Diagnosis of Endometriosis
Unsure if your period pain is normal? Take this quick 4-question survey to see if you need to see a gynaecologist.
When should I see a gynaecologist for period pain?
Period pain is common, but pain that disrupts your life is not normal. See a gynaecologist if you have:
• Pain that stops you going to college, school or work
• Period pain that painkillers don't control
• Pain during sex, or while passing stools or urine around periods
• Pain that is getting worse over the years, or heavy bleeding
• Difficulty getting pregnant
How is endometriosis diagnosed?
• History and pelvic examination: your symptoms and tender spots or nodules behind the womb can point to endometriosis.
• Mapping of endometriosis on ultrasound and MRI: a transvaginal ultrasound and, when needed, an MRI of the pelvis show the exact extent of the disease and whether other organs such as the bowel, bladder or ureters are involved.
Is there a blood test for endometriosis?
No blood test can confirm it. CA-125 can be raised but also rises in other conditions. AMH, a test of egg reserve, is useful when the ovaries are involved.
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Will a normal ultrasound rule it out?
No. Small patches of endometriosis on the lining of the pelvis do not show on scans. If your symptoms are strong and scans are normal, treatment can still start, and further evaluation may be advised.
What are the stages of endometriosis?
Endometriosis is graded from stage 1 (minimal) to stage 4 (severe), depending on how much disease there is, cysts and scar tissue. The stage does not always match the pain: some women with stage 1 have severe pain.
Endometriosis FAQs
Q: Why does endometriosis take so long to diagnose?
Its symptoms overlap with ordinary period pain, IBS and urine infections, and scans can look normal in early disease.
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Q: Which scan is best for endometriosis?
A transvaginal ultrasound first; an MRI when deep endometriosis is suspected or surgery is being planned.
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Q: Can endometriosis be seen on an ultrasound?
Often, yes. Chocolate cysts and deep endometriosis can be seen by an experienced doctor, but small superficial spots may not show on a scan.
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Q: Does CA-125 confirm endometriosis?
No. It can be high in endometriosis but also in other conditions, so it is only one clue.
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Q: Can a regular gynaecologist diagnose endometriosis?
Mild cases, yes. Deep endometriosis is best assessed by a specialist who scans and operates on it regularly.
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Q: What should I bring to my first appointment?
Any previous scans, reports and a list of your symptoms, especially when they happen in your cycle.
