Diagnosing endometriosis

As with all clinical conditions, an accurate and detailed history and examination of the patient is mandatory. The symptoms of endometriosis include chronic pelvic pain (including dysmenorrhoea, dyspareunia and inter-menstrual pain) and infertility. A number or predisposing factors are age, family history, menstrual cycle length, constitutional factors and cultural influences. However, the clinical symptoms overlap a number of other conditions and therefore care must be taken to include a detailed gastrointestinal and urinary history as well as a social history. Physical findings are equally diverse but may include retroversion of the uterus, pelvic masses, nodules and pelvis tenderness. Laboratory tests are of no value in diagnosing the disease but may be useful in monitoring treatment. Imaging using ultrasound or magnetic resonance imaging may be useful adjuncts. Laparoscopy remains the gold standard to diagnose endometriosis but surgeons who perform this must be appropriately trained and this doubles the diagnostic efficiency. Recognition of peritoneal implants in their various guises, endometriomas, and deep infiltrating disease is fundamental in appreciating the severity of the disease which will govern the choice of therapy the patient will be offered.