Endometriosis can be an overwhelming diagnosis. It is an often a painful and life altering condition in which endometrial tissue, which normally lines the uterus, develops outside of the uterine cavity in abnormal locations such as the ovaries, fallopian tubes, and abdominal cavity.1<\/sup> This tissue responds during the menstrual normal cycle but cannot be shed out of the body.<\/p>\n Although some women may not have any symptoms, many suffer from pain and infertility<\/a>. ASRM (American Society for Reproductive Medicine<\/a>) estimates up to 10% of all women have endometriosis though African American women are less likely to be diagnosed than Caucasian women. ASRM also indicates that risk factors include low body mass index (BMI), alcohol use and smoking.2<\/sup> It is still under debate about whether endometriosis causes infertility, it has been estimated that 30% to 50% of infertile women have endometriosis.3<\/sup> Staging of the disease is used to describe the severity of the case and is often used by physicians to develop a treatment or surgical plan.<\/p>\n The staging of endometriosis helps physicians takes into consideration the location of the abnormal tissue growth, the extent, and the depth and seriousness of the endometrial scar tissue and cysts that are present.4<\/sup> The four stages of endometriosis are described as: Stage 1-Minimal, Stage 2-Mild, Stage 3-Moderate or Stage 4-Severe. The scoring system correlates with pregnancy success and if surgery may help your chances of getting pregnant naturally.5<\/sup><\/p>\n A patient usually has different goals associated with pursuing a diagnosis of endometriosis. The first goal of a diagnosis of endometriosis can be pain management. This goal usually begins with a conversation with the patient\u2019s primary gynaecologist. Usually the patient has such pain that it is interfering with their quality of life and they are compelled to have a conversation with their provider. This provider will attempt to diagnose or stage and then can progressively offer management strategies based on the severity of the disease. The second goal of many women seeking an endometriosis diagnosis can be for fertility success or because they are trying to get pregnant. Many of these women start with their primary OB\/GYN provider to and are given a stage.<\/p>\n Each of these goals have very different timelines and motivations for treatments. Sometimes accelerated family building and even the end of family building can be advantageous because it can lead to treatment options that help with pain and health management. Some pain management treatments reduce or eliminate fertility. It is important for a patient to communicate the primary goal of her treatment so that her provider can prioritize her care and give her appropriate treatment options.<\/p>\n The diagnosis of endometriosis typically occurs when a woman first approaches her doctor describing pelvic or abdominal pain. This pain can occur in the time around her menstrual cycle or sex. The physician may perform a comprehensive verbal, physical, MRI, and\/or ultrasound examination trying to determine the cause of the discomfort. Other women who are already experiencing infertility may have their provider find and cyst or endometrioma on their ovary. The only way to have a true diagnosis is to have laparoscopic surgery and look for endometriosis using a camera or a tissue sample.<\/p>\n This surgery is minimally invasive and uses small instruments inserted through incisions in the abdominal area to view and possibly remove adhesions. It is usually a procedure that allows the patient to go home later that day with few risks or complications. Also, microscopic evaluation of tissue samples might be needed if a visual diagnosis cannot be made during surgery.6<\/sup> 7<\/sup> But in a woman that has possible asymptomatic endometriosis that is causing her infertility actually establishing a diagnosis might be less important that seeking treatment for her infertility because no staging system has been proposed yet that correlates well to the chance of conception following treatment.8<\/sup> 9<\/sup><\/p>\nDiagnosis of endometriosis<\/h2>\n