Endometriosis

To see whether your symptoms are caused by endometriosis, your health professional first will:

• Talk to you about your family and medical history, symptoms, and menstrual periods.
• Do a pelvic exam. This often includes checking both the vagina and rectum, where endometriosis sometimes forms.

If your exam, symptoms, and risk factors strongly suggest that you have endometriosis, your health professional may suggest that you first try nonsteroidal anti-inflammatory drug (NSAID) and/or hormone therapy before you have other tests. If treatment improves your symptoms after a few months, the diagnosis of endometriosis is more certain.

Possible ovarian endometrioma

If your health professional feels an abnormal mass on an ovary during the pelvic exam, you may have an endometriosis-filled cyst on an ovary (ovarian endometrioma) or other problems. The following tests can be used to evaluate a mass:

• A transvaginal ultrasound uses a probe that is inserted into the vagina. A computer processes the sounds waves to create a picture of the internal organs on a computer screen. Transvaginal ultrasound can detect endometriomas but not scar tissue. It is sometimes recommended before starting infertility treatment.¹
• A CT scan uses X-rays to produce a cross-sectional picture of internal organs.
• An MRI uses a magnetic field and pulses of radio-wave energy to provide pictures of internal organs. MRI can help a doctor tell the difference between an endometrioma and another type of ovarian growth.

Further testing

Laparoscopy is the most common surgical procedure used to diagnose and treat endometriosis. But laparoscopy is not always needed. It is usually done when infertility requires rapid treatment and probable surgery or when treatment has not relieved pain or infertility. If your doctor recommends a laparoscopy, it will be used to look for and possibly remove implants and scar tissue. During the same procedure, the doctor can:

• View the internal organs, looking for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a "no endometriosis" diagnosis is never certain—growths (implants) can be tiny or hidden from the doctor's view.
• Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. A doctor uses one or more techniques, including cutting and removing growths (excision) or destroying them with a laser beam or electric current (electrocautery). If an endometriosis cyst is found growing on an ovary (endometrioma), the cyst is likely to be removed.