How Is Endometriosis Diagnosed?

Endometriosis is a disorder in which tissue called endometrium, which normally lines the inside of the uterus, grows outside it. This abnormal tissue growth can affect the ovaries, fallopian tubes, and the tissue that lines the pelvis. Only in rare cases does the endometrial tissue grow beyond the pelvic organs to others like the intestines, stomach, or rectum.

Although not in the uterus, this endometrial tissue continues to follow the normal menstrual cycle, thickening, breaking down, and bleeding each month. However, since the blood and tissue can’t exit the body, it can cause several issues.

If endometriosis affects the ovaries, cysts (known as endometriomas) may develop. In addition, other tissues irritated by the endometrium can be scarred or develop adhesions, which are bands of fibrous tissue that can cause organs and pelvic tissues to stick together.

Endometriosis affects an estimated 2% to 10% of women aged 25 to 40.

Endometriosis Causes

Experts aren’t sure what causes endometriosis but suspect it may be related to:

• Tissue movement through the blood or lymph systems. Tissue may be carried to areas outside the uterus by blood or lymph flow.
• Cell transplantation due to surgery. Procedures like C-sections and hysterectomies may enable endometrial cells to attach to tissue or organs outside the uterus.
• Reverse menstruation. During a period, endometrial tissue moves into the fallopian tubes and abdomen rather than exiting the body.
• Cell transformation. Other types of cells may transform into endometrial cells and start growing outside the uterus.

Endometriosis Signs and Symptoms

The main symptom of endometriosis is pelvic pain, which is commonly associated with menstrual periods but more intense than normal cramping with this condition. Women typically report that the pain increases over time and extends several days into their period. 

Other signs and symptoms include:

• Excessive bleeding or bleeding between periods
• Pain during or after intercourse
• Painful urination or bowel movements during menstruation
• Infertility
• Fatigue
• Constipation or diarrhea
• Bloating and nausea

 The amount of pain a woman experiences and the extent of her endometriosis don’t necessarily go hand in hand. A mild case of the condition may cause severe pain, while an advanced case can cause little to no discomfort.

How Doctors Identify Endometriosis

Doctors use various types of exams to diagnose endometriosis, including:

• Pelvic exam. Your doctor manually assesses different areas in your pelvis, looking for cysts, scarring from endometriosis, etc. However, abnormalities may be small enough that they’re difficult to detect. 
• Ultrasound. This procedure uses sound waves to produce images of your reproductive organs. Your doctor holds a device against your abdomen, inserts it into your vagina, or uses both approaches. Ultrasound can’t produce a definitive diagnosis, but it can identify cysts, which are an indicator of endometriosis.  
• Magnetic resonance imaging (MRI). An MRI scan uses radio waves and magnetic fields to produce detailed pictures of your reproductive organs.
• Laparoscopy. Your doctor may refer you to a surgeon for a procedure where they put you under general anesthetic, make a tiny incision near your navel, and insert a thin device that lets them look for endometrial tissue outside the uterus. This exam can determine the location and size of any abnormal tissue and can also be used to obtain a tissue sample (biopsy).

Endometriosis is categorized into stages 1 through 4, depending on how far the tissue has spread and how much of it is in areas outside the uterus. Stage 4 is the most advanced. 

Endometriosis Treatment

Doctors can treat endometriosis in several ways, depending on the severity of the condition and other factors. Treatments include everything from pain medication and hormone therapy to a hysterectomy with ovary removal. 

Get details on endometriosis treatment in a related blog post. 

Risk Factors for Endometriosis

Endometriosis can develop at any point after a woman has started menstruating but is most common in the 30s and 40s. Both reproductive and other factors can affect your risk. 

Reproductive factors

• Early onset of menstruation
• Short periods (less than 28 days apart)
• Long periods (lasting more than seven days)
• Never giving birth
• Other uterine-related medical conditions, particularly if they block menstrual blood flow
• Later-than-average onset of menopause

Other factors

• Low body mass index (BMI)
• Exposure to higher-than-average levels of estrogen throughout life or currently having high levels of estrogen in your body
• Family history of endometriosis

Endometriosis-Related Conditions

Certain conditions can mimic endometriosis or occur with it, including:

• Infertility: Up to 40% of women who’ve had trouble getting pregnant have endometriosis, according to the American College of Obstetrics & Gynecology. Managing your endometriosis can be an important step toward getting pregnant.
• Polycystic ovarian syndrome/ovarian cysts: Endometriosis can sometimes be confused with this condition. Some women may have both endometriosis and polycystic ovarian syndrome/ovarian cysts.
• Ovarian cancer: Very few women develop this type of cancer. However, women with endometriosis are slightly more prone to it than the general population. Women who’ve had endometriosis can also develop a rare type of cancer called endometriosis-associated adenocarcinoma.

Learn About Baptist Health Women’s Services

Endometriosis is a treatable condition. If you think you may be suffering from it, talk with your doctor about it and our outstanding women’s health services.