How to Test for Endometriosis: A Simplified Guide

A Look at Endometriosis Testing Methods 

• Challenges of Diagnosing Endometriosis|
• How to Test for Endometriosis|
• Natural Treatments for Endometriosis|
• Final Thoughts|

Endometriosis affects nearly 15% of women during their reproductive years, and can lead to debilitating symptoms, like heavy and painful periods, pelvic pain, and infertility [1, 2]. Testing for endometriosis is often a tedious and invasive process, as it is officially diagnosed through a surgery, known as a laparoscopy.

Diagnosing endometriosis may be tricky, as it can mimic many other female reproductive disorders. Fortunately, alternate testing methods, like imaging, bloodwork, and a physical exam, can be used to screen for endometriosis, prior to a laparoscopy. 

While they can’t technically be used to diagnose endometriosis, these screening exams can shorten the duration of time that it takes to receive a diagnosis. Ideally, they may even prevent some women from having to undergo an invasive, and potentially unnecessary, surgical procedure. 

Although an endometriosis work-up may be time-consuming, there are several lifestyle changes and holistic treatment options that can help relieve endometriosis symptoms — even without an official diagnosis. 

Read on as we break down how to test for endometriosis, the challenges that you may face when pursuing a diagnosis, and how to start your endometriosis recovery. 

The Challenges of Diagnosing Endometriosis

Endometriosis is a health disorder that affects the female reproductive organs [3, 4]. Endometrium is normal tissue that lines the uterus and sheds during menstruation [5]. However, endometrial tissue can implant itself in other pelvic organs and body tissue, including:

• Ovaries and Fallopian tubes
• Urinary tract (ureter, bladder, and urethra)
• Lung tissue
• Brain and spinal cord
• Tissue surrounding the heart (pericardium)
• Digestive tract (intestines and rectum)

This abnormal tissue is thought to occur from retrograde (backward) flow of menstrual blood into the pelvis, but the verdict is still out on the exact cause [3]. A diagnosis of endometriosis is given when this inappropriate growth of the endometrial tissue occurs.

After diagnosis, endometriosis is categorized into four different stages, based on the size, location, and severity of abnormal tissue [2]. Regardless of the stage, it can be difficult to diagnose, as it’s not always visible on imaging and the symptoms of endometriosis mimic many other disorders. In fact, most women with endometriosis don’t receive a diagnosis until four to 11 years after they first start experiencing symptoms [3].

Despite these challenges in diagnosing endometriosis, it’s well-known that this condition can lead to many distressing symptoms, such as [1]:

• Irregular, painful, or heavy menstrual cycles
• Pelvic and abdominal pain
• Lower back pain
• Infertility
• Pain during intercourse
• Bloating and abnormal bowel movements, like constipation and diarrhea
• Bladder pain and frequent urination

So how is endometriosis diagnosed, and what tests are used to assess for it? 

How to Test for Endometriosis

The “gold standard,” or preferred method for diagnosing endometriosis, is currently an exploratory surgical procedure, known as a laparoscopy. The term “exploratory” refers to the fact that the surgeon often does not know what they’ll find until the actual procedure.

Laparoscopic Surgery Explained

A laparoscopic surgery is done under general anesthesia, where a laparoscope is inserted into the abdomen and pelvis through a small cut. Once inside, a small camera is used to look for endometrial lesions, cysts (endometriomas), and adhesions (scar tissue) on various organs. 

If abnormal growths are found, a tissue sample is taken for biopsy, in order to confirm that it’s endometrial tissue [6]. Typically, if found, the abnormal endometrial tissue will be removed during the same procedure. 

Unfortunately, this is a fairly invasive way to diagnose any health disorder, and many women may have to undergo an unnecessary surgery in order to find out that they don’t have endometriosis. Because of this issue, there are other tests that can be used to screen for endometriosis, but typically cannot confirm a diagnosis. 

However, they can be helpful for raising suspicion for endometriosis in women who are experiencing symptoms. Below are some of the test methods that may be used when evaluating for endometriosis. 

Medical Imaging Tests

Imaging may be helpful in identifying endometriosis in select cases. Transvaginal ultrasound (where a transducer is inserted into the vaginal canal) uses sound waves to detect abnormal growths in the female reproductive tract and other organs that may indicate abnormal endometrial tissue [7].

Ultrasound is currently the best imaging method for finding endometrial tissue on the ovaries and in deep tissues of the pelvic cavity [8]. In fact, ultrasound is so successful at finding abnormal endometrial tissue that the International Deep Endometriosis Analysis (IDEA) group is backing that it be used to confirm a diagnosis of endometriosis [7].

The proposed criteria for diagnosing endometriosis via ultrasound are as follows [7]:

1. Examination for abnormal growths in the pelvis
2. Localized tenderness and restricted movement of the ovaries
3. Light pressure applied to the pelvic organs to assess mobility
4. Assessment for deep nodules on the front and back of the uterus

This new criteria could potentially eliminate the need for unnecessary surgical procedures, but comes with the caveat that a diagnosis of endometriosis cannot be excluded if the ultrasound exam findings come back normal [9].

Other imaging methods, like magnetic resonance imaging (MRI), can occasionally identify endometrial growths, but typically aren’t used in a clinical setting [3]. However, unlike transvaginal ultrasound, an MRI or CT scan can look at the entire body. For this reason, they may be useful in detecting severe cases of endometriosis, where abnormal tissue is found in distant organs, like the lungs and digestive tract.

Assessing Hormone Levels

Endometriosis is thought to be an “estrogen-dominant” condition, meaning it can be influenced by an excess amount of estrogen in the body. As estrogen is needed for the growth of the endometrium, elevated levels of estrogen may cause growth of endometrial tissue outside of the uterus [10].

