- Listening to the patient – listening to the patient is an art and it helps in endometriosis diagnosis as well. Most of the patients after going to several doctors tell us “they were never heard”
- Proper clinical history – clinical suspicion of endometriosis when they have painful periods is very important but this may not be the only presentation. They should also be asked for other symptoms which may be non-specific but very relevant in reaching the diagnosis.
- Proper clinical examination – abdominal, vaginal, and bimanual examinations are very important to diagnose endometriosis. Sometimes rectal examination may be needed. Sometimes patients have severe pelvic pain and they don’t want pelvic examination, this can be carried out under anaesthesia if required. This gives us a lot of information regarding the presence of rectovaginal nodules, uterosacral nodules, and endometriomas.
- Ultrasonography – high-resolution ultrasound is done by a trained sonologist is the best initial modality for diagnosing endometriosis. Complete mapping of lesions can be done and surgery can be planned with multi-disciplinary team involvement. For young girls abdominal scan may not give proper information, rectal ultrasound and MRI may be required.
- MRI – most of the endometriosis lesions can be picked up on ultrasound but stage 1 or 2 lesions which are very early and subtle lesions, MRI may be required for diagnosis.
- Laparoscopy – THE GOLD STANDARD for endometriosis excision. The advanced equipment with high resolution helps us to identify not-so-endo-looking lesions as well. It’s the training and ability to identify all types of endometriosis lesions and excise them for good results. If someone is not trained to identify, early and subtle lesions may be missed. Always try to find a specialist who deals with endometriosis extensively and does excision surgeries.
Our approach
Before surgery, these are steps we follow
A proper history and physical examination – after going through your history and symtpoms we conduct a physical examination. This examination involves, cervical examination with a speculum, pelvic bimanual examination to rule out nodules in the upper vagina and rectovaginal area and we also note down the pulling up of uterosacrals, lesions in cul de sac and lateral vaginal walls, and tenderness. We also check for neuropathy if any.