Endometriosis can cause a woman to have pelvic pain that initially is most intense during the menstrual flow and progresses over time to become increasingly severe and extend throughout the entire monthly cycle. Women with any stage of endometriosis can also have infertility, possibly due to a substance produced by the endometriosis lesions or due to scar tissue (pelvic adhesions) caused by chronic inflammation that results from the presence of endometriosis. However, some women with endometriosis have no symptoms at all- they experience no pelvic pain and they have normal fertility. Thus, it is not possible to accurately diagnose endometriosis based on symptoms alone.
Endometriosis can only reliably be diagnosed by direct visualization of the endometriosis lesions (which occur most often within the pelvis), and this diagnosis can be confirmed by biopsying the lesions and examining those biopsies under a microscope. In most situations, endometriosis can only be diagnosed with certainty at the time of pelvic surgery.
Endometriosis is defined as endometrium (the cells that normally line the uterine cavity and allow for the implantation of an embryo) that is growing outside the body of the uterus. Endometriosis is not uncommon; it is thought to occur in up to 10% of all women and up to 50% of women with infertility.
Women with a variety of symptoms and findings on physical exam are thought to “most likely have” endometriosis, but many of these women do not undergo laparoscopy to confirm their diagnosis. Therefore, women with a variety of clinical findings are either treated for “presumed endometriosis” or they receive delayed and/or suboptimal treatment.
When laparoscopy is performed to diagnose and treat endometriosis, the experience and expertise of the surgeon becomes critically important. As stated in the guidelines of the European Society of Human Reproduction and Embryology “On the other hand, diagnosis during laparoscopy is dependent on the ability of the surgeon to recognize peritoneal disease in all its different appearances. If the surgeon performing the laparoscopy is not familiar with these appearances, endometriosis may be missed or left untreated- you see only what you recognize. This is especially relevant in deep infiltrating disease, where sometimes endometriosis is hidden beneath the peritoneal surface.” (Management of women with endometriosis: September 2013, page 5).
Several recent studies have reported significant delays in the diagnosis of endometriosis, including a delay of 10-11 years in Germany and Austria (2012), 8 years in the UK and Spain (2006, 2011), 6-7 years in Norway (2006), and 7-10 years in Italy (2011). This is a widespread problem for women suffering from the problems associated with endometriosis.
At The NJ Center for Fertility and Reproductive Medicine, Dr. Eric Daiter, MD has performed thousands of minimally invasive laparoscopic surgeries for the diagnosis and treatment of all stages of endometriosis. In his clinical practice, Dr. Daiter has focused on repairing problems of the pelvis, including endometriosis, to improve fertility and reduce pelvic pain.
Women with clinical symptoms or physical findings suggestive of endometriosis are encouraged to seek medical attention from an expert in endometriosis. Sometimes this might be your OB-GYN doctor, but most often, finding a doctor that specializes in the identification and treatment of pelvic endometriosis is beneficial.