eMedicine Specialties > Pediatrics: Surgery > Gynecology

Endometriosis: Differential Diagnoses & Workup

Author: Tod C Aeby, MD, Generalist Division Director, Assistant Professor, Department of Obstetrics, Gynecology and Women's Health, University of Hawaii, John A Burns School of Medicine
Coauthor(s): Mark K Y Hiraoka, MD, Assistant Professor of Obstetrics and Gynecology, University of Hawaii; Consulting Staff, Department of Obstetrics and Gynecology, Queen's Medical Center
Contributor Information and Disclosures

Updated: May 15, 2006

Differential Diagnoses

Appendicitis
Chlamydial Infections
Gonorrhea

Other Problems to Be Considered

Dysmenorrhea
Pelvic adhesions
Serositis
Functional or neoplastic ovarian cyst
Ovarian Cysts
Pelvic Inflammatory Disease
Uterine malformation

Workup

Laboratory Studies

  • No laboratory studies have been shown to be useful in the diagnosis of endometriosis.
  • Cancer antigen 125 (CA-125) levels may be elevated in advanced cases but are rarely elevated in mild-to-moderate disease. The test lacks adequate sensitivity or specificity to be of clinical value.

Imaging Studies

  • Pelvic ultrasonography, CT scanning, and MRI are only useful in the case of advanced disease with endometrial cyst formation or severe anatomic distortion.
  • Intravenous pyelography and colonic studies are indicated if the clinical presentation suggests extragenital involvement of these organ systems.

Procedures

  • Gross visualization of endometrial implants remains the definitive method of diagnosis.
  • In this era of minimally invasive surgery, laparoscopy is the procedure of choice.
  • Laparotomy can be another method of diagnosis. This is usually performed when another cause of patient pain is suspected.

Histologic Findings

Histologic demonstration of both endometrial glands and stroma in biopsy specimens obtained from outside the uterine cavity is required to make the diagnosis of endometriosis. Occasionally, the finding of fibrosis in combination with hemosiderin-laden macrophages is sufficient for a presumptive diagnosis.

Staging

The American Society for Reproductive Medicine has a staging scheme based on the size, number, and location of endometrial implants and associated adhesion formation noted at the time of surgery.

The patient's stage (ie, 1-4, or minimal, mild, moderate, and severe) may be useful in determining her prognosis for subsequent reproduction. The staging system can also be used to monitor a patient's response to therapeutic efforts. Surgical exploration is required for this staging system, both initially and for subsequent follow-up, and a discussion of its details is beyond the scope of this article.

More on Endometriosis

Overview: Endometriosis
Differential Diagnoses & Workup: Endometriosis
Treatment & Medication: Endometriosis
Follow-up: Endometriosis
Multimedia: Endometriosis
References
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References

  1. Ailawadi RK, Jobanputra S, Kataria M, et al. Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. Fertil Steril. Feb 2004;81(2):290-6. [Medline].

  2. American College of Obstetricians and Gynecologists. Endometriosis. Technical Bulletin. 1993;Number 184:1-6.

  3. American College of Obstetricians and Gynecologists. Endometriosis in Adolescents. Committee Opinion. April 2005;Number 310:1-7.

  4. Cook AS, Rock JA. The role of laparoscopy in the treatment of endometriosis. Fertil Steril. Apr 1991;55(4):663-80. [Medline].

  5. Creatsas G, Hassan E, Koumantakis E. Adolescent laparoscopy. Clin Exp Obstet Gynecol. 1997;24(3):147-8. [Medline].

  6. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. Jun 1997;24(2):235-58. [Medline].

  7. Ferrero S, Abbamonte LH, Anserini P, et al. Future perspectives in the medical treatment of endometriosis. Obstet Gynecol Surv. Dec 2005;60(12):817-26. [Medline].

  8. Goldstein DP. Acute and chronic pelvic pain. Pediatr Clin North Am. Jun 1989;36(3):573-80. [Medline].

  9. Goldstein DP, De Cholnoky C, Emans SJ. Adolescent endometriosis. J Adolesc Health Care. Sep 1980;1(1):37-41. [Medline].

  10. Kontoravdis A, Hassan E, Hassiakos D, et al. Laparoscopic evaluation and management of chronic pelvic pain during adolescence. Clin Exp Obstet Gynecol. 1999;26(2):76-7. [Medline].

  11. Olive DL, Schwartz LB. Endometriosis. N Engl J Med. Jun 17 1993;328(24):1759-69. [Medline].

  12. Ryan IP, Taylor RN. Endometriosis and infertility: new concepts. Obstet Gynecol Surv. Jun 1997;52(6):365-71. [Medline].

  13. Scialli AR. Evaluating chronic pelvic pain. A consensus recommendation. Pelvic Pain Expert Working Group. J Reprod Med. Nov 1999;44(11):945-52. [Medline].

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Further Reading

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Keywords

endometriosis, secondary dysmenorrhea, endometriosis externa, endometrioma

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Contributor Information and Disclosures

Author

Tod C Aeby, MD, Generalist Division Director, Assistant Professor, Department of Obstetrics, Gynecology and Women's Health, University of Hawaii, John A Burns School of Medicine
Tod C Aeby, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, and Hawaii Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mark K Y Hiraoka, MD, Assistant Professor of Obstetrics and Gynecology, University of Hawaii; Consulting Staff, Department of Obstetrics and Gynecology, Queen's Medical Center
Mark K Y Hiraoka, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth Alderman, MD, Director of Fellowship Training Program, Director, Adolescent Ambulatory Service, Clinical Professor, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
Elizabeth Alderman, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Maureen Strafford, MD, Arnold P Gold Foundation Associate Professor, Departments of Anesthesiology and Pediatrics, Tufts University and Tufts-New England Medical Center
Maureen Strafford, MD is a member of the following medical societies: American Medical Women's Association, American Pain Society, American Society of Anesthesiologists, International Anesthesia Research Society, Society for Education in Anesthesia, Society for Pediatric Anesthesia, and Society of Cardiovascular Anesthesiologists
Disclosure: Nothing to disclose.

 
 
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