Endometriosis can be hard to identify because its symptoms—like pelvic pain, heavy periods, or pain during sex—often resemble those of other conditions.
A diagnosis usually starts with a detailed review of your symptoms and a pelvic exam. Imaging tests like ultrasound or MRI can help rule out other issues, but they can’t always detect endometriosis.
The most reliable way to confirm a diagnosis is through a laparoscopy, a minimally invasive surgery that allows healthcare providers to look for endometrial tissue outside the uterus. This procedure can also guide treatment planning.
Here's each step of the diagnostic process, including what to expect and why diagnosis can sometimes be delayed.
What to Expect During an Endometriosis Diagnosis
The process of diagnosing endometriosis usually starts with a detailed conversation with your healthcare provider. They’ll ask about your symptoms, medical history, and menstrual cycle.
Common signs that may prompt further evaluation include chronic pelvic pain (especially during your period or sex), heavy or irregular bleeding with clotting, pain with bowel movements or urination, particularly around menstruation, and trouble getting pregnant.
If you have any of these symptoms, your provider may recommend some additional steps like a pelvic exam or imaging tests to rule out other conditions. In some cases, a diagnostic laparoscopy—a minimally invasive surgical procedure—can be used to confirm the presence of endometrial tissue outside the uterus.
Getting an early diagnosis of endometriosis can help you access appropriate treatment sooner and may help preserve fertility.
Step 1: Assessing Your Symptoms and Medical History
If your provider suspects endometriosis, the first step will usually be a detailed discussion about your symptoms and medical history. This helps narrow down possible causes and decide whether further testing is necessary.
You’ll likely be asked questions like:
- When your symptoms began
- How intense your pain is
- Where you feel the pain
They may also ask whether the pain worsens during your period, if your cycle is regular or unusually heavy, whether you're trying to get pregnant and struggling, and if any of your close relatives have ever been diagnosed with endometriosis.
Being specific and honest with your answers will help your medical provider identify any patterns that could point to endometriosis. While having a family history doesn’t guarantee you have it too, it does raise your risk, so it’s an important piece of the overall picture.
Step 2: Physical Exams
If your symptoms and medical history suggest the possibility of endometriosis, your provider may recommend a physical exam to look for any additional signs of the condition.
During a pelvic exam, they'll examine your reproductive organs, typically by both looking and gently pressing on areas in the pelvis. They’ll check for anything unusual, like:
- Tenderness
- Enlarged ovaries
- Ovarian cysts
- Thickened tissue that could suggest endometriosis or another issue
While the exam may feel uncomfortable, it shouldn’t be painful. If it is, let your provider know—pain during a pelvic exam can be an important clinical clue.
Physical exams also can't confirm endometriosis on their own, but they can help your provider decide whether any additional testing is needed, such as imaging or a laparoscopy.
Step 3: Imaging Tests
Imaging tests can help your provider get a closer look at your reproductive organs and pick up the signs that may suggest endometriosis. While these tests can't confirm a diagnosis on their own, they’re often used to support the diagnostic process.
Ultrasounds
An ultrasound is typically the first imaging test used when endometriosis is suspected. It uses sound waves to produce images of the uterus, ovaries, and surrounding structures.
Your provider may use a transabdominal ultrasound, which involves placing the probe on your lower abdomen, or a transvaginal ultrasound, where the probe is inserted into the vagina for a clearer view of the pelvic organs.
Ultrasounds can help detect ovarian cysts, particularly endometriomas, which are sometimes associated with endometriosis.
However, this test has limitations. It often can't detect small implants or endometrial tissue that's located outside the ovaries and uterus.
MRIs
Magnetic resonance imaging (MRI) provides more detailed images than ultrasounds and can be useful if your provider suspects deep endometriosis or disease that extends beyond the pelvis.
MRIs use magnetic fields and radio waves to produce high-resolution cross-sectional images of your body for a much clearer picture.
Your provider may recommend an MRI if your ultrasound shows abnormalities or if your symptoms strongly suggest endometriosis but haven't been confirmed by other tests.
What Imaging Can—and Can’t—Show
Not all cases of endometriosis will show up on imaging, especially if the lesions are small or hidden in less accessible areas. On the other hand, some findings may look like endometriosis but turn out to be something else.
For these reasons, imaging is usually just one part of the diagnostic process. A definitive diagnosis often requires laparoscopy, which is the fourth step.
Step 4: Laparoscopy
A laparoscopy is a minimally invasive surgical procedure that allows a provider to examine the inside of the abdomen and pelvis. It’s considered the gold standard for diagnosing endometriosis because it offers the clearest view of endometrial growths and related changes in the pelvic area.
To perform a laparoscopy, a surgeon makes a small incision near the navel and inserts a thin tube with a camera (called a laparoscope) into the abdomen. This tool sends live video to a monitor, giving the surgeon a detailed look at the pelvic organs.
