Diagnosis
Diagnosis is based on a clinical assessment supplemented by further tests. As the symptoms are variable and non-specific, it often takes several years to reach a diagnosis. The WHO estimates that the average time taken is between 4 and 12 years.
Medical history, focusing on the characteristics of the pain and its cyclical nature, is essential. Symptoms of endometriosis vary greatly from one person to another and do not necessarily correlate with the severity of the condition; the pain may also be accompanied by psychological symptoms, particularly anxiety or depression.
Imaging, particularly pelvic ultrasound and MRI, plays a central role in identifying lesions.
Laparoscopy, long considered the gold standard, is no longer systematically necessary to initiate treatment. Current guidelines favour a clinical and radiological approach, allowing treatment to begin without surgical confirmation in many cases.
Recommendations from the European Society of Human Reproduction and Embryology (ESHRE) on endometriosis
Offer a transvaginal ultrasound to all women or individuals with suspected endometriosis, even if the pelvic or abdominal examination is normal, in order to:
- identify ovarian endometriomas and deep endometriosis, including where it affects the bowel, bladder or ureters;
- identify or rule out other conditions that may be causing the symptoms;
- guide management and enable referral to an appropriate service based on the ultrasound results.
The National Institute for Health and Care Excellence (NICE) also recommends against testing for biomarkers in endometrial tissue, blood, or menstrual or uterine fluids to diagnose endometriosis.
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