Endometriosis Diagnosis

Although endometriosis is generally diagnosed between the ages of 25 and 35, the condition most likely begins much earlier, with the onset of regular menstruation.

Initial Diagnosis

If endometriosis is suspected, the patient may be asked to keep a diary of their symptoms, particularly pelvic pain in relation to menstrual cycle.

Patients will be asked to describe their symptoms, sites of pain, and if pelvic pain worsens during menstruation. A routine pelvic examination is required to diagnose the condition, evaluate endometriosis stages and to check for abnormalities, such as cysts or scars.

Physical examination has its limitations. A pelvic exam alone will not pinpoint exactly which of the endometriosis stages the patient is in, the degree of implantation, or the cause of pelvic pain.

Other tests may be necessary to confirm endometriosis and specific endometriosis stages.

Advanced Endometriosis

Tools Used to Determine Endometriosis Stages

Transvaginal ultrasound (TVUS): A scanner, also known as a transducer, is inserted into the vagina. Although TVUS is effective for detecting ovarian endometriosis, this method may not detect the disease or the stages of endometriosis in other organs.

Pelvic ultrasound: An image scanner is passed across the abdomen to establish the extent and endometriosis stages at various sites throughout the reproductive organs.

Trial drug period: Before resorting to a more invasive method, drug trials offer a less invasive approach to diagnosing the early stages of endometriosis and controlling pelvic pain. Only if the drugs fail to alleviate pelvic pain, is laparoscopy recommended.

Laparoscopy: If ultrasound techniques fail to detect endometrial implants, a procedure called laparoscopy may be necessary. Although more expensive, laparoscopy is the most accurate method for diagnosing endometriosis and confirming endometriosis stages. Laparoscopy involves minor surgery under general anesthetic.

What is Staging?

Staging involves tracking the “stages” of a disease so a treatment strategy, tailored to the individual patient, can be initiated. Tracking endometriosis stages helps evaluate a patient’s response to treatment.

Endometriosis Stages

Endometriosis stages are based on the revised staging criteria, defined by the American Society for Reproductive Medicine:

  • Stage I: Minimal. Few or superficial implants are evident in the early stages of endometriosis.
  • Stage II: Mild. More implants and deeper involvement.
  • Stage III: Moderate. More implants, with ovaries affected and the presence of adhesions.
  • Stage IV: Severe. As Stage III, but with multiple and more dense adhesions.

Researchers have identified a link between infertility and endometriosis Stages I and II. Patients with advanced Stages III and IV further confirm these findings.


U.S. National Library of Medicine