During the procedure, the surgeon checks for visible signs of endometriosis, including endometrial tissue growing outside the uterus, scar tissue, adhesions, or ovarian cysts (endometriomas).
If these are present, they may take a biopsy—a small tissue sample—for lab analysis. This helps confirm the diagnosis and assess the severity of the condition.
Diagnosis and Possible Treatment
Laparoscopy is the only way to definitively diagnose endometriosis. If endometrial tissue is found during the procedure, the diagnosis is confirmed. In many cases, the surgeon can also treat the condition during the same procedure by removing or destroying the abnormal tissue. This may help relieve symptoms and, in some cases, improve fertility.
Biopsy results can provide important information about how extensive the endometriosis is and help guide next steps in treatment, including medication or additional procedures.
Step 5: After Your Diagnosis
Once endometriosis is diagnosed, your provider will work with you to outline a treatment plan based on your symptoms, goals, and overall health.
This might include hormonal therapy, pain management strategies, or surgery. If fertility is a concern, your care team may also discuss options to support that.
Follow-up care is important, as endometriosis is a chronic condition that may require ongoing management.
Challenges in Diagnosing Endometriosis
Even with improvements in diagnostic tools, endometriosis can still be tough to identify. Dr. Jackie Wong has met with many patients who are understandably frustrated by how long it has taken them to be accurately diagnosed.
Two of the most common challenges are delays in diagnosis and misdiagnosis.
One reason for this is that endometriosis symptoms often overlap with those of other conditions, including:
- Irritable bowel syndrome
- Pelvic inflammatory disease
- Common menstrual pain
Because of this, the condition may be overlooked or mistaken for something else. On average, it takes between 7 and 10 years from the first appearance of symptoms to reach a diagnosis. That delay can affect daily life, increase the risk of complications, and make fertility planning more difficult for women trying to conceive.
If you suspect you may have endometriosis, it’s worth taking a structured approach to your care. Here are a few steps that can help:
Track Your Symptoms
Keep a detailed record of when symptoms occur, how severe they are, and how they affect your daily activities. This can help your healthcare provider recognize patterns and narrow down potential causes.
Be Persistent
If your concerns are being dismissed or your symptoms aren’t improving, don’t hesitate to ask follow-up questions or seek a second opinion. Delays in care are common, but that doesn’t mean they’re acceptable.
Look for a Specialist
A healthcare specialist who regularly treats endometriosis, such as a gynecologist with experience in pelvic pain and minimally invasive surgery, may be more likely to identify the condition early and recommend appropriate next steps.
Stay Informed
Learning about endometriosis, including the latest research and available treatments, can help you have clearer and more productive conversations with your healthcare team.
The symptoms most commonly associated with endometriosis include severe pelvic pain, heavy or painful periods, and pain during sex or bowel movements. If these sound familiar, it’s worth speaking with a provider who knows what to look for.
Navigating Diagnosis with Confidence
Endometriosis can be difficult to diagnose, but understanding the diagnostic steps can help you approach your care with confidence. The process typically involves tracking your symptoms, some clinical exams, imaging tests, and ultimately a laparoscopy for a definitive diagnosis.
If you suspect you may have endometriosis, it’s important to discuss your concerns with a healthcare provider you trust. Early diagnosis and the right treatment can significantly improve your symptom management, protect your fertility, and enhance your quality of life.
For reliable information on diagnosis, Roon provides comprehensive guides and expert Q&As featuring specialists like Dr. Edward Nguyen and Dr. Asha McClurg.
While the path to diagnosis can be complex, there are clear resources and medical expertise available to support you.
You deserve health information you can trust. Join Roon and connect with vetted experts, not internet opinions.
Frequently Asked Questions (FAQ):
How does a doctor know if you have endometriosis?
Healthcare providers may suspect endometriosis based on your symptoms, medical history, and a pelvic exam. Imaging tests like ultrasound or MRI can also provide supporting evidence. But the only way to confirm a diagnosis is through laparoscopy—a minimally invasive surgery that allows providers to view and potentially biopsy endometrial tissue.
What are three signs of endometriosis?
The most common signs include pelvic pain during menstruation, pain during sex, and heavy or irregular menstrual bleeding.
What are the three Ds of endometriosis?
These refer to three hallmark symptoms: dysmenorrhea (painful periods), dyspareunia (painful intercourse), and dyschezia (painful bowel movements, particularly during menstruation).
What does stage 1 endometriosis feel like?
Stage 1 endometriosis involves minimal visible tissue and may come with mild or even no symptoms. Some people experience occasional pelvic discomfort or mild menstrual pain, while others may not notice anything unusual. Symptom severity doesn’t always match the stage of the condition.
