Making a Diagnosis
There are many important steps in the process
of diagnosing endometriosis including a physical
exam, diagnostic testing, imaging studies, biopsy,
and laparoscopy.
Physical exam and history
The diagnosis of endometriosis can actually be
a relief to many women. For some, it means there
is a name for the pain from which they have suffered
for years. For others, it means they now know
a possible cause of the infertility they are hoping
to overcome.
The first step in diagnosing endometriosis is
a complete physical exam and thorough family history.
Both can provide important clues and often lead
directly to a diagnosis without further testing
or surgery. Before conducting a physical exam,
the doctor will probably ask about personal and
family health history, because endometriosis appears
to run in families. Women whose mothers or sisters
have suffered from the disorder are more likely
to suffer from it, too.
When conducting a physical exam for endometriosis,
a doctor looks for a number of signs:
- bumps behind the uterus
- masses or cysts on the ovaries
- scar tissue on the uterus or ovaries
In rare cases, endometriosis can be seen on the
cervix, in the vagina, or even in the belly button
(umbilicus) of patients who have had previous
abdominal surgery. A physical exam is also helpful
in diagnosing endometriosis because it sometimes
reproduces the pain the patient typically experiences.
Diagnostic testing and imaging studies
If the doctor finds no signs of endometriosis
during a physical exam, the next step is usually
imaging studies. Imaging studies, including ultrasound,
computed tomography (CT) scans and magnetic resonance
imaging (MRI) create a picture of an area inside
the body that the doctor can't see with a normal
physical examination.
Ultrasound uses sound waves to create an image
of tissues and organs. Often, an ultrasound can
help locate anything suspicious that the doctor
discovered during the physical exam. In some cases,
doctors will turn to more advanced imaging tools,
such as CT scans or MRIs, to obtain more detailed
images.
Biopsy and laparoscopy
The only way to be absolutely sure a patient is
suffering from endometriosis is to remove a tissue
sample (biopsy) and examine it under a microscope.
In most cases, the biopsy is removed during a
minimally invasive procedure called laparoscopy.
Laparoscopy gives the doctor a view inside the
pelvis and abdomen. The doctor makes a small incision
next to the navel and then inserts an instrument
called a laparoscope. A camera and light attached
to the laparoscope allow the doctor to search
for abnormalities, scarring or any other evidence
of endometriosis.
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