Your endometriosis stage will depend on what your doctor finds in your physical exams, scans, and other tests. The location, extent spread , and depth of the implants along with the severity of scar tissue found will help your doctor determine the stage of your endometriosis. The American Society of Reproductive Medicine classifies endometriosis into four stages:.
A person diagnosed with stage I endometriosis can have severe discomfort and other symptoms, while someone with stage IV endometriosis may have no symptoms. Ultrasound scans including transabdominal, transvaginal, and transrectal imaging are the most common imaging tests for endometriosis along with MRI.
An MRI uses radio waves in combination with a strong magnetic field to generate clear images inside the body. It can show your doctor where you have endometriosis. If you need surgery to remove endometriosis tissue, an MRI scan can show your doctor the exact location and size of the implant to remove. Without treatment, endometriosis can lead to serious complications including infertility, pelvic pain, and cancer.
While there is currently no cure for endometriosis, your symptoms can be treated and managed, allowing for a better quality of life. Treatment for endometriosis varies from person to person. Your treatment plan will depend on the stage of your endometriosis and your symptoms. Many people with endometriosis prefer trying medication first before surgery.
Ultrasound imaging is an important tool for diagnosing endometriosis and keeping an eye on its stage and possible progression. Early diagnosis and treatment is important with this condition. An ultrasound scan may be enough to diagnose endometriosis and can help your doctor pinpoint the source of your symptoms. You have several treatment options to help you manage and ease your symptoms. You will need regular checkups with your doctor, as endometriosis can take time to fully diagnose and treatment can continue for years.
Living with endometriosis can impact your life in many ways and comes with unique challenges. Superficial endometriosis deposits are located on the surface of pelvic organs, for example the surface of the womb, and are usually on a few millimetres wide and few millimetres deep. It is the most common type of endometriosis and is difficult to diagnose accurately using transvaginal ultrasound or other imaging tests.
Endometriosis can cause an ovarian cyst when endometriosis grows in the ovary, which are called endometriomas. They are sometimes known as chocolate cysts because they have a melted chocolate appearance. Deep endometriosis generally invades structures within the pelvis including the bowels, bladder, or ligaments. When all three types are combined, they often referred to by gynaecologists as overall pelvic endometriosis.
Dr Susanne Johnson GynaecologyUS , is an internationally recognised expert in the diagnosis of endometriosis using ultrasound scan. She publishes an excellent website which contains many different videos describing the ultrasound features of endometriosis. They included research studies which evaluated transvaginal ultrasound as a replacement test for keyhole surgery.
They included:. The researchers concluded that people with pain symptoms suggestive of endometriosis with evidence of endometriosis identified during a transvaginal ultrasound scan were likely to have endometriosis. Unfortunately, a negative transvaginal ultrasound scan did not exclude the possibility of endometriosis and these people will require further investigation.
The researchers commented on the low quality of the published research, for example, significant differences in the people included in the research studies, the use of older ultrasound machines, and limitations in the expertise of the individuals performing the ultrasound scans. These factors made it difficult to draw any firm conclusions about the accuracy of transvaginal ultrasound scan to diagnose endometriosis. Transvaginal ultrasound is more than just a diagnostic test. It is a test that can help patients and their doctors understand the severity of endometriosis.
In our opinion, when an ultrasound is performed by a colleague who has received high quality training in the diagnosis of endometriosis, and it is normal, this does not mean there is no endometriosis.
In fact, many people with the classic symptoms of endometriosis and a normal scan do have superficial endometriosis. What this ultrasound result tells us is that there is no ovarian endometriosis or deeply infiltrating endometriosis, which is important to know when thinking about treatment options. Can technology help provide answers to a complex condition?
This guide demonstrates how to use ultrasound as a first-line diagnostic tool. The classic collection of signs and symptoms include cyclical pain during menstruation dysmenorrhea , pain with deep penetrative intercourse dyspareunia , pain with bowel movements dyschezia , non-cyclical pelvic pain chronic pelvic pain CPP that lasts more than 6 months , and infertility.
