In most cases endometriosis causes mild to severe pain. Your doctor can only diagnose you based on the information you give him/her. They can’t feel what you feel. So don’t hold back describe every little possible thing that you might have noticed. No matter how insignificant it might seem. I know in the beginning it is slightly awkward and we as humans don’t like to admit that there might be something wrong with our bodies. But it is like I used to tell the sales reps I worked with ‘crap in, crap out‘. Keep a little log book for about 2 months of your pain, the location and the days including when your period occurs and any irregular flows that you might experience and how much pain killers you take and how often. This might help giving an exact description to your doctor, we all tend to forget something minor 2 or 3 months down the line. I always tell myself that doctors have seen worse, it helps me describing the small details to them.
There is mainly 3 types of test a doctor might perform in order to diagnose endometriosis.
- Pelvic exam: A doctor will manually feel areas in your pelvis for any abnormalities (cysts on your reproductive organs or scars behind your uterus). This is probably the least popular method as they will only be able to feel evidence of endometriosis if cysts have already formed as it is not likely for them to be able to feel the small areas of endometriosis. Neither one of the 2 doctors I saw performed this test.
- Ultrasound: The regular ultrasound that would be used to see the fetus in a pregnant woman is used to get a clearer image of the severity of endometriosis. The first doctor I consulted did the external ultrasound where the device called a transducer, is pressed against your abdomen. The second doctor also made use of this with my first visit, but for my annual check ups she does transvaginal ultrasound where the transducer is inserted into your vagina. In some cases they perform both to get the best possible view of your reproductive organs. Even though ultrasounds won’t definitely tell your doctor whether you have endometriosis, it is considered a good starting point to identify cysts associated with endometriosis (endometriomas).
- Laparoscopy: Most doctors try to manage the cysts (if identified with an ultrasound) at first with medication. But if the severity on the ultrasound is worrying they will refer you to a surgeon (if not themselves) to get an actual view inside your abdomen and look for signs of endometriosis using a procedure called laparoscopy. The second doctor I consulted immediately recommended that I go for a laparoscopy due to the severity of the cysts around my ovaries that she saw on the ultrasound. This basically means that they make 3 small incisions in your abdomen (one on your belly button ridge, one below your bikini line and one to the left of your belly button forming a triangle) and inserting a slender viewing instrument (laparoscope) in order to look for endometrial tissue outside the uterus. My doctor also took a tissue sample as a biopsy. This is the best method to get an accurate diagnosis, but due to the cost of surgery considered the last test. Laparoscopy will also provide information on the location, extent and the size of the endometrial implants that helps to determine the best treatment option and the way forward.