Welcome back to the endo series. Today’s session is about diagnosis and the stages of endometriosis. And I will go into a little bit of the types of treatments that are available for women who have endometriosis.

So diagnosis is really a very difficult thing for women with endometriosis because there’s no non-invasive diagnosis of this disease. Unfortunately, the only way to know whether you have it is to do what’s called a laparoscopy, which is keyhole surgery, which is surgery where we put a camera through your belly button, inflate your tummy with some gas, and look around the pelvis for these deposits of endometriosis. It is a visual diagnosis, although most gynecologists will take a sample, a biopsy of these endometriosis deposits, and send them to the lab so that we can confirm that diagnosis of endometriosis.

Then we stage the disease. So staging is a surgical procedure and it’s often done at the same surgery. We look around the abdomen, and we look for the locations of endometriosis. Endometriosis is staged essentially one to four within the pelvis, and can even go to five if you have disease outside of the true pelvis.

Stage one usually refers to very superficial deposits, quite small areas that are placed around the pelvis that are seen. Stage two to three, refer to larger amounts of endometriosis, or even deeper disease such as deep infiltrating endometriosis, which can affect the bowel and the ovaries.

As I mentioned in my first session of the endo series, endometriosis can affect the ovaries. So if you have a thing called an endometrioma, so an ovarian cyst, which is filled with endometrial lining or the lining of the womb, that’s called an endometrioma. When you have endometriomas, often you will be a stage four endometriosis. Or if you have a thing called an obliterated pouch of Douglas, which is the pouch between the uterus and the rectum. When endometriosis completely fills that area and the area is basically laid down with scar tissue, which causes terrible pain with intercourse. That is one of the highest stages of endometriosis. So stage four within the pelvis is the highest stage.

Unfortunately, once again, this only can be done surgically. However, we can have a guideline as to whether you may have stage four endometriosis. You can have a pelvic ultrasound, and on the ultrasound, we may see the endometrioma, or there are now DIE, or deep infiltrating endometriosis specific scans, where they look at signs for deep disease such as nodularity, or whether the organs are all adherent to one another. So if they don’t see that the organs move around on ultrasound, then it makes it more likely that you have the highest stage of endometriosis.

And when you seek advice from a gynecologist such as myself, we would normally do an examination of you. This will involve a speculum exam, so a bit like a pap smear, and then an internal exam. And as one of the most likely places for endometriosis is down near behind the cervix and an area called the uterosacral ligaments. Sometimes when I do an internal examination, I can feel that endometriosis by examining you. It also can be quite painful, and that being able to elicit that pain, also guides me as to whether you do have endometriosis or not.

You can also have other symptoms that go along with endometriosis that are more indicative of the higher stages, such as bowel disease where you can have diarrhea, or even fluctuating bowel habits at different times in your cycle. And for some women who have endometriosis where it’s affecting their bladder, they can have urinary symptoms. They can have pain when their bladder fills, or what we call dysuria, so discomfort when they pass urine.

In terms of treatments, there are a number of treatments that are on offer, that you may see online, or may have heard about. In general, things like diet and exercise are always very important. And we know that women who do exercise and have pelvic pain or menstrual pain, have improvement when they have a really healthy life and exercise as compared to women that don’t.

In terms of diet, although endometriosis is a disease which is driven by hormones such as estrogen, and a lot of people promote a diet low in soy, for instance, to minimize the amount of estrogen that you’re ingesting. To my knowledge, I don’t think there’s strong evidence that there a diet that improves or makes endometriosis worse.

But certainly, alterations of your diet to help with bowel symptoms may lessen the load of symptoms such as bloating, and that may, in turn, help the pain with endometriosis as well.

I hope that this session has been useful, the part two of our endo series. All right, if you have any questions or any interest for future series, please do let me know through Woollahra Health and Beauty, you can message me via our website or on Facebook.


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  • Eliana Martinez January 16, 2019 11:44 pm

    Its weird. My doctor told me I might have endometriosis, but they don’t want to do surgery on me. Which I guess she has her reasons. So ordered to do a trans-vaginal ultrasound, not only it hurt so bad, but it said the pouch of Douglas is free. I don’t know what that means. I am sore everyday, but I don’t feel like “dying” like many women with endometriosis. Sex hurts so bad I have to stop. I don’t know whats happening. I know endometriosis happen to be a disease that in every women the symptoms are different and the treatment and all, but ugh. Its so frustrating.

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