"Ask Dr. Cook" is a series of questions and answers regarding endometriosis. The current subject and answer can be found on Current Ask Dr. Cook web page. The questions may represent a summary of questions I have been asked by several different patients. I hope you find this information helpful. If you have a question you would like answered, please Submit A Question.

Diagnosing Endometriosis

I have received a lot of questions recently. In an attempt to keep up, I will occasionally group similar questions together.

Question:
#1)
I've been having pain in my lower pelvic region and my gynecologist has ruled out ovarian cysts through sonograms, but he doesn't believe that it's endometriosis because I don't have any lower back pain. Do you think that I could possibly have endometriosis and need to have a laparoscopy done?

#2)
Is it possible to miss a diagnosis even after having laproscopy?

#3)
My wife is suffering from Pelvic pain since June 2000. She was given Duphaston for 3 month but did not get relief. Now one doctor is suggesting Nasarel and another doctor is suggesting operation. I am confused. What should I do?

#4)
Is there any other method to discover endometriosis than laparoscopy? How about MRI

Answer:
#1
Absolutely. The only way to diagnose endometriosis is during a laparoscopy. Persistent pelvic pain that is progressive or is interfering with your life, preventing you from your normal activities, is an indication for laparoscopic evaluation. A lot of women have endometriosis without back pain.

#2)
Yes. I have personally seen this situation. When a patient comes to me with a history of pelvic pain and a "normal" laparoscope, I will often perform another laparoscopy to double check (this is where a video tape of the previous surgery is helpful). I have found that the patients history of symptoms is more accurate than a previous laparoscopy. I have performed laparoscopy 6 weeks after a patient has had "normal" findings at a lapraroscope by another physician, only to find endometriosis - proven by pathology report. She either had rapid formation and growth of endometriosis over a couple of weeks or the endometriosis was missed at the previous surgery.

#3)
The medications you are referring to function to shut down estrogen production by the ovaries. This group of medications can have significant side effects including bone loss, osteopenia and even osteoporosis. Even if the decision is made to use these medications, a laparoscopic diagnosis of endometriosis should be made first. However, the endometriosis is usually treated at the time of the laparoscopy, eliminating the need for the use of this medications and their associated side effects.

#4)
For the most part, no laparoscopy is the method of diagnosing endometriosis. If there are large volumes of endometriosis, i.e. larger than 2cm (about 1 inch) then MRI may be helpful. An endometrioma can be diagnosed with an MRI. The problem is that the average lesion of endometriosis is not large enough to be seen with the MRI. In other words if an MRI shows endometriosis, great, but most women with endometriosis will have normal MRI findings.

Updatede October 29, 2005