It may take some time to get a diagnosis as the symptoms of endometriosis can be wide-ranging and are very similar to other common conditions.
If you suspect you have endometriosis keep a symptom diary and discuss your symptoms with a GP or gynaecologist that specialises in endometriosis. In New Zealand you can refer yourself to a gynaecologist in private practice otherwise you will need a referral from a GP. If you have medical / health insurance your policy may cover the fees associated with the gynaecologist appointment and treatment options.
Endometriosis can only be diagnosed by a laparoscopy, an operation that is performed under general anaesthetic in which a camera (laparoscope) is inserted into the pelvis via a small cut near the navel. The camera is used to see the pelvic organs and to look for any signs of endometriosis.
During the surgery tissue that is suspected to be endometriosis is removed and sent to a pathologist for examination and diagnosis. A laparoscopy is also a treatment option as during the operation the surgeon can remove patches, cysts and adhesions and also repair any damage caused by endometriosis.
Your GP may suggest you have endometriosis based on your symptoms, medical history and family history.
The doctor may suggest trying medical treatment without a definitive diagnosis to reduce your symptoms. Options for medical treatment are analgesics, hormonal contraceptives or progestogens. If these treatments help relieve your symptoms you may decide not to undergo laparoscopy.
Ultrasound, MRI, CT-Scan and CA-125
Endometriosis can sometimes be felt on vaginal examination or an endometriotic cyst, ovarian endometriosis or deep endometriosis may seen on an ultrasound scan.
In established deep endometriosis an MRI can be used to assess the extent of endometriosis.
A blood test measuring a protein, CA 125, may also assist in diagnosis as the protein can be raised in endometriosis. However a raised level is not specific to endometriosis but indicates irritation or inflammation inside the body and can also be raised with appendicitis, pelvic infection and ovarian cysts.
A normal vaginal examination or a normal scan does not exclude endometriosis.
Stages of Endometriosis
Endometriosis is often classed as mild, moderate or severe or may be recorded in your medical notes as Stage I, Stage II, Stage III or Stage IV.
Mild or Stage I
Appears as small patches or surface lesions scattered around the pelvic cavity, with no scarring.
Moderate or Stage II - III
Appears as large patches or patches that are more widely spread. They may be attached to the ovaries, fallopian tubes, uterosacral ligaments and the Pouch of Douglas. Cysts may be present and are often associated with significant scarring.
Severe of Stage IV
At Stage IV endometriosis affects most of the organs in the pelvic cavity, often with severe scarring. The uterus, ovaries, fallopian tubes, bowel, bladder, uterosacral ligaments and the Pouch of Douglas are often held down by adhesions.