Diagnosing endometriosis at TFC

As I discussed last week, endometriosis is a very common condition. It affects anywhere from 6-10% of all women of reproductive age, and up to 45% of infertile women. The condition can cause infertility, so diagnosing endometriosis is very important.

The basics of diagnosing endometriosis

Some women present with classic endometriosis symptoms, including severe pain with periods, pain with intercourse, and pelvic pain. However, many women who have significant endometriosis have no symptoms. This can often confuse patients and uninformed physicians alike.

Many studies have shown that the severity of symptoms and this disease often have nothing to do with each other. Women with severe disease may have no symptoms. In contrast, women with minimal disease can have excruciating pain. This can make the diagnosis of endometriosis quite challenging.

Over the years, researchers have discovered several types of tests detect the presence of endometriosis. Blood tests, such as the CA 125 assay – while often abnormal in the presence of endometriosis – are simply not reliable. Many women with severe endometriosis have normal CA125 levels.

In addition, several other conditions such as ovarian cysts, ovarian cancer, or uterine fibroids can cause an abnormal elevation of CA125. Therefore, although this test once held promise, more recent studies have demonstrated that it is not helpful. As a result, it is now very rarely used to detect endometriosis.

Diagnosis tools and procedures

There is no accurate blood test to use when making the diagnosis of endometriosis. However, ultrasound, CT scanning, and MRI have been shown to be very good at detecting or confirming the presence of endometriosis, especially if an ovarian mass is present.

Ultrasound, specifically transvaginal ultrasound, is the simplest and the least expensive of these techniques. This exam involves the painless placement of a camera, or probe, into the woman’s vagina. Sound waves then pass through the woman’s pelvis and back into the camera. These reflected sound waves generate images on a TV monitor that allow physicians to visualize the uterus and the ovaries.

An endometrioma (or cyst made of endometriosis fluid) usually appears as a round mass within an ovary. It has white or gray echoes when seen with ultrasound. Both CT and MRI examinations are much more expensive than ultrasound. In addition, they occur in a radiology office or hospital, which is much more difficult to schedule. For these reasons, we rarely order CT and/or MRI.

The only truly accurate diagnostic test is laparoscopy. This involves the passage of a surgical telescope through a woman’s belly button so that the pelvic organs can be actually seen. I will discuss this technique more in the next blog, so please check back to learn more about endometriosis and how it can affect your fertility.