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- What is endometriosis?
- Symptoms of endometriosis
- Causes of endometriosis
- Prevention of endometriosis
- Risk factors for endometriosis
- Complications of endometriosis
- When to see a doctor about endometriosis
- Diagnosis of endometriosis
- Conventional treatment of endometriosis
- Alternative/complementary treatment of endometriosis
- Living with endometriosis
- Caring for someone with endometriosis
Initial diagnosis of endometriosis involves the following:
- Medical history of symptoms - the doctor will ask a series of questions about severity and duration of symptoms, including the onset, to determine if there is a risk factor of endometriosis
- Physical examination - the doctor will perform a physical examination to determine if there are any obvious physical symptoms of endometriosis
Your doctor can can also perform the following examination:
- Internal examination - you doctor inserts one digit into your vagina and puts their other hand on your pelvic area to feel the pelvic area from both the inside and outside and determine if there are any obvious signs of endometriosis (or other abnormalities)
The internal examination is completely voluntary and many women feel nervous about it, which is understandable. If you don't want to have this test, you can say no, as it wont diagnose the endometriosis anyway, it only gives the doctor a very general impression of the uterus and other organs in the pelvic region.
Your doctor can also recommend you have the following tests:
- Pelvic ultrasound (external) - an ultrasound is a diagnostic test involves the clinician spreading some gel on the pelvic area and then moving a special instrument around the pelvic area to get a picture of the organs in this area
- Pelvic ultrasound (internal) - an intrauterine ultrasound is a diagnostic test and is usually performed at the same time as the external ultrasounds and involves the clinician inserting a special wand-like instrument into your vagina and up the cervix. This test cannot diagnose endometriosis, but it can provide a better view of the ovaries and determine if there are any cysts or other abnormalities that may need further investigation
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If the doctor thinks it warrants further investigation, you may be referred to see a gynaecologist who can properly investigate the symptoms and definitely diagnose endometriosis (or rule it out).
A gynaecologist will complete the following tests:
- Medical history of symptoms - the gynaecologist will ask the same (or more detailed) series of questions
- Physical examination - you doctor inserts one digit into your vagina and puts their other hand on your pelvic area to feel the pelvic area from both the inside and outside and determine if there are any obvious signs of endometriosis (or other abnormalities)
Again, the internal examination is completely voluntary with the gynaecologist too. You can refuse it if you do not feel comfortable having this type of examination.
Based on your symptoms (and physical examination if it is performed), the gynaecologist will recommend the following diagnostic procedure, which is the only definitive way to confirm (or rule out) endometriosis:
- Laparoscopy - in this test you will be given a general anaesthetic (although it can be sometimes performed under light sedation too). The gynaecologist will make some cuts in the abdominal wall in which a laparoscope (a thin fibre-optic rod with a light source and video camera at the end) is inserted inside.
The abdominal cavity will be inflated with carbon dioxide to help separate the organs and make it easier to view the organs and any possible endometrial tissue that is outside the endometrium.
The gynaecologist can also insert other instruments into the laparoscope (incision tools to remove the endometrial implants) and take video shots of the area both before and after incision (if there is to be any). Your gynaecologist will ask you for your written permission to be able to remove external endometrial or other abnormal tissue prior to having this procedure, including the possibility of a full abdominal incision if necessary.
The length of this procedure will depend on what (if anything) the gynaecologist finds in the pelvic region. If there is little or no endometrial implants, this procedure can take about 30 minutes, but the more implants found, the longer the procedure. Once completed, the gynaecologist will remove the instruments and stitch up the incisions made.
A laparoscopy is normally performed as a day procedure.
After the procedure, it is normal to feel a little pain from the stitches (you will be given pain relievers to remedy this) and some shoulder/neck pain due to the carbon dioxide irritating the diaphragm and you may need to urinate more often than normal, because of the effect of the carbon dioxide on the bladder.
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