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Pelvic endometriosis is a complicated condition affecting roughly 1 million women in Canada and 11% of women in the U.S. Despite those numbers, endometriosis is not fully understood and it can be difficult to get a clinical diagnosis. Symptoms often vary radically from patient to patient, and some patients can even be asymptomatic.
But endometriosis can be debilitating, causing painful ovulation, heavy bleeding during your menstrual cycle, uncomfortable intercourse, intense fatigue and even infertility. If you have been diagnosed with, or think you might have, endometriosis, this article will explain:
The endometrium is the mucous membrane that lines the inside of the uterus. Endometriosis is a condition in which a similar tissue implants anywhere outside of the uterus.
Healthy endometrial tissue thickens during a menstrual cycle to support a potential embryo. The misplaced endometrial-like tissue also thickens, but since it is not where it’s supposed to be, it cannot be shed during a period. Instead, the endometrial glands and tissue implants form cysts, lesions and other growths, which cause inflammation, pain and scarring.
Endometriosis can occur in any of the pelvic organs: the bladder, fallopian tubes, ovaries or even the pelvic lining. Occasionally it can form adhesions, bands of fibrous tissue which cause pelvic organs and tissue to stick together. There is currently no cure for endometriosis, though there are several types of treatment.
The American Society for Reproductive Medicine (ASRM) classifies endometriosis into stages according to the intensity with which it presents in each patient. Stage I is considered minimal, II is mild, III is moderate and IV is severe.
There are 3 main types of endometriosis:
Bowel endometriosis is rare but possible, and there have been rare cases where endometriosis spreads to the chest cavity or even the cutaneous layer of the skin.
Uterine adenomyosis is a condition similar to endometriosis, in which endometrial tissue invades or grows through the uterine muscle wall, but it is not classified as endometriosis.
Part of the difficulty with diagnosing endometriosis is that symptoms can vary dramatically between patients, both in terms of presentation and intensity. Some of the most common symptoms are:
While itself classified as a “non-cancerous condition”, endometriosis can slightly increase the risk of contracting certain types of breast, cervical or ovarian cancers. However, other determinants like family health history are stronger risk factors than endometriosis.
If you have suspected endometriosis, you may be sent for more than one of the following tests on your way to a clinical diagnosis.
During your pelvic exam, the doctor will insert fingers into your vagina while placing a hand on top of your abdomen to check for lumps or nodes and to test if pressure or movement causes discomfort or abdominal pain.
A pelvic exam does not take long, usually ten minutes or less, and requires no special preparation. As a diagnostic tool it is not particularly effective. However, it can rule out other potential diseases or conditions.
An ultrasound is an imaging technique that uses sound waves to capture internal images of your body. A transducer produces high-frequency sound waves which create echoes when they bounce off your internal structures, which are compiled into live images.
Depending on the type of endometriosis suspected, you might have a transvaginal ultrasound, in which the transducer is inserted vaginally, or a transrectal ultrasound, in which the wand is inserted into your rectum. You may require an enema for the latter.
Your pelvic ultrasound will likely take around 30 minutes. Doctors will be looking for cysts or other endometrial implants. Ultrasounds provide excellent images of soft tissues and organs, but endometrial tissue may be beneath the surface, or too small to spot.
Laparoscopy is a surgical procedure as well as an imaging technique. During laparoscopy, a very small camera on a thin tube is inserted through a small incision made through your abdomen. The camera lights up the pelvic organs, so the doctor can examine the fallopian tubes, ovaries, uterus and surrounding area for endometrial tissue. The doctor may take a biopsy during the procedure to provide a definitive diagnosis of endometriosis.
You should refrain from eating or drinking from the midnight before this procedure. The laparoscopy itself can take anywhere from 1.5-4 hours, after which you’ll spend 60-90 minutes in recovery. In most cases, you can return home the same day after a laparoscopic procedure.
Magnetic resonance imaging (MRI) uses radio waves and strong magnets to capture internal images of your body. MRIs are taken from several different views to create a detailed 360° image of your pelvic area.
You should avoid eating or drinking for 4-6 hours before your pelvic MRI, which should take 45-60 minutes. If you require a contrast agent, typically administered by IV, your appointment will last at least 30 minutes longer.
