A doctor may suspect endometriosis in a woman who has the typical symptoms or unexplained infertility.
A physical examination may yield normal findings, but occasionally a woman may feel pain during the examination or the doctor may feel a mass of tissue behind the uterus or near the ovaries.
Rarely, endometrial tissue is found in the vulva, cervix, vagina, navel (umbilicus), or surgical scars.
The diagnosis can usually be made only if patches of endometrial tissue are seen.
Generally, a doctor inspects the abdominal cavity through a fiber-optic viewing tube (a laparoscope) inserted into the abdominal cavity through a small incision just below the navel.
In some cases, endometriosis can't be recognized when viewed, and the diagnosis can only be made by a biopsy (removal of a small sample of tissue for microscopic examination at a laboratory), usually performed during the endoscopy.
Other procedures, such as ultrasound scans, barium enemas with x-ray, computed tomography (CT), and magnetic resonance imaging (MRI), may be used to determine the extent of the disease and follow its course, but their usefulness in diagnosis is limited.
Certain blood tests that detect markers for endometriosis, such as CA-125 and antibodies to endometrial tissue, may also help a doctor follow the course of endometriosis.
However, because these markers may be elevated in several other diseases, they aren't useful in making the diagnosis.
The American Fertility Society has established criteria for classifying endometriosis based on where the endometrial tissue is located, whether it is on or buried beneath an organ's surface, and whether filmy or dense adhesions are found.
Considering all these factors, a doctor may classify the disease as minimal, mild, moderate, or severe. Tests also may be performed to determine if the endometriosis is affecting the woman's fertility
From The Merck Manual
