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Endometriosis Diagnosis

The only way that the diagnosis of endometriosis can be made is to undergo a laparoscopy and have a biopsy (tissue sample) taken.

A laparoscopy is a surgical procedure, performed under a general anaesthetic where a thin telescope is placed into the umbilicus (belly button). This allows your doctor to see inside your abdomen and assess the organs of the pelvis and abdomen. A laparoscopy can magnify the tissues and even small amounts of disease can be seen. Tissue that is thought to contain endometriosis is removed at the time of the laparoscopy and sent to the pathologist to be viewed under a microscope to confirm the diagnosis.

Sometimes the diagnosis is suggested without having a laparoscopy. This may be due to the fact that your doctor can feel tissues in your pelvis that are affected by endometriosis, can see an endometriosis cyst affecting your ovary or other pelvic organ or very occasionally see the endometriosis if it has grown through the vagina.

Remember that the only way to be 100% certain of the diagnosis is to have a laparoscopy and/or biopsy.

Is a Diagnosis Essential?

No. Sometimes your doctor may suggest that you have endometriosis because of your symptoms and/or the clinical signs that they can feel on examination. The decision to have a diagnosis made by laparoscopy should be discussed with your doctor since this involves an invasive test. You should be aware of the risks involved with a laparoscopy before you decide to have this procedure performed.

If you and your doctor decide to treat your symptoms with medications, then you do not have to have a surgical procedure. The decision to have a laparoscopy will depend on your clinical symptoms and your wishes for pregnancy in the immediate future.

4 Stages or Grades

Endometriosis is often classified as mild, moderate or severe or recorded in surgical notes as stage or grade I – IV.
Mild or stage/grade I endometriosis appears as small patches or surface lesions scattered around the pelvic cavity.
Moderate or stage/grade I or II endometriosis appears as larger widespread disease starting to infiltrate tissue and often found on the ovaries, uterosacral ligaments and Pouch of Douglas. Sometimes there is also significant scarring and adhesions.
Severe or stage/grade IV endometriosis affects most of the pelvic organs, often with distortion of the anatomy and adhesions.
These stages of endometriosis are accepted worldwide and described by the American Society of Reproductive Medicine. They provide a useful tool but have limitations as well. For instance, the extent of endometriosis is not generally related to the symptoms experienced.
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