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Endometriosis Excision Specialist in Palo Alto, California

How Is Endometriosis Diagnosed?

As part of your initial diagnostic work-up, your health care provider usually starts with the following:

  • Review of medical history & symptoms
  • Pelvic exam
  • Transvaginal ultrasound
  • Ultrasound with Color Doppler
  • Laparoscopy with biopsy


While a pelvic exam and careful review of your symptoms by an endometriosis specialist can often be highly predictive, as mentioned, the only way to definitely diagnose endometriosis is by undergoing a surgical procedure called a laparoscopy so that your doctor can look inside of your body and take a tissue biopsy.

Basic facts about a laparoscopy

  • Considered the definitive manner for diagnosing endometriosis
  • Minimally invasive surgical procedure
  • Performed while the patient is under general anesthesia
  • Abdomen is inflated with carbon dioxide to aid in viewing the pelvic organs
  • Surgeon makes small abdominal incision to insert a thin telescope-like instrument with a lens and light to evaluate the presence of endometriosis
  • Biopsies are taken which will be sent to a pathologist for histopathological analysis.


Diagnostic and operative laparoscopy perfomed on the same day

Please note that, at our Center, we perform both a diagnostic and operative laparoscopy on the same day. This way, you can avoid having to undergo two surgical procedures.



Although researchers have been working on a non-invasive diagnostic test for years, unfortunately there is still no blood test or any other non-invasive means for definitely diagnosing endometriosis at this time.

Even so, there are a few other non-surgical tests that may be helpful for assessing the size and position of endometriotic cysts, for example, or for ruling out other conditions that can have similar symptoms as endometriosis.

The most common non-surgical tests include:

  • Blood tests
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)
  • Hysterosalpingography (HSG)


Used mostly to rule out other conditions, other minor surgical diagnostic tests may also be recommended, including:

  • Cystoscopy
  • Colonoscopy
  • Hysteroscopy
  • Proctoscopy
  • Sigmoidoscopy

While these procedures are rarely effective for diagnosing endometriosis itself, they are usually very helpful for ruling out other conditions that can cause similar symptoms as endometriosis. Cystoscopy, for example, can help your doctor check for interstitial cystitis, a bladder condition which often co-exists with endometriosis and/or can cause similar bladder symptoms. And, hysteroscopy (not to be confused with hysterectomy), can help detect uterine abnormalities like congenital aplasia, a condition that can contribute to the development of endometriosis, as well as cause its own unique set of symptoms.



It’s important to be aware that sometimes doctors (and pathologists!) completely fail to diagnose endometriosis, even after performing all of these tests. There are many reasons that this can occur, ranging from the lingering belief that painful periods are normal (they are not), to the fact that endometriosis symptoms can be atypical. Non-specialists often have a difficult time making a diagnosis even when looking inside the body with a laparoscope because endometriosis can appear in many different shapes and colors. For example, endometriosis growths can be red, black, white, bluish-purple (like the ones that grow on the diaphragm) and even clear in color. In addition to being different colors, the growths may also appear as flat lesions that grow very superficially on the surface of organs or they can become firm nodules that grow deeply through the entire wall of an organ, as can occur with deeply-infiltrating endometriosis (DIE). Endometriosis can also grow in cystic form, as it commonly does on the ovaries.

Pathologists are also not infallible when it comes to the supreme inscrutability of endometriosis. Even they can fail to recognize endometriosis under the microscope because atypical histopathological features may be present.

School nurses and/or parents themselves may also be unfamiliar with endometriosis or may have been told by their own mothers or doctors that painful periods are normal. As a result, these medical mythologies continue to be passed down, from one generation to the next. (Learn how you can join our upcoming endometriosis awareness campaign and help end this sad, centuries-long saga of misdiagnoses).

Because of such widespread misinformation, sadly, many girls and women with endometriosis experience about 6-10 years delay and have to see several doctors before being accurately diagnosed.

So, again, the take home message is, listen to your body and trust your instincts. If you think you might have endometriosis, it’s definitely worth it to seek out a second opinion by an endometriosis specialist.

Please email us at for your questions about Endometriosis.

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