How does a doctor know that my daughter has endometriosis?
There are no x-rays or blood tests to diagnose endometriosis. The only 100 percent way to be certain of the condition is to have a procedure called a laparoscopy. This surgical procedure allows a doctor to look at the pelvic organs with a tiny camera.
Other tests that your physician may order before the laparoscopy include:
- blood tests or vaginal cultures (to check for infection)
- a pelvic ultrasound or MRI (to rule out other conditions)
For Medical Professionals
Endometriosis—the presence of extra-uterine endometrial glands and stroma that can lead to subsequent inflammation and fibrosis—is a chronic disease affecting 5 to 10 percent of women of reproductive age, most commonly occurring in adolescents. It can cause pain, infertility and significant quality of life impairment, and often presents as cyclic and noncyclic pelvic pain. Since there is no non-invasive diagnostic test, there are high rates of misdiagnosis or delayed treatment.
Since early diagnosis and treatment may prevent further pain, functional impairment and a cycle of lower self-esteem, depression and anxiety, primary care providers (PCPs) have a unique opportunity to intervene. The diagnostic challenge is determining when the symptoms are not dysmenorrhea and require further evaluation:
- Ask targeted questions about personal history: Familial history, early dysmenorrhea, menarche after the age of 14, absenteeism from school during menses, pain that is resistant to non-steroidal anti-inflammatory drugs (NSAIDs) and use of combined oral contraceptives (COCs) to treat uncomfortable, heavy periods can indicate endometriosis. If there is a family history of endometriosis or infertility then the PCPs should have heightened concern. Also ask about structural abnormalities of the reproductive or renal systems.
- A pelvic exam is not obligatory in adolescents with dysmenorrhea, but if an obstructive anomaly is suspected, a Q-tip or Calgiswab can be inserted into the vaginal canal and moved gently side-to-side to document patency. If a sexually active patient presents with noncyclic pain, a pelvic exam can help rule out pregnancy, an indolent form of pelvic inflammatory disease or an ovarian mass.
- A blood count and erythrocyte sedimentation rate, urinalysis and culture, sexually transmitted infection screen and pregnancy test should be considered to rule out other conditions that may mimic endometriosis such as urinary tract infection or pelvic inflammatory disease.
- If pain persists through NSAID use or interferes with daily activities, a combination of NSAIDs and cyclic hormonal treatment for three months should be trialed to prevent hormonal cycling and ovulation, restrict endometrial growth and decrease bleeding.
- Patients should be encouraged to keep a symptom diary detailing menstrual pain and any other patterns. Treatment efficacy should be evaluated every three to six months.
- Progestin-only pills should not be used as first-line therapy, but as an alternative for patients with contraindications to estrogen use, such as complex migraines.
Refer to a specialist when pain relief is not sufficient to enable regular daily activities.
For adolescents who have persistence of pain symptoms on cyclic COCs and NSAIDS, endometriosis is suspected and a laparoscopy is indicated for diagnosis and treatment.
For more information, please call the Center for Young Women’s Health at 617-355-2994.