How is the diagnosis of endometriosis made?

The diagnosis of endometriosis is often difficult and can be delayed for up to 10 years. The main symptom that should guide the doctor to suspect this pathology is pain, typically at the time of menstruation (dysmenorrhea), although in many cases it can appear in other forms such as dyspareunia, chronic pelvic pain. There is also a percentage of patients between 15 and 30% who remain asymptomatic.

A detailed history, followed by a gynaecological examination that includes Speculoscopy and vaginal examination will be the initial steps for diagnosis. As complementary tests, we can use the following:

Transvaginal ultrasound: It is the most useful test for the diagnosis of endometriosis since it allows detecting endometriomas (endometriotic cysts in the ovaries), as well as signs of adenomyosis. The Doppler study as an additional test can differentiate endometriomas with an atypical pattern, improving diagnostic accuracy. In addition, at present, high resolution and 3D allow, by making a correct preparation, to detect deep endometriosis lesions.

Nuclear Magnetic Resonance (NMR): It has a sensitivity for ovarian endometriosis similar to that of transvaginal ultrasound, although its cost is higher. It is a very accurate test for the diagnosis of deep and extragenital (intestinal, urinary, pulmonary) endometriosis. MRI allows the retroperitoneal study and involvement of nerve roots. It would be advisable to always perform this test prior to surgical treatment, since it can detect distant foci of endometriosis, thus helping to plan the surgery.

Analytics with markers: Currently, there is no valid marker for the diagnosis of endometriosis. CA-125 can be seen to have high levels in this pathology, but the sensitivity and specificity of this marker are low, so it is not used in the endometriosis diagnostic protocol.

Laparoscopy: It is considered the reference test for the diagnosis of ovarian, peritoneal and deep endometriosis, being the histopathological study of the lesions the gold standard for its diagnosis. However, the use of exploratory laparoscopy as a diagnostic technique for endometriosis is not recommended. In asymptomatic patients, endometriosis can be diagnosed incidentally during the course of a laparoscopy performed for another reason. In symptomatic patients with suspected or diagnosed endometriosis, laparoscopy will only be performed as a treatment for the pathology.

Abdominal ultrasound: It can help rule out endometriosis in other locations such as the bladder, kidneys or ureters.

Specifically, laparoscopy should be performed when the woman is menstruating since it facilitates the visualization of endometrial implants.

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