How is Endometriosis Diagnosed?

There are many types of gynecological diseases in life, especially in major hospitals, where gynecological clinics are basically overcrowded. Among them, people with endometriosis are also common. If women do not know much about this disease, they can only find it through gynecological examinations. So, what are the diagnostic methods for endometriosis?

How to diagnose endometriosis:

1. The focus of medical history inquiry is menstrual history, pregnancy and childbirth history, family history and surgical history. Pay special attention to the relationship between the occurrence and development of pain or dysmenorrhea and menstruation and surgeries such as cesarean section, artificial abortion, and fallopian tube insufflation.

2. In addition to the bimanual examination, the gynecological examination should emphasize the need for a triple examination. In pelvic endometriosis, the uterus is often posterior, with poor mobility or fixed; the characteristic physical signs are tender nodules in the uterosacral ligament and posterior fornix; in ovarian endometriosis, cystic masses can be felt in the adnexal area, which are adherent to the uterus or broad ligament and pelvic wall, with poor mobility and often mild tenderness. The cysts are generally smaller than 10 cm.

3. Laparoscopy is currently internationally recognized as the best method for diagnosing endometriosis. If typical lesions described in gross pathology are seen under laparoscopy, the diagnosis can be basically established, and what is seen during the operation is also an important basis for clinical staging. Especially for patients with mild to moderate endometriosis, infertility and chronic pelvic pain caused by suspected endometriosis, and patients with pelvic tender nodules in gynecological examinations but no positive findings in B-type ultrasound examinations, laparoscopy should be used as the first choice for diagnosis if conditions permit. Laparoscopy is also the most commonly used method for treating endometriosis.

4. Other auxiliary examinations

(1) Imaging examination: Vaginal and abdominal B-mode ultrasound examination is an important means to differentiate ovarian endometriosis cysts from rectovaginal septum endometriosis. Its diagnostic sensitivity is 97% and its specificity is 96%. B-mode ultrasound examination can determine the location, size, shape and contents of ovarian endometriosis cysts, as well as their relationship with surrounding organs, especially the uterus. Ultrasound images generally show that the cysts are oval or round. The cysts can be single-chambered or multi-chambered, with obvious boundaries and adhesions to surrounding tissues. The cyst wall is thick and rough, with tiny flocculent light spots inside the cyst. The size of the cyst changes with the menstrual cycle. Since the echo image of the cyst is non-specific, it cannot be diagnosed based solely on B-mode ultrasound images. The diagnostic value of pelvic CT and MRI for pelvic endometriosis is equivalent to that of B-mode ultrasound, but the examination cost is higher.

(2) CA125 value determination: The serum CA125 value of patients with moderate to severe endometriosis may be elevated, but generally it is a mild increase, mostly below 100 IU/ml. However, the specificity and sensitivity of CA125 are limited, and it has cross-positive reactions with many diseases, so it cannot be used alone for diagnosis or differential diagnosis.

(3) Anti-endometrial antibodies: Anti-endometrial antibodies in normal women's serum are mostly negative, while more than 60% of patients with endometriosis are positive. It has been reported that its sensitivity is 60% to 90% and its specificity is 90% to 100%. The detection of this antibody in the patient's blood indicates that there is ectopic endometrial stimulation in the body and changes in the immune environment in the body. However, this method has not yet been popularized in clinical practice.

Will endometriosis come back?

Endometriosis is a common disease with a high recurrence rate. The treatment of endometriosis is not a one-time solution, and the recurrence rate is closely related to the woman's physical condition and treatment method.

The treatment of endometriosis mainly includes preserving the area near the uterus and removing the uterus and its appendages. The choice of treatment method should also be based on the woman's physical condition and the severity of the disease.

Will endometriosis recur? Experts point out that the possibility of recurrence is not only related to the surgical plan, but also has a lot to do with the patient's age. For women approaching menopause, the possibility of recurrence decreases due to the decline in estrogen secretion function.