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Endometriosis cannot be diagnosed from symptoms alone. While a physician may suspect the disease if an infertile woman complains of severe menstrual cramps or pain during intercourse, many patients afflicted with the condition have no discomfort at all. The diagnosis thus can be confirmed only by a laparoscopy.
Laparoscopy enables the doctor to look inside the pelvis and inspect the reproductive organs to confirm the presence of endometriosis. In fact, since endometriosis is often without symptoms, many doctors advise laparoscopy as part of the diagnostic study for all infertile women.
Looking through the laparoscope the surgeon can observe the surface of the uterus, tubes, ovaries, and other pelvic organs. He can visually confirm the presence of the endometriosis and gauge its extent. If desired, a small piece of tissue can be removed for microscopic examination (biopsy). It is easy to miss early endometriosis if the laparoscopy is not performed carefully. The entire ovary should be inspected carefully; and if it is found to be enlarged, it should be punctured to look for "chocolate" cysts.
In most cases, the surgeon will treat the endometriosis during the laparoscopy. If so, he makes other small abdominal incisions through which additional instruments are introduced for operative laparoscopy it self. The surgeon may then vaporize the lesions with a laser beam, or destroy them with an electric current called diathermy.
Fig 4. Operative laparoscopy, for removal of a chocolate cyst of the ovary (endometrioma)
Other imaging technologies, such as ultrasound, computerized tomography or magnetic resonance imaging may be used to get more information about the extent of the disease. However, these procedures are useful only for identifying endometriotic cysts in the ovary.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
