Endometriosis cannot be diagnosed with certainty by symptoms and physical examination alone. The healthcare practitioner may consider other conditions such as infections or tumors. One condition that may have similar symptoms to endometriosis is interstitial cystitis, or chronic inflammation of the bladder. Direct visualization of the endometriosis implants, typically via laparoscopic surgery, provides the definitive diagnosis. In order to diagnose endometriosis, the following steps may be taken:
- A biopsy of the suspected tissue may be accomplished by laparoscopy. During this procedure, a tiny camera is inserted through small incisions in the patient's abdomen. Instruments are used to remove a small piece of tissue that is examined in the laboratory. More invasive surgery, called laparotomy, requires a larger surgical incision, and does not rely on the use of a surgical camera.
- During surgery, samples of the suspected areas are taken and evaluated by a pathologist. Microscopic examination of tissue samples taken during surgery may reveal endometrial cells in areas outside of the uterus.
Once a diagnosis of endometriosis has been made, the woman and her healthcare practitioner will discuss treatment options.
Is There Surgery to Treat Endometriosis?
- If treatment with medications does not work or is not appropriate for a woman, surgery can be considered if she has severe pain or severe damage to the pelvic structures.
- Laparoscopic surgery (a minimally invasive, camera-guided surgical procedure) may be used in an attempt to remove all endometrial tissue outside of the uterus. This removal is often performed during the surgery when endometriosis is diagnosed.
- Surgery to remove the uterus and ovaries, called a hysterectomy, is considered for women who fail medical therapy and no longer wish to have additional children.
- Although surgery can be very effective, endometriosis may recur following surgery. Some studies have shown the recurrence rate of endometriosis following surgical treatment to be as high as 40%.
- Most women find relief from symptoms once menopause is complete and when the levels of hormones responsible for promoting this disease diminish.
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