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Why is Endometriosis So Tricky to Diagnose?

Why is Endometriosis So Tricky to Diagnose?

Endometriosis is a painful disease that affects 1 in 10 women, but it can be tough to diagnose because it shares symptoms with so many other conditions. What happens is the tissue that normally lines the inside of a woman’s uterus grows outside the uterus. But, it doesn’t break down and shed like it would inside the uterus. Instead, the trapped tissue can trigger inflammation, sometimes intense pain, and a host of other issues.

There is no single cause for endometriosis, but here are some risk factors to keep in mind: infertility, shortened cycles, elevated estrogen levels, smoking, starting menstruation earlier or experiencing menopause later. If a close family member has endometriosis, you are at an even higher risk.

What are the Symptoms of Endometriosis?

Symptoms typically begin during puberty and most often parallel menstrual periods. But, pain and cramping can begin before and last several days after a period. The most common symptoms include:

  • Painful periods
  • Pain with urination or bowel movements
  • Excessive bleeding
  • Pain during or after sex
  • Fatigue
  • Infertility
  • Gastrointestinal issues like diarrhea, constipation or nausea

The Diagnosis Dilemma

There is an average 10-year delay from the onset of symptoms to the diagnosis of endometriosis, according to the Endometriosis Foundation of America.

The lag in proper diagnosis is partly due to misinformation about endometriosis but more so because the symptoms are similar to other gynecologic and gastrointestinal issues. Here are the top conditions that endometriosis is mistaken for:

  • Dysmenorrhea: This is the medical term for menstrual cramps. Primary dysmenorrhea refers to common cramps that may include other symptoms like nausea, vomiting and fatigue, while secondary dysmenorrhea is caused by a disorder in the reproductive organs.
  • Adenomyosis or Uterine Fibroids: Adenomyosis occurs when endometrial tissue moves into the outer muscle walls of the uterus, resulting in a mass of cells that can cause painful cramping, heavy bleeding, bloating and infertility. Because the symptoms are so similar, adenomyosis is often misdiagnosed as uterine fibroids, which are benign tumors growing in or on the uterine wall. An ultrasound can rule out fibroids, making endometriosis the likely culprit. Adenomyosis is harder to diagnose – imaging is an option but often surgery is necessary.
  • Ovarian cysts: These are common and often go away on their own, but if the cysts get too large or rupture, they can cause a lot of pain. Certain cysts can mimic endometriosis on an ultrasound.
  • Pelvic adhesions: Scarring from an infection of previous surgery is often misdiagnosed as endometriosis. The pain from these adhesion is not as tied to a woman’s cycle, which is a big clue that it’s not endometriosis.

What to do?

If you or your daughter feel like something is not right, listen to your body but don’t try to figure it out alone. An OB/GYN will take the time to listen to your concerns – and those painful symptoms – and get to the bottom of what’s really at play. The good news is that effective treatments are out there, but an accurate diagnosis is key in choosing the right one.

John Wise

Dr. John Wise, OB/GYN
Baton Rouge General Physicians

Phone: (225) 237-1880

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