The diagnosis of Endometriosis is a particular challenge for every Gynaecologist as it is very important not only to diagnose the disease but also to assess its extent, which will determine to a large extent the treatment plan that will be followed.
The diagnostic tools we have at our disposal are the targeted history, the bilateral gynecological examination, the specialized ultrasound of the pelvic organs, the MRI and the cancer marker CA 125.
The targeted history should give us all the information about symptoms related to endometriosis and their correlation with the onset of the period, the intensity of symptoms and the recording of the amount and frequency of painkillers taken. We also need to collect information related to infertility problems as well as whether all these symptoms affect the woman’s daily life and quality of life.
During the amnio-gynaecological examination, the gynaecologist specialising in Endometriosis checks for evidence of any foci of Endometriosis in the rectovaginal septum and the sacro-uterine ligaments and the size of the uterus. In cases where the rectum is suspected of being affected by the disease, a finger examination of the rectum is also recommended.
A specialised pelvic ultrasound can show us foci of endometriosis in the uterus, ovaries and fallopian tubes, jeromedullary ligaments, rectosigmoid, bladder and ureters. This specialized ultrasound imaging requires at least 20-25 minutes, as opposed to routine gynecological ultrasound which takes about 5 minutes. It is easy to understand that such an ultrasound examination requires proper specialization by the gynecologist.
The diagnostic tools also include MRI with contrast which can give us even more detailed information already collected from the ultrasound and is usually used as a complementary tool.
The cancer marker CA 125 is a non-standard blood test used in the investigation of endometriosis. Often its elevated value confirms our suspicion, but a normal value of the index does not exclude the existence of Edometriosis and often misleads us.
When the above means are properly utilized then the Gynaecologist has a complete picture of the patient’s condition and the extent of the disease and can set the right treatment plan so that the woman can benefit to the fullest in all areas.