Diagnosing endometriosis: how to detect the condition?

Endometriosis is a gynecological disease that affects 1 in 10 women. Because of the vagaries of the medical profession, diagnosis can take between 7 and 10 years from the onset of the first symptoms.

Is it possible to diagnose endometriosis?

Pain during menstruation is often perceived as a fatality and something normal for many women. For this reason, screening forendometriosis takes a long time, even though the condition could be diagnosed as early as puberty.

But the symptoms of this gynaecological condition are often more marked in women who menstruate naturally, every month, whose ovarian activity is still functioning and is not stopped by hormonal contraception. Endometriosis is therefore often diagnosed in women not taking hormonal contraception, in teenagers, in nulliparous women who stop taking contraception to become pregnant, or in multiparous women who wish to choose another (non-hormonal) method of contraception.

However, in some women, particularly those who are asymptomatic, the diagnosis of this condition is made by chance, during an MRI scan, an ultrasound scan or during surgery (performed for other reasons). Another complicating factor in diagnosing this endometrial cell disorder is that symptoms vary greatly from one patient to the next, since each endometriosis and its degree of involvement is different.

What tests are needed to diagnose endometriosis?

If you suffer from intense, incapacitating pain during your menstrual flow or during your cycle (which doesn't go away with painkillers), dyspareunia (pain during intercourse), pain during urination or defecation, you may be suffering from endometriosis. In this case, make an appointment with your gynaecologist or healthcare professional for a check-up, consisting of an examination and a clinical examination.

Examination by your gynaecologist

The first step in diagnosing endometrial dysfunction is anexamination. The healthcare professional will ask the patient questions to formulate initial hypotheses and lines of inquiry. The doctor or gynecologist will then compile a list of the various symptoms experienced, their severity and intensity.

Every stage of the disease is different, and endometrial lesions are not located in the same places and organs in every person. Likewise, symptoms can be highly variable, numerous and multi-factorial from one woman to another. Generally located in the uterine sphere, ovaries, peritoneum, bladder... the disease can be multiple. For example, stomach ache and pain on defecation can be a sign of digestive endometriosis. The examination must therefore be carried out in minute detail to guide you towards the right diagnosis, the right treatment and the right specialist if surgery is required.

Vaginal examination

Thevaginal examination completes the examination and can be performed in one of two ways:

  • with a speculum: this must be performed with great care. It may reveal a deep endometriosis nodule infiltrating the vagina, taking the form of fibrous retraction, black microcysts or a budding lesion.
  • Vaginal touch: very important, as it can help diagnose deep endometriosis by palpating the recto-vaginal wall.

Abdominal and pelvic ultrasound

Radiological examination is often used for diagnosis. Pelvic ultrasound, also known as endovaginal ultrasound, is the first imaging test performed. For an effective diagnosis, it is best to go to a center with expertise in this type of pathology.
The pelvic examination can identify disorders such as :

  • Ovarian cysts
  • adenomyosis
  • deep endometriosis nodules in the bladder, rectum and distal sigmoid colon.

Abdominal ultrasound will diagnose complications such as ureteral stenosis with pyelo-caliceal dilatation, kidney atrophy, etc.

MRI and hysterography

MRI, or magnetic resonance imaging, is used to diagnose and map intra-pelvic and intra-abdominal lesions, providing 2D or 3D views. MRI will detect the presence of cysts, nodules or lesions, and is often prescribed to confirm and obtain more precise results following an endo-vaginal ultrasound. If surgery is planned, MRI is virtually indispensable.

Hysterography is an X-ray examination of the uterus and fallopian tubes. It is performed after introducing a probe and an opaque liquid into the cervix. This technique can be used to detect uterine malformations or deformations of the uterine cavity due to adhesions. This is an important examination when infertility is a concern. Please note, however, that this examination is not recommended for initial research, but is used for fertility assessment.

Other complementary examinations

For deeper endometriosis, additional tests may be carried out. These include endorectal ultrasound to explore lesions that may be located in the rectum, coloscanner, virtual colonoscopy and uroscanner to examine lesions located in the rectum, colon and ureters. These examinations are complementary to MRI.

When is endometriosis most often diagnosed?

There are certain moments in a woman's life that make it easier to diagnose endometriosis. We explain.

After stopping a hormonal contraceptive pill

When women decide to stop taking the contraceptive pill, particularly if they are planning to have a baby. Taking the pill reduces symptoms. When the pill is stopped, the risk is that symptoms will return and infertility may be observed. This is when the diagnosis is easier to make. Menstruation becomes very painful again, and X-rays can reveal previously unknown endometrial lesions.

After childbirth

After childbirth, when many patients opt for mechanical rather than hormonal contraception, menstruation and other symptoms become increasingly severe, making the diagnosis more obvious.

Endometriosis diagnosis FAQ

How can endometriosis be detected?

There are several ways of detecting the disease. Endo-vaginal ultrasound, pelvic ultrasound, abdominal ultrasound, MRI, or simply a vaginal touch. Symptoms must first be identified, in the form of questioning, so that the right examination method can then be chosen.

When is endometriosis diagnosed?

Endometriosis can be diagnosed at any stage in a woman's life, from the onset of menstruation to the menopause, and sometimes even afterwards. It takes a long time to diagnose endometriosis, however, because the disease is still under medical scrutiny.

Who should I consult to diagnose endometriosis?

You can contact your gynecologist or healthcare professional, who will then be able to refer you to specialized centers for further tests and appropriate treatment.

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