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How to Diagnose Endometriosis

Endometriosis is a condition in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside it. Endometriosis is a complex condition that can be difficult to diagnose as its symptoms are easily mistaken for other medical conditions. Similar symptoms like pelvic pain and heavy bleeding sometimes overlap with other GYN conditions like fibroids or ovarian cysts. Endometriosis can also mimic the signs of other health conditions like irritable bowel syndrome. It’s important to consult a specialist who can help to either rule out or confirm endometriosis.

 A specialist will typically start with preliminary tests to check for endometriosis signs, including a manual pelvic exam, ultrasound or MRI. But the only definitive way to confirm an endometriosis diagnosis is through a visual laparoscopy, a minimally invasive procedure during which a small camera is inserted through the belly button to examine the pelvic area. To avoid a separate procedure to treat endometriosis after it is diagnosed, CIGC specialists typically perform the innovative DualPortGYN procedure to diagnose and treat the condition at the same time.

Pelvic Exam

When evaluating a patient for possible endometriosis, a doctor may conduct a pelvic exam to manually feel for any abnormalities on the reproductive organs or behind the uterus. The presence of lumps or nodules, or pain when pressure is applied to certain areas, may be a sign of endometriosis. A pelvic exam is also used to check for “frozen pelvis,” meaning the reproductive organs are not easily moved and feel frozen or stuck. A frozen pelvis could indicate the formation of extensive adhesions around and behind the uterus, restricting its movement. But a pelvic exam can be limited as a diagnostic tool because endometriosis lesions are often too small to feel. 


CICG recommends a pelvic ultrasound to help detect signs of a GYN condition in its early stages. This test uses high-frequency sound waves directed at the uterus, with frequencies higher than the upper audible limit of human hearing. It may be performed by pressing a device called a transducer against the stomach or inserting it into the vagina. The echoes from these sound waves produce an image of the pelvic region that helps the physician to see larger endometrial implants or other abnormalities. Evidence of endometriosis doesn’t always show up on an ultrasound, but it can be helpful to rule out other GYN conditions like fibroids. 

Magnetic Resonance Imaging (MRI)

Another way to capture an image of the pelvic region is through magnetic resonance imaging (MRI). An MRI is a medical imaging technique that uses a magnetic field and radio waves to produce an image, which can show cysts and scar tissue that may indicate endometriosis. However, an MRI cannot provide a definitive diagnosis because lesions are often too small to be detected on imaging. 

Diagnostic Laparoscopy

A diagnosis of endometriosis can only be definitively confirmed by direct visualization of the lesions through a diagnostic laparoscopy. A diagnostic laparoscopy is a procedure in which a small, thin camera is inserted into the abdomen to inspect the entire pelvis. Endometriosis looks like burn spots within the pelvis, but it can also appear as raised red patches, white or yellow-brown lesions or dense, brown cysts.2 The physician will take a biopsy, a small sample of tissue, of any suspected areas of endometriosis and send it to pathology for an accurate diagnosis.

Because a diagnostic laparoscopy is a surgery that does not offer symptom relief, CIGC’s recommended approach is to diagnose and treat endometriosis during the same procedure. The DualPortGYN endometriosis excision procedure is a minimally invasive surgical technique used to both diagnose and treat endometriosis.

Getting a Diagnosis

To ensure you’re getting the accurate diagnosis you need, schedule a consultation with one of CIGC’s endometriosis specialists. They are experts in evaluating individual cases to determine if endometriosis is the cause of persistent symptoms. During your consultation, a specialist will discuss your symptoms and recommended course of action with you.


  1. Burney R, Giudice L. Pathogenesis and pathophysiology of endometriosis. Fertil and Steril. 2012;98(3):511-519

  2. SRM. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. 1997;67(5):817-821