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Endometriosis; Diagnosis.

Gynecologists and reproductive endocrinologists, gynecologists who specialize in infertility and hormonal conditions, have the most experience in evaluating and treating endometriosis.

The condition can be very difficult to diagnose, however, because symptoms vary so widely, and may be caused by other conditions.

Among the ways doctors diagnosis the disease are:

Laparoscopy. At present, laparoscopy is still the gold standard for the diagnosis of endometriosis, and is commonly used for both diagnosis and treatment. Performed under general anesthesia, the surgeon inserts a miniature telescope called a laparoscope through a small incision in the navel to view the location, size and extent of abnormalities in the pelvic region, such as adhesions.

However, laparoscopy can't diagnose deep endometriosis disease, in which the endometrial tissue is hidden inside adhesions or underneath the lining of the abdominal cavity.

Many women have a combination of both deep and superficial (in which the endometrial tissue can be easily seen) endometrial disease.

Peritoneal tissue biopsy. During the laparoscopy, the doctor may remove a tiny piece of peritoneal tissue (the outer layer of the lining of the uterus) to confirm the presence of endometrium elsewhere in your body. This is recommended by the American College of Obstetricians and Gynecologists (ACOG), which notes that only an experienced surgeon familiar with the appearance of endometriosis should rely on visual inspection alone to make the diagnosis.

Ultrasonography, MRI and CT scan. An ultrasound uses sound waves to visualize the inside of your pelvic region, while an MRI uses magnets and a CT scan radiation. While these tests can suggest endometriosis, none can definitively confirm the condition.

At this point, there is no non-invasive method to diagnosis endometriosis, which is frustrating for both women and their health care providers.

Pelvic exam. A typical pelvic exam can't detect endometriosis unless there is a pelvic mass or lesion in the ovary that causes a cyst, which is relatively rare.

Medical history. A detailed medical history may offer your health care professional the earliest clues in making the correct diagnosis. According to the Endometriosis Association, clues you may be at risk for endometriosis include irritable bowel syndrome, frequent respiratory infections (a sign your immune system isn't working properly), allergies, chemical sensitivities, frequent yeast infections and severe menstrual cramps. A simple five-question test about these conditions can quickly determine if you are at risk.

Blood test. CA-125 is a blood test used to detect a certain protein commonly found in the blood of women with endometriosis. Although CA-125 commonly reveals an elevation in such blood protein in women with advanced endometriosis, it's not as sensitive to earlier stages of the disease.

References

Ryan, Kenneth, Ross Berkowitz, et al., eds. Kistner's Gynecology and Women's Health. 7th ed. St. Louis: Mosby, 1999. pp. 501-502.

"FDA Approves New Labels for Estrogen and Estrogen with Progestin Therapies for Postmenopausal Women Following Review of Women's Health Initiative Data." FDA News/Press Release. January 8, 2003. http://www.fda.gov. Accessed March 2003.

Grady D, Herrington D, Bittner V, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 1. Cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:49-57.

Hulley S, Furberg C, Barrett-Connor E, et al, for the HERS Research Group. Heart and estrogen/progestin replacement study follow-up (HERS II): Part 2. Non-cardiovascular outcomes during 6.8 years of hormone therapy. JAMA 2002;288:58-66.

Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321-333.

"Estrogen Plus Progestin Study Stopped Due to Increased Breast Cancer Risk, Lack of Overall Benefit." National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov. Updated July 9, 2002; accessed July 9, 2002.

"Women's Health Initiative," National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov. Updated July 9, 2002; accessed July 9, 2002.

"The Women's Health Initiative New Facts About: Estrogen/Progestin Therapy." National Heart, Lung and Blood Institute.http://www.nhlbi.nih.gov. Updated July 9, 2002; accessed July 9, 2002.

"Use of Hormone Replacement Therapy Questioned For Some Women: A Preliminary Response from The North American Menopause Society." http://www.nams.org. Updated July 9, 2002; accessed July 9, 2002.

Lacey, James V., et al. "Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer." JAMA 2002. Vol. 288:334-341.368-369.

Droegemuller, William. "Endometriosis and Adenomyosis: Etiology, Pathology, Diagnosis and Management," in Comprehensive Gynecology, 4th Ed., Stenchever, Droegemuller, Herbst, Michell (2001), p. 531-564.

"About DES (diethylstilboestrol)" Endometriosis.org. http://www.endometriosis.org. Dated 1999. Accessed August 2001.

"Endometriosis Family Study Identifies High Risk of Cancer and Autoimmune Diseases." Endometriosis Association. http://www.endometriosis.org. Dated 1999. Accessed August 2001.

Guidelines on the Treatment of Endometriosis: Update. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin no. 11, Obstetrics and Gynecology, Dec. 1999.

Reproductive Conditions-Endometriosis. Veritas Medicine. http://www.veritasmedicine.com. Dated 2001. Accessed August 2001.

The Endometriosis Association. http://www.endometriosisassn.org. July 2005.

Endometriosis.org http://www.endometriosis.org. July 2005.

Endometriosis. Mayo Clinic. Available at: http://www.mayoclinic.com. Accessed October 2005.

Berkley KJ, Rapkin AJ, Papka RE. The pains of endometriosis. Science. 2005 Jun 10;308(5728):1587-9.

Keywords: endometriosis, laparoscopy, diagnosing endometriosis, menstrual cramps, pain, pelvic
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Publication:NWHRC Health Center - Endometriosis
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Date:Mar 5, 2007
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