Diagnosis

1. Investigations:
1. Laparoscopy: - considered the gold standard when endometriosis is suspected. 50 % of women with pelvic pain and dysmenorrhoea have endometriosis diagnosed at laparoscopy.

2. Hysteroscopy.

3. Colposcopy.

4. Ultrasonography: - have limited value in the diagnosis of endometriosis but is helpful when there is an endometrioma.

5. MRI: - detects endometrioma, ovarian adhesions and extra peritoneal masses and detects invasion to bowel, bladder and rectovaginal septum.

6. Blood test CA 125: - this protein increases in patients with severe endometriosis but also increases in ovarian cancer and peritonitis. It is not a sensitive test since it cannot detect the disease in early stages and it is not specific, but can be used for follow up in treated patients to check their response to treatment.

The diagnosis is suspected on the basis of the symptoms described above and/or physical findings. Pelvic examination may be normal or may reveal visible lesions on the vulva or cervix, in the vagina, the umbilicus, and in surgical scars. There may be a retroverted and fixed uterus, enlarged ovaries, or uterosacral nodularity.

The diagnosis can be established only by visualizing lesions, usually by endoscopy of the pelvis. In the absence of visible lesions on physical examination, the primary diagnostic modality is direct visualization and/or biopsy of lesions by laparoscopy. Diagnosis could also be made during laparotomy or on rectoromanoscopy or cystoscopy.

Other diagnostic procedures (ultrasonography, barium enema, urogram, CT, or MRI) may be useful for demonstrating the extent of disease and following its course but are not specific or adequate for diagnosis. Investigational serum markers for endometriosis (CA-125 and antiendometrial antibody levels) may help monitor the disease but will require further refinement. Infertility studies may be indicated.

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