Relationship between pelvic pain and diagnosis of endometriosis. Dr Marlain Mubarak MD FRCOG CCT UK MsC Oxford, Consultant Gynecologist and Head of British Society Accredited Endometriosis Center, Canadian Specialist Hospital
Diagnosing endometriosis remains a challenge in view of non-specific symptoms that overlap with other gynecological and bowel diseases hence the gold standard for evaluation is still laparoscopy.
Common signs and symptoms of endometriosis may include:
- Painful periods (dysmenorrhea).
- Pelvic pain and cramping may begin before your period and extend several days into your period.
- Pain with intercourse.
- Pain with bowel movements or urination especially when you are on your period
- Heavy periods
- Heavy or painful periods in young girls that results in having to miss school due to pain
- Other symptoms such as constipation, feeling of incomplete emptying bowels or rectal bleeding
Several studies have demonstrated that clinical examination by an experienced gynecologist in endometriosis can identify severe endometriosis and as well help in planning what is the best investigations
Ultrasound is readily available and regarded as first tool used in the process of establishing diagnosis and management plan. Ultrasound can identify endometriotic cysts on the ovary; however superficial peritoneal (endometriosis of the skin lining the inside of the abdomen) can’t be seen on ultrasound. Hoover internal ultrasound in by an experienced doctor can identify deep infiltrating endometriosis at the back of the uterus and possibly the bowels.
Pelvic MRI has currently a fundamental role in the diagnosis of Deep infiltrating Endometriosis establishing a complete assessment of the disease extent, especially in the presence of sub-peritoneal pelvic localisations, which are often undetected by gynecological examination and laparoscopy. However it needs specialist expertise, using special MRI protocols (MRI techniques) and a specialist in this field to identify and report accurately. Usually such services are available in Specialist Endometriosis Centers.
Biomarkers (blood tests)
Serum biomarkers such as CA125 has been evaluated extensively as potential diagnostic measures for endometriosis, but they have been shown to be non-specific and of limited value. However, an elevated level between 50 and 150 can usually be seen more frequently in severe endometriosis.
Laparoscopy is regarded as the gold standard in the diagnosis and classification of endometriosis. It allows the inspection of the pelvis.
And it also allows inspection of the bowel to assess the involvement of the appendix, sigmoid colon, and the upper rectum. At the same time we can treat the endometriosis by removing it with Laparoscopic techniques. To identify severe endometriosis accurately and treat it properly we need special expertise hence in Europe and UK this type of surgery is only performed in specialist centers called Endometriosis Centers, licensed and monitored by the British or the European Society of Gynaecology Endoscopy.