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How Is Endometriosis Diagnosed?

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Contributing Author: Guy Slowik FRCS

Endometriosis is diagnosed by:

Physical Examination

It's not unusual for a pelvic examination to reveal no sign of possible endometriosis. In some cases, however, there are some signs:

  • Occasionally during a pelvic exam, a physician may feel a cyst on an ovary that is caused by endometriosis.
  • A physician can tell during a pelvic exam if a woman's uterus is retroverted (tilted backwards) and cannot be moved easily, which may indicate endometriosis behind the uterus.
  • A woman may feel pain during an examination that can range from mild to severe; this pelvic tenderness might be a sign of endometriosis.
  • A physician may feel small bumps of tissue caused by endometriosis behind the uterus.
  • In rare cases, endometriosis lesions may be seen in a woman's belly button or in scars around the abdomen, the cervix, or the vagina.


A physician may suspect endometriosis from a woman's symptoms or from a pelvic exam, but a definite diagnosis is made with laparoscopy. This is a short surgical procedure performed through a very small incision in the abdomen (usually the belly button). A pencil-thin instrument called a laparoscope is inserted into the incision, and it gives the physician an exceptionally clear view, on a television monitor, of the inside of the abdominal cavity.

Endometriosis resembles small bluish blisters, nodules, or spots. If endometriosis is suspected but isn't visible, a small sample of tissue may be removed for study under a microscope (biopsy).

If endometriosis is found, it is classified from minimal to severe based on:

  • Where the endometrial tissue is located
  • Whether it is on or under an organ's surface
  • What type of adhesions are found

Transvaginal Ultrasound

Transvaginal ultrasound (also called pelvic ultrasound) uses high-frequency sound waves and a computer to create images of organs and structures inside the body. The test can be performed in a doctor's office and is painless.

During the exam, a woman lies on her back on an exam table, and the doctor inserts a probe into her vagina. The probe releases high-frequency sound waves that bounce off the pelvic organs. A computer converts these "echoes" into images that can be viewed on a monitor, where areas of endometriosis may be visible.

Other Tests

Other tests that may be performed include:

  • A barium enema for women who are experiencing rectal bleeding, to rule out the possibility of gastrointestinal ailments or diseases such as colon cancer. It involves x-rays of the colon using a contrast medium (barium), which is introduced into the rectum by enema and is visible on the x-rays. The barium fills the colon, and areas of abnormalities can be seen.
  • Blood tests, such as CA-125. CA-125 is a protein that is elevated when certain conditions, including endometriosis, are present. This test generally is done to help a doctor evaluate the effectiveness of endometriosis treatment rather than diagnosis it. That's because conditions other than endometriosis can cause this substance in the blood to be elevated.




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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.