Diagnosing Endometriosis
I have received a lot of similar questions recently. In an attempt to keep up, I will occasionally group similar questions together.
Question(s):
- I've been having pain in my lower pelvic region, and through sonograms my gynecologist has ruled out ovarian cysts. But he doesn't believe that it's endometriosis because I don't have any lower back pain. Do you think that I could possibly have endometriosis, and should I have a laparoscopy done?
- Is it possible to miss a diagnosis, even after having a laparoscopy?
- My wife has been suffering from pelvic pain since June 2000. She was given Duphaston for 3 months, but did not get relief. Now one doctor is suggesting Nasarel, and another doctor is suggesting surgery. I am confused. What should I do?
- Is there any method other than laparoscopy that will discover endometriosis? How about an MRI?
Answer:
- The only way to diagnose endometriosis is during a laparoscopy. Persistent pelvic pain that is progressive or is interfering with your life, or is preventing you from your normal activities, is an indication for laparoscopic evaluation. A lot of women have endometriosis without back pain.
- Yes. I have personally seen this situation, in which endometriosis has been missed during a laparoscopy. When a patient comes to me with a history of pelvic pain and a "normal" laparoscope, I will often perform another laparoscopy to double-check (in this instance, a videotape of the previous surgery is helpful). I have found that the patient’s history of symptoms is more accurate than a previous laparoscopy. I have performed a laparoscopy six weeks after a patient has had "normal" findings during a laparoscopy by another physician, only to find endometriosis – proven by the pathology report. Unlike her pervious surgery, her pain significantly decreased after I diagnosed and removed her endometriosis. She either had the rapid formation and growth of endometriosis over a couple of weeks, or the endometriosis was missed during the previous surgery.
- The medications you are referring to function to shut down estrogen production by the ovaries. This group of medications can have significant side effects, including bone loss, osteopenia, and even osteoporosis. Even if the decision is made to use these medications, a laparoscopic diagnosis of endometriosis should be made first. But since endometriosis is usually treated during a laparoscopy, this will eliminate the need for the use of these medications and their associated side effects.
- For the most part, laparoscopy is the only sure method of diagnosing endometriosis. If there are large volumes of endometriosis, i.e., larger than 2cm (about 1 inch), then an MRI may be helpful. An endometrioma can be diagnosed with an MRI. The problem is that the average lesion of endometriosis is not large enough to be seen with an MRI. In other words, if an MRI shows endometriosis, great. But most women with endometriosis will have normal MRI findings.
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