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Endometriosis is not always easy to detect. Studies have shown that it takes an average of four years from the time a woman has her first symptom to the time she discusses it with her doctor. It takes an average of nine years from the time she first experiences symptoms until a diagnosis of endometriosis is finally made. Endometriosis is often found when the patient is having pelvic surgery for something else or is having trouble getting pregnant.

When to See a Doctor

You should see your family doctor if you are experiencing severe menstrual cramps, other types of pelvic pain or if you are finding you cannot get pregnant. Your family doctor will probably refer you to a specialist.

Pelvic Exam

A physician may suspect endometriosis based on what she or he feels during a pelvic exam. Your doctor may check both the vagina and rectum. If he or she feels nodules on the ligaments behind the uterus, or an enlarged ovary, endometriosis is a possibility. Endometrial growths may also be detected on the vagina, cervix and/or rectum. However, a diagnosis of endometriosis cannot be based solely on a pelvic exam. Other conditions, such as ovarian cysts, pelvic inflammatory disease (PID), ovarian cancer, interstitial cystitis (IC) and irritable bowel syndrome, have some symptoms similar to endometriosis. To avoid a misdiagnosis, appropriate follow-up exams need to be done.


A CA-125 blood test may be done to see if you have an elevated level of a certain blood protein, which can indicate advanced endometriosis. The test is less able to detect the disease in its early stages. Elevated CA-125 levels can also be caused by other conditions, such as fibroids, benign tumors and ovarian cancer; therefore, elevated levels do not necessarily mean you have endometriosis. A CA-125 blood test can produce false positives as well as false negatives. For these reasons, the test is not used to give a definitive diagnosis. It is usually used in addition to other diagnostic tests. For example, if your symptoms and pelvic exam suggest endometriosis, your doctor may recommend a CA-125 blood to confirm this suspicion before doing a laparoscopy.


If a woman has symptoms of endometriosis, laparoscopy is used to confirm this diagnosis, and possibly treat it. This procedure is a day surgery, performed in a hospital, using a general anesthetic.

Laparoscopy is a way to look inside the abdomen and examine the reproductive organs. A laparoscope is a small telescope with a light that the surgeon inserts through an incision just below the belly button. The surgeon can then view the pelvis and abdominal organs to see whether or not there is any endometriosis. Then, a small piece of the tissue is removed and examined under a microscope. The laparoscope can also be used to remove the implants and scar tissue that are causing the pain and possibly infertility.

Laparoscopy is the only way to confirm that a woman has endometriosis. No one should be aggressively treated for endometriosis unless it has been accurately diagnosed. For example, unless the doctor knows for sure that endometriosis is present, the woman should not be taking any of the more aggressive medications, such as Danazol or GnRH analogs.


In some cases, the physician may use imaging methods, like an ultrasound, CT scan or MRI, to assess whether a woman has endometriosis. Each of these methods gives the doctor some form of image of the internal organs. They can help to show how much endometriosis is present. Imaging can also identify cysts on the ovaries and fluid collection in the pelvis.


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  • A publication of:
  • Women's College Hospital