How is endometriosis diagnosed?

Written by Yue Hua

Obstetrics and Gynecology

Updated on September 24, 2024

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Endometriosis is a condition where the uterine lining grows outside of the uterine cavity, commonly seen in the pelvic region, particularly above the ovaries. Therefore, ultrasound (B-ultrasound) examinations are primarily used for accuracy. The ultrasound may reveal a large mass on one side of the fallopian tubes or ovaries, with uneven content inside. During the ultrasound, it can also be observed that the capsule of the mass is intact. Additionally, during a gynecological examination, the doctor may also feel a mass in the adnexa.

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Written by Shen Li Wen

Obstetrics and Gynecology

1min 9sec

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How is endometriosis diagnosed?

The gold standard for diagnosing endometriosis in women is laparoscopy. Under laparoscopy, the lesions of endometriosis can be clearly seen, the severity of the condition is understood, and it can also serve as a surgical treatment. However, generally speaking, this method of examination tends to be relatively expensive, so other methods are usually used for a comprehensive evaluation. For example, understanding the normal menstrual cycle, the duration of menstruation, and the presence or absence of dysmenorrhea. In addition, some related auxiliary examinations, such as vaginal ultrasound, can be combined to check for any abnormal cysts on the ovaries and the echo characteristics of the cyst content. Blood tests for CA125 can also aid in the diagnosis if a significant increase is observed.

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Obstetrics and Gynecology

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Causes of endometriosis

The causes of endometriosis are not yet fully understood, but the theory of endometrial implantation is recognized by most experts and scholars. The main reason is that during menstruation, endometrial glandular epithelium and stromal cells can retrograde with menstrual blood, enter the pelvic cavity through the fallopian tubes, implant on the ovaries and adjacent pelvic peritoneum, and grow and spread there, forming pelvic endometriosis. Most clinical and experimental data also support this theory, indicating that approximately 70%-90% of women experience menstrual blood retrograde. Additionally, congenital vaginal atresia can also lead to endometriosis, as well as iatrogenic endometrial implantation, such as abdominal scar implantation after cesarean section or endometriosis at the perineal incision site after childbirth. These factors may also contribute to the development of endometriosis.

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Obstetrics and Gynecology

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Endometriosis has several manifestations.

When women suffer from endometriosis, the clinical manifestations can vary depending on the specific location of the ectopic endometrial tissue, but there are some commonalities. A major symptom is pain related to menstruation, such as dysmenorrhea. For example, ovarian chocolate cysts can cause progressively worsening dysmenorrhea and affect the amount of menstrual flow; issues like increased menstrual volume and prolonged menstrual periods can also occur, and some women may experience pain during intercourse. Endometriosis often leads to the occurrence of pelvic adhesions, so some women may also experience chronic pelvic pain. When endometrial tissue is located on the ovaries, it can affect normal ovulation and hormone secretion, leading to irregular menstrual cycles and infertility.

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Obstetrics

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Is it easy to get pregnant with endometriosis?

Endometriosis, which has a relatively high incidence among women, refers to the condition where the endometrial tissue is located outside the uterine cavity. This condition can easily lead to infertility. Although endometriosis is a benign disease, it exhibits characteristics similar to those of malignant diseases, primarily manifesting as local infiltration that causes adhesions and can disrupt the function of the fallopian tubes and ovaries. First, it can lead to the presence of chocolate cysts on the ovaries, which can affect the ovulation function of the ovaries. Second, it can sometimes cause adhesions in the fallopian tubes or pelvic adhesions, affecting the egg-pickup function of the fallopian tubes. This prevents sperm and eggs from fertilizing within the fallopian tubes. Even if fertilization occurs, the impaired function of the fallopian tubes may also lead to an increased risk of ectopic pregnancy.

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Obstetrics and Gynecology

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Endometriosis symptoms

When women suffer from endometriosis, the typical symptom is progressively worsening dysmenorrhea. What is progressively worsening dysmenorrhea? It is mainly because the ectopic endometrial tissue also becomes congested, swollen, and sheds each month during menstruation, causing the ectopic lesions to gradually enlarge, thus making the dysmenorrhea increasingly painful. Some women may have ovarian endometriomas or ectopic endometrial lesions in the posterior cul-de-sac of the vagina, which can also cause severe pain during intercourse. Ovarian endometriomas can also affect the normal ovulation of the ovaries, leading to menstrual cycle disorders, such as irregular menstruation or increased menstrual flow, among other phenomena. Endometriosis can also alter the pelvic environment, leading to difficulties in conception for women.