How is it Diagnosed?
Endometriosis is diagnosed primarily through clinical assessment and, when needed,
surgical visualization. It occurs when endometrial-like tissue grows outside the uterus,
often causing chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility.
The diagnostic process begins with a detailed history and physical examination. Pelvic
examination may reveal tenderness, nodularity in the posterior fornix, or fixed uterus in
advanced cases. Imaging plays a supporting role: transvaginal ultrasound is useful,
particularly for detecting endometriomas (ovarian cysts caused by endometriosis).
However, it may miss superficial peritoneal lesions.
MRI is more sensitive for detecting deep infiltrating endometriosis affecting bowel,
bladder, or uterosacral ligaments. Nonetheless, the definitive diagnosis is made via
laparoscopy, a minimally invasive surgery that allows direct visualization and biopsy of
endometriotic lesions. Histopathological confirmation is considered the gold standard.
There is often a significant delay in diagnosis—averaging several years—due to
overlapping symptoms with other pelvic disorders. Hence, some patients may be
offered empirical treatment based on clinical suspicion alone, especially when imaging is
inconclusive but symptoms are typical.
Early diagnosis enables better symptom control, fertility preservation, and improved
quality of life through medical therapy (like hormonal suppression) or surgical excision.