Research shows that women with diagnosed endometriosis typically have elevated levels of estrogen in their body. Furthermore, this dysregulation of hormones likely contributes to the pain and inflammation associated with this condition [10].

Fortunately, estrogen levels can be easily measured through a blood test. A clear picture of estrogen dominance in a woman with symptoms of endometriosis can help guide further diagnostic testing. However, not all women with endometriosis show elevated levels of estrogen, so it cannot be used as a diagnostic marker [11].

Medical History and Physical Exam

A gynecologist, or other women’s health care practitioner, can help screen for endometriosis by completing a thorough medical history and comprehensive physical exam. A medical intake may reveal several risk factors that can indicate endometriosis, such as [3]:

• Family history of endometriosis 
• Benign (non-cancerous) ovarian cysts
• History of prior pelvic surgery
• Menstrual cycles that last less than 26 days
• Having your first menses before the age of 12
• Infertility

A physical and pelvic exam can also help with diagnosis, as the following findings can indicate endometriosis:

• Pelvic pain
• Vaginal tenderness 
• Presence of vaginal nodules
• An immobile (stationary) uterus

However, the prior symptoms and exam findings aren’t exclusive to women with endometriosis, and are often present in other female health disorders. Additionally, many women with endometriosis can have completely normal physical exams, and an absence of these findings doesn’t exclude a diagnosis of endometriosis. 

While testing for endometriosis can be a little tricky and time-consuming, there are lifestyle changes you can make to help alleviate your symptoms. Even better, they can be used to treat many other types of female health disorders. 

So, even if you don’t have endometriosis or you’re still waiting for an official diagnosis, there are steps you can take now to address your reproductive health. 

Natural Treatment Options for Endometriosis 

While testing for endometriosis may be complicated, treating it doesn’t have to be. Conventional treatment of endometriosis includes [12]:

• Oral contraceptives (birth control)
• Anti-inflammatories, like NSAIDs
• Surgery, including hysterectomy
• Prescription medications, like Danazol

Unfortunately, many of these therapies don’t address the underlying issue and can have significant side effects. However, there are lifestyle factors that can be implemented now, even prior to diagnosis, to alleviate your symptoms and improve your overall quality of life. 

Change Up Your Diet

A poor diet that involves eating inflammatory and processed foods can actually worsen your endometriosis symptoms, as inflammation is thought to be a contributing factor in the development of endometriosis [3].

The good news is that fixing your diet doesn’t need to be a tedious process. Research shows that a simple elimination diet — including one that is similar to the Paleo diet — that removes common food allergens can significantly improve endometriosis symptoms after only three months [13].

If the Paleo diet doesn’t seem to offer any relief after three to four weeks, it may be time to switch things up. A more specialized approach, such as the low FODMAP diet, can help address any imbalances in gut bacteria that may be contributing to chronic inflammation and endometriosis symptoms [13, 14]. Other diets that have shown to be successful in improving symptoms of endometriosis include [13]:

• A low-nickel diet (to combat a nickel allergy or sensitivity)
• A gluten-free diet
• A Mediterranean diet (emphasis on healthy fats, fruits, and vegetables)

It’s likely that there’s no single best diet for endometriosis, and the benefits seen from the above diets are probably due to them addressing various food sensitivities. The preferred diet is about finding what fits your individual needs and eliminating your specific food intolerances. 

The beneficial effects of these diets may be further amplified by adding in natural anti-inflammatory supplements, such as fish oil, quercetin, turmeric, and probiotics [13, 15]. That being said, it’s important that you’re eating a diet that removes your unique food sensitivities and addresses any underlying issues, like poor gut health, in order to get the most benefit out of your supplements. 

Get Moving and Stress Less

While the research is mixed on whether exercise can directly improve symptoms of endometriosis, those who added yoga and meditation onto their other medical treatments had significantly lower levels of pain. Furthermore, they experienced better body image and overall well-being [16].

A systematic review, which offers the highest quality evidence, showed that exercise and physical activity likely offer a wide-range of benefits for those with endometriosis. However, the extent to which exercise helps relieve symptoms is unclear at this time [16].

Regardless, exercise is known to offer numerous health benefits, such as better sleep and reduced stress, making it a safe and likely effective treatment option.

Alternative Therapies

Several alternative therapies also show significant benefit in improving endometriosis symptoms, such as pelvic pain, pain during intercourse, and pain with menstruation. Research supports that the following alternative treatment options are likely effective:

• Manual physical therapy (pelvic floor therapy) [17]
• Acupuncture and Chinese herbs [18, 19]
• Electrotherapy (TENS unit) [19]

While these treatments can greatly improve your symptoms, it’s important to do these under the guidance of a health care provider that is knowledgeable in alternative medicine or physical therapy techniques.

Final Thoughts on How to Test for Endometriosis

Endometriosis is a painful reproductive disorder that affects millions of women, often leaving them with debilitating symptoms. Diagnosing endometriosis can be difficult, as many conditions can mimic it, and the official diagnosis is made during surgery. 

While a laparoscopic procedure remains the best method for diagnosing endometriosis, certain screening tests, such as imaging and hormone tests, can help screen for the disorder and potentially prevent unnecessary surgery. 

While there’s certainly more research that needs to be done on how to test for endometriosis, you don’t have to wait for a diagnosis to start treating it. Many natural therapies and lifestyle changes can successfully reduce your symptoms. For further assistance in addressing endometriosis, or other women’s health disorders, reach out to our clinic at the Ruscio Institute for Functional Medicine.

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