Endometriosis – Diagnosis and Treatment

Diagnosis

Doctors use several steps and tools to check for endometriosis. The process often begins when a person reports symptoms such as pelvic pain, painful periods, pain during sex, discomfort when urinating or having a bowel movement, or difficulty getting pregnant.

While these symptoms may suggest endometriosis, they are not enough to confirm the condition on their own. Because these signs can overlap with other health issues, further evaluation is usually needed to better understand what’s causing them.

Asking About Symptoms

Doctors begin with a conversation about symptoms. They’ll ask what kind of pain you have, where it happens, how often it comes, and what makes it better or worse.

Common symptoms include:

• Pelvic pain, often worse during periods
• Painful periods.
• Pain during or after sex.
• Pain when using the bathroom
• Heavy or irregular periods
• Difficulty getting pregnant

Some individuals don’t have symptoms at all, but endometriosis can still be there.

Physical Examination

Next comes a physical or pelvic exam. The provider puts on gloves and gently checks the pelvic area. They feel for:

• Cysts on the ovaries
• Painful, tender spots
• Nodules (unusual lumps)
• Scarring or tissue behind the uterus

Tiny endometriosis spots often go unnoticed during these exams, especially if there aren’t larger growths.

Imaging Tests

Imaging lets doctors look at organs and tissues inside the pelvis. Still, most endometriosis—especially superficial types—won’t show up on basic scans.

Ultrasound

Ultrasound is usually the first imaging test. It uses sound waves to make pictures of the inside of the body.

There are two main types:

• Transabdominal Ultrasound: The probe goes on the belly.
• Transvaginal Ultrasound: The probe goes inside the vagina for a closer look at the uterus and ovaries.

Ultrasound can spot bigger growths or cysts linked to endometriosis (endometriomas), but small spots almost never show up.

Imaging Type	Used For	Finds Endometriomas	Finds Small Lesions
Abdominal Ultrasound	General organ overview	Often	No
Transvaginal Ultrasound	Detailed pelvic views	Often	No
MRI	Detailed internal images	Often	Sometimes

Magnetic Resonance Imaging (MRI)

MRI uses magnets and radio waves to create detailed images. It helps doctors plan surgery and can reveal deep-infiltrating endometriosis, which sometimes affects organs like the bladder or bowel.

MRI can help guide treatment, but it still misses small, surface-level endometriosis patches.

The Role of Laparoscopy

Laparoscopy is a minimally invasive surgery that gives the clearest diagnosis. During laparoscopy:

1. The patient gets anesthesia.
2. The surgeon makes a small cut near the belly button.
3. A thin tube with a camera (laparoscope) goes inside.
4. The surgeon looks for abnormal tissue, cysts, and scarring.

This is really the only way to see endometriosis directly and confirm it. Sometimes the doctor will take a small tissue sample (biopsy) and send it to a lab. Only then can they make a certain diagnosis.

Advantages of laparoscopy:

• Surgeons can see the size, location, and number of endometriosis spots.
• They can remove or destroy growths during the same procedure, which might relieve symptoms.
• Doctors can also check for other causes of pelvic pain.

Test Type	What It Detects	Limitations
Ultrasound	Ovarian cysts, large growths	Misses small patches, not specific for endo
MRI	Deep-infiltrating endo, organs	Misses small or superficial spots
Laparoscopy	All visible endometriosis, cysts	Needs surgery and anesthesia
Biopsy	Confirms endometriosis cells	Only done during surgery

Other Factors in Diagnosis

Doctors might order blood tests, but none of them confirm endometriosis. Blood work helps rule out other conditions, but it doesn’t diagnose endometriosis.

A pathologist will examine any biopsy under a microscope. If they see endometrial-like cells outside the uterus, they confirm endometriosis.

Diagnosing Endometriomas and Cysts

Endometriomas are cysts that form on the ovaries because of endometriosis. These cysts usually contain old, dark blood and sometimes go by the nickname “chocolate cysts.”

Doctors can spot these cysts more easily on ultrasound or MRI than tiny endometriosis patches. If a cyst shows up and you have other symptoms, the doctor may suspect endometriosis.

Common Diagnostic Steps in Table Format

Step	What Happens	Purpose
Medical History	Doctor asks about pain, periods, fertility	Looks for common symptoms
Physical Exam	Checks pelvis for lumps or tenderness	Looks for cysts, nodules, or swelling
Ultrasound	Imaging of pelvic organs	Spots cysts, large growths
MRI	Detailed imaging	Finds deep-infiltrating endometriosis
Laparoscopy & Biopsy	Surgery with tissue removal	Finds, confirms, and may treat

Importance of Reporting Symptoms

If you have pelvic pain, share all the details with your doctor. Keeping a symptom diary can help spot patterns. Note when the pain happens, how bad it is, and what other issues come up (like bowel changes or pain during sex). This can make diagnosis a little easier.

