Endometriosis: Diagnosis

Endometriosis is usually suspected from the history, although tender nodules and masses may be palpable or visible on the vagina or cervix during pelvic examination.

Many gynecologists believe that definitive diagnosis can be made only by laparoscopic visualization of lesions and/or biopsy. Endometrial implants may appear in various colors (black, red, yellow, white, blue, or clear). If a visual diagnosis is in question, a biopsy that reveals endometrial glands and stroma is considered diagnostic. As most endometriosis is asymptomatic and many women with typical endometriosis symptoms have no visible disease, an alternative view is that endometriosis is better diagnosed by history, physical examination, and response to therapy than by surgical visualization.

Endoscopy of the colon or cystoscopy may reveal implants of the sigmoid or proximal colon and bladder.

Elevated serum CA–125 concentration suggests the presence of the condition, and higher values may correspond with advanced disease. CA–125 can also be followed to evaluate response to medical treatment.

Imaging studies are not usually of value, although an ultrasound may be used to detect bulky disease such as endometriomas, which may benefit from surgical removal.