How Doctors Diagnose Endometriosis

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If you have menstrual problems and pain, your doctor will need to find the source. The doctor will probably run tests to either diagnose endometriosis or rule it out. Endometriosis occurs when the tissues that line the inside of the uterus grow outside of the uterus. With the right diagnosis, your doctor can work on the best way to treat the pain endometriosis causes. It can also help to manage infertility or other complications of endometriosis.

Your doctor will probably follow a specific process to decide if you have endometriosis:

1. Symptoms and Medical History

The first step is usually a conversation with your doctor. The doctor will ask questions about your symptoms. You will need to explain where and when you have pain. Your doctor may ask about your menstrual cycles. Questions will also cover your personal and family medical history. Endometriosis tends to run in families. It will help your doctor to know if you have a mother, sister, aunt or other close female relative with the condition.

2. Pelvic Exam

Next, your doctor will do a pelvic exam to examine your uterus. Your doctor will also feel (palpate) your pelvis to tell if there are cysts. The doctor can't really "feel" endometriosis. But, he or she may be able to feel the cysts endometriosis may cause.

3. Imaging Tests

To get a better view, your doctor may have you get an imaging test, like an ultrasound. This shows the doctor if there are any cysts. Your doctor will use an ultrasound wand. One type of ultrasound wand presses against the outside of your abdomen, and another type is inserted it in your vagina.

Your doctor might also order an MRI (magnetic resonance imaging) test to diagnose endometriosis. The machine takes detailed pictures of your entire pelvic area. This will show any endometrial growths that the doctor may not find during an exam.

4. Medications

Next, your doctor may try medication to see if that relieves your pain and symptoms. Birth control drugs that contain hormones can ease endometriosis pain and symptoms. Another drug, called a gonadotropin-releasing hormone (GnRH) agonist, stops menstruation and reduces estrogen production. If these medications relieve your pain and symptoms, your doctor may be able to diagnose endometriosis.

5. Laparoscopy

If medications don’t work, your doctor may recommend laparoscopy. This is surgery, but it involves only a small cut in your abdomen. You are under anesthesia so you don’t feel anything. Your doctor, or perhaps another doctor who specializes in pelvic surgery, uses tiny tools, including a camera, to check inside your pelvis. The doctor will be able to see if there is endometrial tissue. If there is, the doctor takes a sample to check under a microscope. A laparoscopy can show exactly where the endometriosis is and how severe the condition is. 

Your doctor may use one or all of these ways to diagnose endometriosis. Once you have a diagnosis, you can determine the best treatment to ease your pain and symptoms.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Nov 27
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