As many as 10% of women are affected by endometriosis1and for many, getting an accurate diagnosis can take up to seven years2. As the endometrial tissue grows outside of the uterus, it can cause a range of symptoms and be extremely painful. The condition may affect various organs such as ovaries, fallopian tubes, uterus, and the tissue lining your pelvis. For women living with such a condition, reaching an accurate diagnosis can be life-changing as it is the first step in beginning treatment. But does endometriosis show up on tests, and how does a doctor reach a diagnosis?
Begin By Discussing Your Symptoms with a Doctor
There is a sizable overlap between various gynaecological conditions, and the symptoms of endometriosis can vary, which may lengthen the diagnostic and testing process. For this reason, before your doctor begins running tests, they will need to know as much as possible about your symptoms and medical history. Keep a diary and take notes of any symptoms you experience. These symptoms include painful periods, excessive bleeding, spotting between menstruation, painful intercourse, painful bowel movements or urination, fatigue, bloating and difficulty getting pregnant. This information will help your doctor choose the ideal test and rule out other potential conditions.
How Do Doctors Choose the Right Test for Endometriosis?
Your doctor will select the most suitable test based on your symptoms, medical history, and their clinical judgment. There is no single definitive test for endometriosis, so in some cases, a combination of tests may be required to reach a diagnosis.
Pelvic Examination
During a pelvic exam, the doctor will manually feel various areas in your pelvis for abnormalities. They may be able to identify cysts on your reproductive organs or scars behind your uterus. However, endometriosis often can’t be detected unless it has affected the vagina or there is the presence of an endometriotic cyst. A pelvic examination is the first step a doctor will take as it is the fastest and may yield other important information.
Ultrasound
Ultrasound is a safe and non-invasive testing method that uses high-frequency soundwaves to form an image of the pelvic area. During the examination, the doctor will insert the ultrasound probe into the vagina to view the reproductive organs. An ultrasound can help identify adenomyosis, endometriotic cysts, ovarian immobility, recto-uterine adhesions, and deep endometriosis potentially affecting uterosacral ligaments, vagina, rectum, bladder, ureters as well as structural abnormalities.
The CA125 Blood Test
Though the blood test for endometriosis is far from definitive, it is able to identify high levels of a protein called CA125 in the blood. Elevated CA125 levels can be a symptom of conditions such as cancer and endometriosis, but some women with endometriosis might not have elevated levels at all. For this reason, researchers are still trying to improve this testing method. Routine use of CA125 is NOT recommended.
Magnetic Resonance Imaging (MRI)
Unlike ultrasound, an MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues in the body to potentially reveal endometriosis. MRIs are non-invasive and painless, but they are usually not the first test suggested due to their cost. An MRI like ultrasound can help identify adenomyosis, endometriotic cysts, ovarian immobility, recto-uterine adhesions, and deep endometriosis potentially affecting uterosacral ligaments, vagina, rectum, bladder, ureters as well as structural abnormalities.
Laparoscopy
While an invasive laparoscopy is considered the gold standard in diagnosing endometriosis, with the advances in non-invasive imaging diagnosis this is being challenged. During this procedure, the doctor will insert the laparoscopic camera into the abdomen near the navel to view the area. This allows them to identify signs of endometrial-like tissue outside the uterus.
Due to the complex nature of endometriosis, a range of testing methods may be required to help doctors identify it. It is essential to discuss these testing methods with your doctor while deciding the best course of action to help ease any concerns or anxiety. If you are experiencing some of the symptoms of endometriosis, don’t wait to get medical advice. Please see your GP and/or gynaecologist to arrange a deep endometriosis ultrasound.
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