Women’s Health with Minoos Hosseinzadeh, M.D. Endometriosis Part II: Diagnosing the Condition to Prepare for Treatment
In issue 1, the signs and symptoms commonly associated with endometriosis were explored. To make an accurate diagnosis of endometriosis, it is important that other disease entities be ruled out, such as pelvic inflammatory disease, ovarian cysts and bowel disease.
The most important thing is to have a high index of suspicion for the disease, especially if a person has a history of progressive worsening dysmenorrhea (painful menstrual cycles), which is not responding to over the counter pain medications and/or oral contraceptives. Also, mothers should seek medical attention early if their adolescent daughters are complaining of menstrual pain that interferes with school and/or athletic activities. Early diagnosis and treatment is essential to minimize the detrimental effect of endometriosis on fertility.
Endometriosis can be suspected from:
Evaluating a patient's history
Performing a pelvic exam
Conducting a pelvic ultrasound, in cases of endometriosis cysts of the ovary
Carrying out a blood test known as CA¬125, which can show elevated levels in some patients with endometriosis, although it is not specific for this condition. It can also be elevated in patients with pelvic inflammatory disease, uterine fibroids, ovarian cancer and liver disease, thus making its use limited.
The gold standard for the diagnosis of endometriosis is laparoscopy. This is a surgical procedure performed under general anesthesia. To confirm the diagnosis, a physician must have direct visualization of the lesions.
Looking into the Abdominal Cavity with a Laparoscope
Laparoscopy is a minimally invasive surgery that uses a thin, lighted tube put through an incision to look at specific organs. Laparoscopic procedures do not require overnight stays in a hospital, and recovery is usually just a few days. The procedure requires two to three very small incisions in the abdomen, conducted with general anesthesia.
The Appearance and Staging of Endometriosis: Identification through Laparoscopy
Endometriosis lesions can look different, depending on its stage. Lesions vary in color; some are clear or white, while others can be yellow, red, blue, brown and/or black. Endometriosis can also lead to the development of scar tissue. The extent of the disease can be staged at the time of the laparoscopy as follows:
Stage 1 = minimal disease
Stage 2 = mild disease
Stage 3 = moderate disease
Stage 4 = severe disease
It is important to realize that the extent of the disease found during the laparoscopic procedure does not correlate with the amount of pain that the patient may be experiencing. Laparoscopy is not only used to diagnose, but can be used to treat at the same time. These treatments, which are offering hope to women with endometriosis and/or infertility, will be discussed in Endometriosis Part III next month.
OC Life Readers: Email questions to Women’s Health with Dr. Minoos at DrMinoos@OCPCmagazine.com. ____________________________________________________________________________
Dr. Minoos Hosseinzadeh is a nationally recognized specialist in reproductive endocrinology at the largest and most-established locally-based fertility center in Orange County, Calif., Coastal Fertility Medical Center (http://www.coastalfertility.com). Double-board certified in Obstetrics and Gynecology and Reproductive Endocrinology & Infertility, she is also a member of the American Society of Reproductive Medicine, Society for Reproductive Endocrinology and Infertility, American College of Obstetrics and Gynecology and the Royal College of Physicians and Surgeons. She has presented at several national and international fertility meetings and authored numerous papers on hormone replacement therapy and age-related female infertility.
