Diagnosis of Endometriosis

Introduction
Definition
Incidence
Cause
Symptoms
Intestinal Endometriosis
Infertility
Diagnosis
Treatment
Adenomyosis
Are you too young to have
a laparoscopy?
Endometriosis and cancer
Treatment summary
Endometriosis and heredity

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The most important thing in medicine is to make the right diagnosis. A basic principle of medicine is that treatment follows diagnosis. It is improper medicine to treat someone without a proper diagnosis. The only way a definite diagnosis of Endometriosis can be made, with rare exceptions, is by laparoscopy.

Laparoscopy is necessary even if there is little doubt as to the diagnosis. In such instances, the laparoscopy serves to do 2 things. First, it definitely establishes the diagnosis because, as I have already pointed out, a woman's pelvic pain could be due to other causes. Secondly, it allows the physician to determine the actual amount of Endometriosis that is present. This is critically important because therapy for the infertile woman is dependent on the actual amount of Endometriosis present, not the severity of her symptoms. In a woman not desirous of pregnancy, the severity of her symptoms often plays a greater role in determining the choice of treatment although obviously both are important.

A blood test - the CA-125 level - has been developed which some have claimed may permit the diagnosis of Endometriosis to be made without laparoscopy. It is true that this test may raise the suspicion of Endometriosis when it might not have otherwise been suspected. However, this blood test will not eliminate the need for laparoscopy, at least for the foreseeable future. There are several reasons for this. First, it is not yet proven that the blood test is that reliable. Second, the treatment of Endometriosis is based mainly on the extent of the disease which can only be determined by direct visualization. The blood test is still too uncertain to replace traditional diagnostic treating.

Most importantly, many other pelvic problems besides Endometriosis frequently give a elevated result. Many other common, benign conditions such as fibroids will elevate the CA-125 level in premenopausal women. Pelvic infection, the condition most commonly confused with Endometriosis, will elevate the CA-125 level. The principal value of this test may be to alert the physician to the presence of Endometriosis in the woman who has no symptoms.

There is also some evidence that changes in the CA-125 levels correlate well with persistence of the disease and decrease in pain. If the level drops, the likelihood is that the therapy is working. Lastly, some insurance companies, most notably Blue Cross, refuse to pay for a CA-125 level unless the woman has ovarian cancer. Thus, women with these types of insurance are being denied the best care possible because their insurance company wants to save money.

Another place where the CA-125 level is important is the evaluation of a woman with pelvic pain. If a woman is examined during the first few days of her menstrual period (something which many women understandably do not like); if she has tender nodularity in the deep pelvis; and if she has an elevated CA-125 level, then there is a strong probability that she has invasive Endometriosis. Invasive Endometriosis must be treated differently. Indeed, a laparoscopy may not even demonstrate the extent of the disease and unless appropriate preparations are made, the maximum benefit from the surgery will not be possible.