Three steps play a key role when assessing patients with suspected endometriosis.
First step: Patient’s clinical history and symptoms (dysmenorrhea, dyspareunia, dyschesia and chronic pelvic pain). Although there is no evidence of a relationship between patient’s symptoms and the presence and severity of endometriotic lesions, the implemented or proposed medical / surgical treatment depends on the context in which endometriosis is observed.
The second step is the physical examination, including evaluation of the posterior vaginal fornix and of the Douglas pouch, which detects more lesions that are missed on ultrasonography and magnetic resonance imaging.
The third step is imaging. A recent meta-analysis found no difference in the detection of endometriotic lesions between ultrasound and magnetic resonance imaging, but these examinations should be performed by a radiologist with expertise in this field.
To date, the final diagnosis of endometriosis is made by laparoscopy with biopsies of the lesions.