There is no question that endometriosis remains enigmatic with respect to etiology 1 and diagnosis. In , is surgery necessary to achieve a diagnosis? In one camp, there are experts who advocate for issuing a presumptive diagnosis and offering empiric therapy to women who present with classic symptoms without a surgical or histologic diagnosis, 6,7 with the idea of reserving surgery for those refractory to medical therapy.
Another camp advocates for increased use of noninvasive tools to diagnose endometriosis, regardless of whether medications or surgery are planned. At this point, neither camp is wrong. Diagnosing all phenotypes of endometriosis noninvasively has not been demonstrated in the literature, but certainly, two of the three phenotypes - ovarian endometrioma OE and deep endometriosis DE - can be accurately and reliably diagnosed on ultrasound. Superficial endometriosis SE remains the most elusive phenotype when it comes to noninvasive diagnosis, although we are making progress with it.
To facilitate that, this article describes use of ultrasound for endometriosis and outlines an approach to noninvasive diagnosis, putting tools in the hands of clinicians to improve their local practices.
Ultrasound is the first-line imaging modality for reproductive or abdominopelvic complaints in women. Essentially, basic pelvic ultrasound has the potential to diagnose OE.
In addition to performing the elements of a basic pelvic ultrasound, we advocate for an advanced evaluation in all patients with endometriosis-related symptomatology that is in line with the recommendations of the International Deep Endometriosis Analysis IDEA group.
We have dubbed this advanced pelvic ultrasound and it includes direct visualization of anatomic structures in the anterior and posterior compartments for DE and assessment of pelvic organ mobility. Specifically, within the anterior compartment, the bladder and ureters should be evaluated. The posterior compartment consists of the bowel, uterosacral ligaments USLs , torus uterinus, posterior vaginal fornix PVF , rectovaginal septum RVS , and rectouterine pouch.
Assessment of pelvic organ mobility is necessary and highly clinically useful due to the strong likelihood of adhesion development in those with endometriosis. Ovarian mobility is also relevant and can be assessed along the pelvic sidewall laterally, USL inferiorly, or uterus medially. The literature supports use of ultrasound for endometriosis. Reid et al.
In , the IDEA group published a consensus opinion with the aim of increasing awareness, improving education on endometriosis ultrasound mapping, and decreasing heterogeneity between published reports on diagnostic accuracy.
A classic example is use of the term rectovaginal endometriosis, which is not a true anatomic structure but a general area. The IDEA consensus opinion publication and growing expertise in endometriosis ultrasound both broadly and locally should actually yield even greater diagnostic accuracy now than in the past.
There is no one right way to perform ultrasound to diagnose endometriosis, 14,18,20,21 as long as the imaging is done thoroughly and systematically. We have published a step-by-step method that is Free Access to all in the Australasian Journal of Ultrasound in Medicine.
Content Warning: Some may find the educational images provided graphic. The ability to diagnose deep infiltrating endometriosis with transvaginal ultrasound has improved dramatically around the world since What can the ultrasound diagnose? Endometriosis is defined as the presence of tissue similar to that of the lining of the uterus endometrium outside of the uterus, most commonly on and below the ovaries, and deep in the pelvis behind the uterus, called the Pouch of Douglas.
Here, the endometriosis grows on the ligaments behind the uterus and on the vagina and rectum. It also may grow on the bladder, appendix, and even sometimes in the upper abdomen or in the abdominal wall in the scars of a laparoscopy or caesarean delivery. There are many presentations of endometriosis which may be identified by the surgeon at laparoscopy. A distinction is made between superficial lesions and deep infiltrating endometriosis.
In the majority of women with endometriosis , the endometriosis found in the pelvis has only implanted superficially. Superficial lesions of endometriosis can never be diagnosed on ultrasound as they have no real mass, only colour, which cannot be detected with ultrasound.
These lesions can cause as much pain as some deep infiltrating lesions but they can only be seen on laparoscopy. They may be removed during a laparoscopy and special preoperative measures are rarely required. The image on the left shows a normal pelvis while the one on the right shows superficial endometriosis deposits. This form of the disease is called deep infiltrating endometriosis DIE. Deep infiltrating endometriosis causes usually more destruction of the normal anatomy and is generally significantly more difficult to remove.
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