Answer from: Sibte Hassan, MBBS, FCPS, MRCOG, MSc
A strong clinical suspicion on the basis of symptoms. Sometimes we do the imaging, which is mainly ultrasound, which is the common modality and ultrasound can only diagnose endometriosis if it is within the ovary like leading to chocolate cyst. Sometimes we have to do a more advanced scan if there is strong clinical suspicion and the patient is not improving to initial therapy, then we could order MRI scan which is more diagnostic, gives more information and can either rule out or diagnose endometriosis in more detail and certain type of endometriosis as well. So, it’s quite a useful modality. The last but not least is obviously a bit more invasive is laparoscopy where we put the camera through the belly button under an aesthetic and we can actually visualize the disease and we can see different organs and we can know about the extent of the disease and we can stage the disease as well.
Summarize: symptoms, imaging, laparoscopy.
Answer from: Dimitris Papanikolaou, MD
I mean, what you want to benefit from, what you want to gain from this. Women who are trying for a baby, I think they are more prone to do this thing, checking even for just in case and all of those women benefit from the effect of the procedure on their body and on their immune system. So, practically it’s beneficial, practically. But if you ask me just to treat the endometriosis, I don’t believe that every woman who is suspecting endometriosis must have keyhole surgery laparoscopy to diagnose it in a few words. Why? Because endometriosis comes and goes – sometimes stronger, sometimes milder. When you don’t have any physical problem: pain or other things, then I don’t believe that you should investigate it because you have nothing to do with it, nothing to win by treating it and of course all these old classic treatments that they apply for the endometriosis, for example, when they switch off the ovaries for months…to be honest, yes, as a doctor I know that it works but as a woman I wouldn’t want to have a treatment like this. I wouldn’t like to be in menopause for three, six, nine months or a year just to stop this thing.
Answer from: Ahmed Elgheriany, MRCOG, MD, MSc
So, this is the problem about the diagnosis. Laparoscopic can be a diagnosis, if it’s for a longer time and actually it was the golden standard and now the debate between ultrasonography or MRI scan. In ultrasonography, we can find that if it’s something in the pelvis we can see endometriosis on the ovary which in the form of endometriotic, endometriosis. Endometrioma it is found by like 40% in women with endometriosis so, it’s very common and we will discuss its effect on infertility later on but you can find these nodules between the vagina and the rectum and sometimes this is very disfiguring nodule and very very uncomfortable to have something inside the rectum which makes you feeling very very difficult sensation in passing, opening your bowel or anything. It may need to have a surgery and this may help you to just discuss with the surgeon how the surgery will be done for this kind of pain so, this can be diagnosed by ultrasound if you are aware and you have proper training and you know what you are looking for. If you have urinary symptoms, we can see bladder endometriosis, bladder nodules on the scan, on the 2D scan, not 3D scan. On the 2D scan, you can expect you to recycle nodule endometriosis by 2D scan so this is very helpful to be aware about what’s inside. Just listen, try to correlate everything with what you are seeing. MRI scans are also helpful. We well recommend MRI scans because the debate on MRI is a gold standard and ultrasound is a golden standard – this is after it was diagnosed with laparoscopy or surgery – is the gold standard for diagnosis. Now the debate between ultrasound and MRI but I will recommend MRI scan for any symptoms away from the pelvis so, it can help to diagnosis endometriosis on the diaphragm, on the bowel itself, up around the stomach, in any place in your in your tummy or on the lung so, it can help actually to see this endometriotic soft tissue gland – it’s very helpful to have MRI scan too. Especially if you are going to have a major surgery for endometriosis which another story will speak about later. So, simply the diagnosis itself could be done very easily, by taking proper history and starting to work on it very early rather than waiting for a long journey to be diagnosed by your specialist.
How is a diagnosis of endometriosis confirmed?
How do you confirm endometriosis? What is the best way to diagnose endometriosis? What are the golden standards for diagnosis of endometriosis?
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