are mild and easily manageable with simple analgesics or hormone therapy, then surgery is usually not needed. However, if endometriosis is very severe and either: causes obstruction of the ureters; causes obstruction of the bowel; or causes a large abdominal mass, then surgery is required.

Fertility issues may require treatment if a woman wishes to become pregnant. If she does not, then there is no need for treatment.

Is there a cure for endometriosis?

Currently, there is no cure for endometriosis.

However, treatment can help to manage symptoms, allowing women to at least complete their reproductive life (and even reach menopause without endometriosis affecting their quality of life) before considering more definitive treatment, like a hysterectomy.

Mr Alfred Cutner is a highly esteemed consultant gynaecologist with more than 35 years of experience. If you require expert diagnosis and treatment for endometriosis, do not hesitate to visit Mr Cutner’s Top Doctors profile today.