Diagnosis of endometriosis: how to detect the pathology?

Endometriosis is a gynecological disease that affects 1 in 10 women. The medical wandering around this disease means that the diagnosis is very late and takes between 7 and 10 years from the appearance of the first symptoms.

Is it possible to diagnose endometriosis?

Period pains are often perceived as a fatality and something normal for many women. This is why screening forendometriosis takes a long time, even though this pathology could be diagnosed as early as puberty.

However, the symptoms of this gynecological condition are often more pronounced in women who have their periods naturally, every month, whose ovarian activity is still functioning and is not stopped by hormonal contraception. Endometriosis is therefore often diagnosed in these women who are not taking hormonal contraception, in teenagers, in nulliparous women who stop taking contraception for a planned pregnancy, or in multiparous women who wish to choose another (non-hormonal) method of contraception.

However, in some women, especially those who are rather asymptomatic, the diagnosis of this disease is made by chance, during an MRI, an ultrasound or during a surgical procedure (done for other reasons). This also makes the diagnosis of this endometrial cell disorder complicated, as the symptoms are very different from one patient to another, as each endometriosis and its degree of involvement is different.

What tests are needed to diagnose endometriosis?

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

Examination by the gynaecologist

The first step in diagnosing endometrial dysfunction is anexamination. The health professional will ask questions to the patient in order to formulate initial hypotheses and lines of inquiry. The doctor or gynecologist will then make a list of the different symptoms experienced, their importance and intensity.

Each stage of the disease is different and the endometrial lesions are not located in the same places and organs depending on the person. In the same way, the symptoms can be very variable, numerous and caused by multiple factors from one woman to another. Generally located in the uterine sphere, ovaries, peritoneum, bladder ... the disease can be multiple. For example, stomach aches and pain during defecation can be a sign of digestive endometriosis. The examination must therefore be carried out in a meticulous manner in order to guide you towards the right diagnosis, the appropriate treatments and the right specialists if surgery is required.

Vaginal examination

Thevaginal examination will complete the questioning and can be performed in two ways:

  • with a speculum: it must be done with care. It may reveal a deep endometriosis nodule that will infiltrate the vagina, taking the form of a fibrous retraction, black microcysts, or a budding lesion.
  • Vaginal touch: very important because it can help to diagnose deep endometriosis by palpating the recto vaginal wall.

Abdominal and pelvic ultrasound

Theradiological 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 allows the identification of disorders such as

  • Ovarian cysts
  • Adenomyosis
  • Deep endometriosis nodules located 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 allows the diagnosis but also the mapping of intra-pelvic and intra-abdominal lesions by obtaining 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 almost indispensable.

Hysterography is an examination of the uterus and fallopian tubes that uses X-rays. It is performed after introducing a probe and an opaque liquid into the cervix. This technique is used to look for uterine malformations, deformations of the uterine cavity due to adhesions. It is an important examination when there are infertility concerns. However, be careful: this examination is not well recommended for a first search, it is used for fertility assessment.

Other complementary examinations

For deeper endometriosis, additional examinations can be performed. These complementary examinations 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 are complementary examinations to MRI.

When is endometriosis most often diagnosed?

There are certain moments in a woman's life that make the diagnosis of endometriosis easier. We explain.

After stopping a hormonal contraceptive pill

When women decide to stop taking the contraceptive pill, especially if they are planning to have a baby. Indeed, taking the pill reduces the symptoms. When the contraceptive pill is stopped, the risk is that the symptoms will return and infertility may be observed. It is then that the diagnosis is easier to make. Menstruation becomes very painful again, and radiological examinations can reveal previously unknown endometrial lesions.

After childbirth

After childbirth, when many patients choose a method of contraception that is mechanical and not hormonal, the menstrual periods and other symptoms become increasingly strong, which makes the diagnosis more obvious.

Endometriosis diagnosis FAQ

How can endometriosis be detected?

There are several methods to detect the disease. Endo-vaginal, pelvic and abdominal ultrasound, MRI, or simply a vaginal touch. It is necessary to identify the symptoms beforehand, in the form of questioning, in order to be able to choose the right method of examination.

When can endometriosis be diagnosed?

Endometriosis can be diagnosed throughout a woman's life, from the beginning of her period until the menopause, and sometimes even after. The diagnosis is very long because of the medical uncertainty that persists around this disease.

Who should I consult to diagnose endometriosis?

You can approach your gynecologist or health professional, who will then be able to redirect you to specialized centers for additional tests and appropriate treatment.

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