I have had menstrual pain for years and have always had pain with sex… How do I go about getting a diagnosis if my PCP mentions endometriosis as an explanation?
Endometriosis
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December 23, 2024
Hello! Great question. Yes, the most common symptoms of endometriosis include painful periods, pain with intercourse (particularly with deeper penetration or in certain positions), pain with bowel movements, alternating constipation and diarrhea, bloating, pain with urination, and pelvic pain. New guidelines from the American College of Obstetricians and Gynecologists (ACOG) say you only need one symptom, and it doesn’t have to be cyclic, to suspect endometriosis. Pelvic ultrasound is usually where we start, but unfortunately about 70% of endometriosis doesn’t show up on any imaging, so surgery is the only way to definitively confirm the diagnosis.
I would seek out a fellowship-trained, high-volume minimally invasive gynecologic surgeon who specializes in endometriosis excision. They have access to the highest-quality imaging (like dynamic ultrasound with sliding sign and a specialized endometriosis-protocol MRI), will do a thorough pelvic exam (feeling for deeply infiltrating endometriosis in the space between the cervix and the rectum), and will discuss the full range of options, including suppressing suspected endometriosis with medication and/or surgery.
If you do move forward with surgery, you’ll already be with someone who can detect even the most subtle endometriosis and remove it from tricky locations like the bowel, bladder, ureters (the tubes that drain the kidneys), and blood vessels, coordinating with general surgeons, colorectal surgeons, and urologists when needed. Good endometriosis centers also have a multidisciplinary team to support you before and after surgery, including ongoing gynecologic care, a dietitian, a pelvic floor physical therapist, an acupuncturist, integrative medicine physicians, and mental health specialists.