A pelvic MRI will result in highly detailed images, which provide a clear view of the entire pelvic cavity, including your ovaries, fallopian tubes and uterus. A pelvic MRI can reveal deeply planted cysts and lesions, making it one of the better imaging tests for detecting deeply infiltrating endometriosis.
A computed tomography (CT) scan is an imaging technique that takes multiple X-rays from different angles and then compiles them into a 3D image. CT scans are excellent at detecting anomalies in hard internal structures like bones, while softer tissues show up more clearly on MRI scans.
CT scans are not the most effective imaging technique for the diagnosis of endometriosis, as they may not detect endometrial cells or tissue. However, a CT may be ordered to rule out other issues, such as possible renal insufficiency.
The technician is not allowed to discuss the results of your imaging test. They will forward the images to a radiologist, who will prepare a report for your doctor. Then your doctor will go over the results with you at a follow-up appointment. The results of your imaging tests will depend on the type of imaging procedure. For example:
What is missing or obscured in one imaging technique may be more visible in another. This is why doctors often request more than one imaging test before returning a clinical diagnosis of endometriosis.
Because endometriosis presents in radically different ways, it can be a long journey to get a clinical diagnosis. Since pain levels vary, it can be years before a diagnosis is sought. Due to size or placement, some lesions will be easier to spot than others, and not all imaging techniques are equally effective in every instance. You may need more than one kind of imaging test to get a clear diagnosis.
When seeking a clinical diagnosis of endometriosis, it is critically important to maintain good records. Keep a journal with you so you can document your symptoms, doctors’ appointments, tests and any results.
Getting an endometriosis diagnosis can mean many visits to different specialists and imaging clinics. PocketHealth is a secure platform where you can collect and store all your images and reports along the way. Having access to all your prior imaging and reports allows you to better understand and track symptom progression, helping you become more empowered during your journey to diagnosis. Access your results today.
You can also use PocketHealth to easily access your images and reports as soon as they are released, often before your follow-up appointment. Should you require a second opinion, you can share your results with specialists in diagnostic quality directly from PocketHealth’s platform.
Radiology reports are full of complex medical terms. Pocket Health’s Report Reader helps you better understand your reports by providing definitions of terms in plain language. And My Care Navigator highlights any follow-up recommendations and provides personalized insights based on your imaging report, such as questions to ask your doctor. By better understanding your report and knowing what questions to ask, you can have more informed conversations with your medical team.
To date, there is no cure for endometriosis. But there are several different options for treatment, depending on the severity of your condition and whether you are trying to get pregnant. Some of the options may be more suited for your situation and needs than others.
Analgesics are used to combat the pain of endometriosis. Non-steroidal anti-inflammatories include ibuprofen and naproxen. Acetaminophen and tramadol are non-NSAID analgesics. The type and dosage you use will depend on the type and severity of your pain.
Hormonal therapy treatments may help you manage pain and also slow the growth of endometrial tissue. Your choices include birth control agents, which stop or pause menstruation, like pills, injections, IUDs, and others. Gonadotropin-releasing hormone (GnRH) analogues, used in fertility treatments, are another option.
Laparoscopy is a tool for treatment as well as diagnosis. Doctors can use laparoscopic procedures to remove endometrial adhesions, peritoneal lesions and scar tissue. The tiny incisions make it a day surgery, which leads to a much shorter recovery time.
A laparotomy is an open abdominal surgery that requires a much larger incision. Used both to explore and treat abdominal issues and chronic pelvic pain, a laparotomy requires general anesthesia and has a recovery time of six weeks or more. Laparotomies are rarely performed today.
Endometriosis can have a significant impact on your quality of life, especially if you are suffering from severe pain or infertility. It can help to connect with a support group that understands the symptoms and ramifications.
The road to a clinical diagnosis of endometriosis can be slow and stressful, especially when you’re already struggling with chronic pelvic pain symptoms or infertility. With PocketHealth, you have all your images and results at your fingertips, which can help you get an early and accurate endometriosis diagnosis and feel more in control of a very complex healthcare journey.
Learn more about how to use PocketHealth to securely access and share your imaging results.
