How do OBGYNs check for endometriosis

Endometriosis is a chronic condition where tissue similar to the uterine lining grows outside the uterus causing pain and potentially leading to fertility issues. Early diagnosis and treatment are important to manage symptoms and improve quality of life.

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Without timely intervention endometriosis can progress, leading to severe pain and complications. By learning about your OBGYN's methods of checking for endometriosis, it can help you seek appropriate care and find relief.

Initial Consultation

The diagnostic journey for endometriosis often begins with an initial consultation with an OBGYN. During this appointment, your OBGYN will discuss your symptoms and take a detailed medical history. This discussion helps us understand the severity and pattern of your symptoms, which is crucial for an accurate diagnosis.

Common Symptoms of Endometriosis

The symptoms of endometriosis can vary widely but often include:

• Severe menstrual cramps (dysmenorrhea) during menstrual cycle
• Persistent or constant pelvic pain
• Pain during intercourse (dyspareunia)
• Pain with bowel movements or urination
• Infertility

By discussing these symptoms and their impact on your daily life, your provider can determine if further evaluation for endometriosis is necessary.

Physical Examination

After discussing your symptoms and medical history, your provider will typically perform a pelvic exam. During this examination, they will manually check for abnormalities in your pelvis.

Specifically, the exam will entail:

• Palpating (feel) the abdomen and pelvic area to check for unusual growths or masses.
• Assessing areas for tenderness, especially near the ovaries and the uterus.
• Looking/feeling for signs of cysts, nodules, or scar tissue, which can be indicative of endometriosis.

While a pelvic exam alone cannot definitively diagnose endometriosis, it can provide important clues.
If they suspect endometriosis based on your physical exam and discussion, imaging tests will be advised.

Imaging Tests

Ultrasound

Ultrasound is often the initial imaging test used to assess for endometriosis. There are two main types of ultrasound: transvaginal and abdominal. Transvaginal ultrasound involves inserting a probe into the vagina to get a closer view of pelvic and reproductive organs, while abdominal ultrasound is done externally over the abdomen. Ultrasound can reveal abnormalities such as ovarian cysts, endometrial implants, and adhesions, providing valuable information for diagnosis.

For endometriosis evaluation, a transvaginal ultrasound is preferred as it allows for the ultrasound probe to be right next to the areas where endometriosis is found most commonly: on or around the ovaries, uterus, bladder, and rectum. Not all pelvic ultrasounds are the same however. The majority of ‘routine’ pelvic ultrasounds done by an ultrasound technician do not assess the rectum, bladder wall, or the tissue between pelvic structures for adhesions, scarring or thickened tissue that could indicate invasive disease. It is essential to have an Endometriosis Specific Ultrasound done by a trained individual who has the ability to assess these things. At the Center for Advanced Gynecology, all pelvic ultrasounds involve a comprehensive evaluation of these structures before considering treatment.

We always say that an ultrasound can rule in endometriosis, but it cannot rule it out: the majority of endometriosis is only a few millimeters thick and spread out on the surface of structures so it cannot be seen with any form of imaging.

MRI

In cases where ultrasound results are inconclusive or further detail is needed, magnetic resonance imaging (MRI) might be recommended. MRI offers a more detailed view of pelvic structures and other organs, and can detect subtle signs of endometriosis that may be missed on ultrasound. MRI is particularly useful for assessing deep infiltrating endometriosis and determining the extent of the disease. This is useful in surgical planning if there is involvement of the colon/rectum, bladder, or other non-pelvic structures where additional surgical specialists will need to be involved in the surgery.

When we consult with patients who live too far away to come into the office for an ultrasound, we often request an MRI as the images are more reliable/consistent then an ultrasound done at an outside facility.

Laparoscopy

Laparoscopy is considered the gold standard for diagnosing endometriosis. During this minimally invasive surgical procedure, a thin, flexible tube with a camera (laparoscope) is inserted through a small incision in the abdomen. This allows us to directly visualize pelvic organs and identify endometrial implants, adhesions, and other abnormalities.

How Laparoscopy Helps in Diagnosing Endometriosis

Laparoscopy provides a direct view of the pelvic cavity, allowing for accurate diagnosis of endometriosis and assessment of its severity. Endometriosis can have multiple variable appearances, so it is important that the surgery is done by a specialist with experience.  Here at the Center for Advanced Gynecology we never do diagnostic laparoscopies, but always plan to treat the disease we find: full excision of endometriosis tissue, removal of adhesions and restoration of normal anatomy.

Benefits and Risks of Laparoscopy

While laparoscopy is considered safe and minimally invasive, it is still a surgical procedure and carries some risks, such as bleeding, infection, and injury to surrounding structures. However, the benefits of accurate diagnosis and treatment outweigh the risks for many women with suspected endometriosis.

Biopsy

At the time of laparoscopy, some doctors plan to take a biopsy of endometriosis implants they see to confirm the diagnosis with plans to then treat with medication.  Biopsy involves taking small samples of tissue from suspected endometrial implants or lesions for further analysis under a microscope.  Be sure to ask your OBGYN what their plan is should they find endometriosis at the time of laparoscopy.  While tissue diagnosis is essential, at the Center for Advanced Gynecology we never do just biopsies, but always plan to treat all disease we find: full excision of endometriosis, removal of adhesions, and restoration of normal anatomy.

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Additional Diagnostic Methods

Blood Tests and Biomarkers

While there is no specific blood test for endometriosis, certain biomarkers, such as CA-125, might be elevated in women with the condition. However, these tests are not diagnostic on their own and are often used in conjunction with other diagnostic methods.

Experimental and Emerging Diagnostic Techniques

Researchers are continually exploring new diagnostic techniques for endometriosis, including molecular and genetic markers, non-invasive imaging modalities, and biomarker panels. These emerging methods hold promise for improving the accuracy and efficiency of endometriosis diagnosis in the future. B-cell chronic lymphocytic leukemia/lymphoma 6 (BCL-6) is a protein that stimulates inflammatory cytokines and is significantly overexpressed (a higher amount of the protein is made) in the endometrium (lining of the uterus) in patients with endometriosis.  A biopsy of the uterine lining can test BCL-6 levels and in a published study, 93.8% of patients that tested positive for high BCL-6 levels had laparoscopic findings of endometriosis .  The test has been shown to have a high positive and negative predictive value. It is used most often to identify asymptomatic (silent) endometriosis in patients with unexplained infertility or failed IVF and can lead to a recommendation of laparoscopy or hormonal suppression before another IVF cycle. (https://receptivadx.com/)  (Louwen et al, Human Reproduction Update, 28(6) 2022, P 890–909)

Why an Accurate Diagnosis Matters

Receiving an accurate diagnosis of endometriosis is important because it allows healthcare providers to tailor treatment plans to meet your specific health needs. Treatment options might include pain management strategies, hormonal therapies, or surgical intervention. By understanding the severity and extent of the disease, healthcare providers can recommend the most appropriate course of action for managing your symptoms and preserving fertility.

Additionally, endometriosis can significantly impact your quality of life, causing chronic pain, fatigue, and emotional distress. An accurate diagnosis enables healthcare providers to address these symptoms more effectively, leading to improved quality of life. By implementing targeted treatments and supportive interventions treating endometriosis, healthcare providers can help you better manage your symptoms and regain control over your life.

Get Help Today at the Center for Advanced Gynecology

If you suspect you might have endometriosis or are experiencing symptoms such as pelvic pain or infertility, don't hesitate to consult with us. We can help you navigate the diagnostic process and work towards finding relief and reclaiming control over your health and well-being.

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