Test or Step	Is it Invasive?	Detects Superficial?	Detects Deep Lesions?	Additional Benefits
Medical History	No	–	–	Guides next steps
Physical Exam	No	Rarely	Sometimes	Can find nodules
Ultrasound	No	No	Sometimes, cysts	Checks for cysts
MRI	No	Sometimes	Yes	Good for planning
Laparoscopy	Yes	Yes	Yes	Confirms diagnosis
Biopsy	Yes	Yes	Yes	Checks tissue type

Treatment

Over-the-Counter Pain Relief

Most people with endometriosis start with over-the-counter pain relievers. NSAIDs, like ibuprofen and naproxen sodium, help reduce inflammation and ease cramps. These medications are common during periods, especially for mild to moderate pain.

Common Painkillers	How They Work	Notes
Ibuprofen	Lowers inflammation and pain	Use as needed
Naproxen Sodium	Decreases swelling and pain	Take with food

Key Points

• Pain relievers help some people, but not everyone.
• If pain sticks around or gets worse, you might need other treatments.
• Sometimes doctors combine these with hormone therapy.

Hormonal Treatments

Hormonal treatments aim to balance or block hormones that make endometriosis tissue grow. There’s a range of options, each with its pros and cons.

1. Hormonal Birth Control
   • Pills, patches, shots, and vaginal rings.
   • Often makes periods lighter and less painful.
   • Using these continuously, with few breaks, can work better for some.
2. Gonadotropin-Releasing Hormone (Gn-RH) Agonists and Antagonists
   • Stops periods and lowers estrogen.
   • Shrinks endometriosis tissue.
   • May cause menopause-like side effects: hot flashes, bone loss.
   • Combining with low-dose estrogen or progestin helps manage side effects.
3. Progestin Therapies
   • Pills, IUDs, implants, or injections.
   • Stops periods and slows endometrial tissue growth.
   • Includes IUDs with levonorgestrel, birth control shots, and progestin-only pills.
4. Aromatase Inhibitors
   • Lowers the body’s estrogen production.
   • Can be used with other hormonal treatments.
   • Doctors may suggest these if other options don’t help enough.

Hormonal Treatment	Example Forms	Goal	Possible Side Effects
Birth control methods	Pills, patch, ring	Lighter periods, less pain	Spotting, nausea, headaches
Gn-RH therapies	Injectables, nasal	Block estrogen, shrink tissue	Hot flashes, bone thinning
Progestins	IUD, shot, implant	Stop periods, reduce tissue growth	Weight gain, mood changes
Aromatase inhibitors	Oral	Lower estrogen, shrink endometriosis	Joint pain, bone thinning

Key Points

• Hormone therapy only works while you’re taking it.
• Symptoms might come back after stopping treatment.
• Not a good choice if you’re trying to get pregnant.

Surgery to Keep Reproductive Organs

Surgical options can remove or destroy endometriosis tissue while keeping the uterus and ovaries. This is called conservative surgery. Doctors suggest this if pain meds and hormones don’t work, or if fertility is a big concern.

• Laparoscopy:
  • Small cuts and a thin camera (laparoscope).
  • Surgeons remove or burn away endometrial patches and scar tissue.
  • Sometimes they use robotic tools for more precision.
• Laparotomy:
  • Larger cut if there’s a lot of scar tissue to remove.

Benefits

• Can reduce pain and improve quality of life.
• Sometimes boosts fertility for those trying to conceive.

Limitations

• Symptoms and tissue can return over time.
• Hormone therapy after surgery may help keep pain away.

Surgery	Organs Kept	Type of Cut	Used For
Laparoscopy	Uterus, Ovaries	Small incisions	Most cases, even severe
Laparotomy	Uterus, Ovaries	Larger incisions	Extensive scar tissue cases

Options for Increasing Fertility

Endometriosis can make it harder to get pregnant. If you’re having trouble, doctors may suggest fertility treatments or refer you to a specialist.

Types of Fertility Treatment

• Fertility Medications:
  • Help ovaries produce more eggs.
  • Sometimes used with other methods.
• In Vitro Fertilization (IVF):
  • Eggs and sperm are mixed in a lab.
  • Fertilized eggs (embryos) go into the uterus.
  • IVF is common if other treatments don’t work or if endometriosis is severe.

Additional Points

• The right treatment depends on your age, health, and how much endometriosis you have.
• Conservative surgery, especially laparoscopy, may be recommended before fertility treatments.
• Many people need a mix of treatments to get the best chance at pregnancy.

Treatment	Purpose	How It Works
Medications	Boost egg production	Oral or injectable fertility drugs
IVF	Overcome blockages, boost fertility	Fertilizes egg outside the body

• Emotional support and counseling can help during fertility treatment.

