What Do They Do to See if You Have Endometriosis?

Ask a Doctor

I’m 15 and I’ve had my period for a couple years now. Every time my period starts, I have this terrible pain that knocks me out for a day or two. I just realized that my friends don’t have these same symptoms with their periods. Even when they have menstrual cramps, they aren’t as bad as mine. I was looking on the internet and I’m afraid I might have endometriosis. How is endometriosis diagnosed? What do they do to see if you have endometriosis?

Doctor’s Response

If you experience symptoms such as pelvic pain, bleeding or spotting, infertility, and digestive problems, endometriosis might be suspected.

Your doctor will first ask for a history of your symptoms and will likely perform a pelvic exam where they can feel for large cysts or scars behind the uterus. Ultrasound or magnetic resonance imaging (MRI) may be used to image the reproductive organs.

However, surgery is the only way to definitively diagnose endometriosis. Laparoscopy is a procedure where a doctor inserts a small camera into the abdomen to look for endometriosis. Sometimes a small tissue sample (biopsy) may be taken. In some cases the endometriosis can be treated with laparoscopic surgery.

A number of different classification systems have been developed for staging endometriosis. Although the stage (extent) of endometriosis does not relate to the severity of clinical symptoms, it may be useful in predicting a woman's chances of fertility.

Typically, endometriosis is classified as minimal, mild, moderate, or severe based upon visual observations at laparoscopy. Minimal disease is characterized by isolated implants and no significant adhesions. Mild endometriosis consists of superficial implants less than 5 cm in aggregate without significant adhesions. In moderate disease, multiple implants and scarring (adhesion) around the tubes and ovaries may be evident. Severe disease is characterized by multiple implants, including large ovarian endometriomas along with thick adhesions.

Endometriosis varies in symptoms and severity depending on the woman and the timing of her menstrual cycle.

  • Endometriosis may not produce any specific symptoms, and the women may not be aware of the condition. In fact, most women with endometriosis do not have any specific symptoms of the condition.
  • The most common symptom of endometriosis experienced by women with the condition is pelvic pain that is worse just before menstruation, and improves at the end of the menstrual period.
  • Because the levels of hormones that affect endometriosis are related to the menstrual cycle, endometriosis can be expected to lessen in intensity or, at the very least, stabilize during periods when hormonal levels are not in constant fluctuation. These conditions include pregnancy and other times when there is a lack of menstruation. Women also tend to notice a reduction in their symptoms once they reach menopause.
  • Other common symptoms are increased:
  • Infertility is common in women with endometriosis; although not all infertile women have endometriosis. The exact mechanism by which endometriosis causes infertility is not clear, but, it may involve physical blocking of the Fallopian tubes due to implants or scarring or hormonal factors related to the presence of the endometriosis implants.
  • The age at which endometriosis develops varies considerably. Some adolescent women note painful menstruation when their periods first begin. This condition is later diagnosed as endometriosis, while other women are in their 20s, 30s, or older before endometriosis is diagnosed.
  • Women often describe the pain as a constant, aching pain that is deep and often spreads to both sides of the pelvic region, the lower back, abdomen, and buttocks.
  • There is no correlation between the severity of the symptoms and the amount of disease (the degree or extent to which endometriosis implants are present).
  • Many women with endometriosis have no findings on physical examination that could suggest the diagnosis, and symptoms provide the only clues to the diagnosis.
  • Although physical examination findings cannot positively diagnose endometriosis, the doctor may find pelvic nodules that are tender during a physical exam or masses in the ovaries that are common signs of the condition.
  • An area of endometriosis on the ovary that has become enlarged is referred to as an endometrioma. Endometriomas which fill with blood are known as a chocolate cysts, referring to the appearance of the tissue. Chocolate cysts can become very painful, mimicking the symptoms of other ovarian problems.

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Melissa Conrad Stöppler, MD coauthored this article.


Office on Women's Health. Endometriosis. 16 March 2018. 7 January 2019 .