Endometriosis – Diagnosis
Obstetrics and Gynecology
- Defined by the presence of endometrial tissue (glands and stroma) outside of the uterine cavity.
- Affects 6 to 10% of women of reproductive age, 50 to 60% of women and teenage girls with pelvic pain, and up to 50% of women with infertility.
- The most common cause of secondary dysmenorrhea in adolescents, with a mean age of presentation 25-30.
- Often the clinical starting point is ruling out critical diagnoses – ruptured ectopic, ovarian torsion, pelvic inflammatory disease, hemorrhagic ovarian cyst.
- Can be a chronic relapsing disorder that necessitates long term follow up. Ensuring adequate follow up after discharge from the ED is crucial.
- Endometriosis is definitively diagnosed by histologic evaluation of a lesion biopsied during surgery.
- A combination of symptoms, signs, and imaging findings can be used to make a presumptive, nonsurgical diagnosis of endometriosis and start initial treatment. Studies have reported an average delay of 7 to 12 years for definitive diagnosis in women with endometriosis.
Key Differential Considerations:
- Endometriosis can cause chronic, acute and acute on chronic pelvic pain.
- Acute pelvic pain in the context of endometriosis could suggest a ruptured endometrioma or ovarian torsion (increased risk from pelvic mass).
- Other critical differential diagnoses include a ruptured ectopic pregnancy, pelvic inflammatory disease and a hemorrhagic ovarian cyst.
- Suggested by the triad of dysmenorrhea, dyspareunia and dyschezia.
- Heavy menstrual bleeding.
- Pelvic mass.
- Less common symptoms include: bowel/bladder dysfunction and back pain, pneumothorax.
- Risk factors include 1st degree family history, prolonged exposure to endogenous estrogen (early menarche, nulliparity, late menopause, or obesity).
- Often normal; lack of findings does not exclude the disease.
- Supportive findings include tenderness on vaginal examination, nodules in the posterior fornix and adnexal masses.
- There are no pathognomonic laboratory findings for endometriosis.
- Ca 125 levels are currently not recommended.
- Beta-HCG should be done in any female of childbearing age with pelvic pain.
- Further labs should be guided by your differential diagnosis.
- Pelvic US (ensure follow up organized if performing as outpatient) acutely if torsion or ectopic under consideration.
- Consider MRI for refractory/atypical cases or if considering thoracic endometriosis.
SOGC Endometriosis Working Group. Management of Symptoms Associated with Suspected or Confirmed Endometriosis. April 2020.
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Dec 05, 2020
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