Diagnosing endometriosis: how to detect the condition?
Lndometriosis is a gynecological disease that affects 1 in 10 women. Lhe medical uncertainty surrounding this disease means that diagnosis is very late, taking between 7 and 10 years from the appearance of the first symptoms.
Is it possible to diagnose endometriosis?
The pain of periods is often perceived as inevitable and normal for many women. This is why screening forendometriosis takes so long, even though the condition could be diagnosed as early as puberty.
But the symptoms of this gynaecological condition are often more pronounced 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 who are 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.
But for some women, particularly those who are asymptomatic, the diagnosis of this disease 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 the symptoms are very different 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. If so, make an appointment with your gynecologist or health care professional for a check-up, consisting of an interview and a clinical examination.
Examination by the gynecologist
The first step in diagnosing endometrial dysfunction is toask the patient questions. The healthcare professional will ask the patient questions to formulate initial hypotheses and lines of inquiry. The doctor or gynaecologist will then compile a list of the various symptoms experienced, their severity and intensity.
Each stage of the disease is different, and endometrial lesions are not located in the same places and organs in every individual. Likewise, symptoms can be highly variable 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. Lnterviewing must be meticulous, to guide you towards the right diagnosis, the right treatment and the right specialist if surgery is required.
Vaginal examination
Lhevaginal examination completes the interrogation and can be performed in one of two ways:
- speculum: this must be performed with great care. It may reveal a nodule of deep endometriosis infiltrating the vagina, taking the form of fibrous retraction, black micro-cysts 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 visit a center with expertise in this type of pathology.
Pelvic examinations can identify disorders such as :
- Ovarian cysts
- Ladenomyosis
- Deep endometriosis nodules in the bladder, rectum and distal sigmoid colon
Labdominal ultrasound will diagnose complications such as ureteral stenosis with pyelo-caliceal dilatation, kidney atrophy, etc.
MRI and hysterography
LMRI or Magnetic Resonance Imaging is used to diagnose and map intra-pelvic and intra-abdominal lesions, providing 2D or 3D views. LMRI 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.
Lhysterography 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 examinations may be performed. 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. However, at lcessation of contraception can lead to a resurgence of symptoms and infertility. This is when the diagnosis is easier to make. The periods become very painful again, and X-rays can reveal previously unknown endometrial lesions.
After childbirth
After childbirth, when many patients choose contraception that is mechanical rather than hormonal, the periods and other symptoms become increasingly severe, making the diagnosis more obvious.
Endometriosis diagnosis FAQ
How can endometriosis be detected?
There are several ways to detect 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 can endometriosis be diagnosed?
Lndometriosis can be diagnosed at any stage in a woman's life, from the onset of periods until menopause, and sometimes even afterwards. Diagnosis can take a long time, due to the long time it takes for the disease to be diagnosed.
Who should be consulted for a diagnosis of endometriosis?
You can contact your gynecologist or other healthcare professional, who will be able to refer you to specialized centers for further tests and appropriate treatment.
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