Surgical Removal of Uterus and Ovaries

A hysterectomy removes the uterus. Sometimes, doctors also remove the ovaries (oophorectomy). This is a last-resort option for those with severe pain who haven’t found relief elsewhere.

Details about hysterectomy and ovary removal:

• Usually seen as a final step, especially for people who don’t want children.
• Removing both uterus and ovaries can stop pain for some, but not everyone.
• Taking out both ovaries brings on early menopause.

Risks and Considerations

• Early menopause raises the risk of heart and blood vessel disease and some metabolic conditions.
• Symptoms might stick around if any endometriosis tissue remains.
• Hysterectomy without ovary removal can still affect long-term health, especially for younger people.
• Sometimes keeping the ovaries but removing the uterus helps with heavy bleeding.

Procedure	Organs Removed	Effects	Main Uses
Hysterectomy	Uterus	No more periods; can’t get pregnant	For pain, heavy bleeding, not for fertility
Oophorectomy	Ovaries	Early menopause	Sometimes with hysterectomy
Both	Uterus and Ovaries	End to periods, menopause	Last resort

Always talk with your healthcare provider to weigh the pros and cons. Getting another opinion is smart before choosing surgery.

Helpful Habits and At-Home Care

People with endometriosis can try simple strategies at home to help with pelvic pain. Using a heating pad or taking warm baths often relaxes muscles, easing cramps and pain from endometrial implants or scar tissue.

Taking NSAIDs, like ibuprofen or naproxen, can lower inflammation and relieve pain, especially during heavy periods or painful bowel movements. Some people benefit from physical therapy focused on relaxing pelvic floor muscles. This can make chronic pelvic pain less intense and easier to manage day to day.

Nontraditional Treatments

Some people turn to nontraditional treatments for endometriosis symptoms. These aren’t standard medical care, but they might give extra relief.

Common examples:

• Acupuncture: Fine needles placed in the skin by a trained professional.
• Chiropractic Care: Licensed experts adjust the spine or body.
• Herbal Remedies: Some try herbs like cinnamon twig or licorice root.
• Dietary Supplements: Things like vitamin B1, magnesium, or omega-3 fatty acids.

Acupuncture may help reduce pain, but there’s not much evidence for other alternative treatments. Herbs and supplements can interact with prescription medicines, so be careful.

Alternative Therapy	Possible Use	Note
Acupuncture	Pain relief	Some positive studies
Chiropractic	Symptom management	Limited research
Herbs	Supportive therapy	May interact with medicines
Supplements	Nutrient support	Talk to a doctor before use

Always talk to a health care provider before starting alternative therapies. Some insurance plans cover these treatments, so it’s worth asking before you book an appointment.

Finding Support and Managing Day-to-Day Life

Building a support network can make living with endometriosis a bit less overwhelming. Talking to others who really get it can help ease stress.

Joining in-person or online groups gives you a safe space to share. Even having just one trusted friend or family member can bring a lot of comfort and understanding.

Getting Ready for Your Visit

Steps You Can Take Before Seeing Your Doctor

Planning ahead helps you make the most of your appointment. Here are a few things you can do:

• Write down all symptoms. List every symptom, even ones that don’t seem related to your period or ovulation.
• Record medicines and supplements. Include all prescription drugs, over-the-counter meds, herbs, and vitamins. Write down the name, dose, and how often you use each.
• Bring a support person. A family member or friend can help you remember what’s said or offer support.
• Use a notepad or device. Bring something to take notes—questions about endometriosis, hormones, or causes.
• Prepare your questions. Make a list ahead of time. Put the most important questions at the top.

Example questions to consider:

Question	Purpose
How is endometriosis diagnosed?	Learn about the evaluation process.
What treatment options are available?	Understand medication and surgical options, and effects on fertility.
Are there side effects to treatments?	Know what to expect, especially with hormones.
Will this affect pregnancy or fertility?	Discuss pregnancy chances and what can be done if you want children.
Are there alternative therapies?	Explore all options, even those outside the usual treatments.

If you don’t understand something, ask the doctor to repeat or explain it differently.

What the Doctor Might Ask You

Doctors usually need a detailed background for conditions tied to periods or the endometrium. They might ask:

• How Long and How Often: When did symptoms start? How often do they happen?
• Severity: How bad are the symptoms? Does pain get worse around ovulation or certain times in your cycle?
• Impact on Daily Life: Are symptoms affecting your school, work, or home life?
• Patterns: Do symptoms improve or worsen with certain activities or medicines?
• Relevant Background: Is there a family history of endometriosis? Does your body mass index matter?

Having clear answers helps your doctor—whether they’re a primary provider, specialist, or part of a team. This can make diagnosis smoother and guide your next steps for care.