The cause of chronic or severe pelvic pain may be difficult to pinpoint.
But discovering the problem early may help you avoid unnecessary complications and pain.

Endometriosis can be suspected based on symptoms of pelvic pain and findings during physical examinations in the doctor's office.

• To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms and medical history (including the location of your pain and when it occurs).
  According to the Endometriosis Association, clues you may be at risk for endometriosis include
  • irritable bowel syndrome,
  • frequent respiratory infections (a sign your immune system isn't working properly),
  • allergies,
  • chemical sensitivities,
  • frequent yeast infections
  • severe menstrual cramps.
     
• Your doctor will perform a pelvic exam to check for any abnormalities, such as cysts on your reproductive organs or scars behind your uterus.
  Occasionally, during a rectovaginal exam (one finger in the vagina and one finger in the rectum), the doctor can feel nodules (endometrial implants) behind the uterus and along the ligaments that attach to the pelvic wall.
  At other times, no nodules are felt, but the examination itself causes unusual pain or discomfort.
  Often it's not possible to feel small areas of endometrial implantation, unless they've caused a cyst to form.
  Sometimes, symptoms and signs are obvious enough that further procedures such as a laparoscopy is not necessary.
   
• Unfortunately, neither the symptoms nor the physical examinations can be relied upon to establish the diagnosis of endometriosis most of the times.
  Imaging studies, such as ultrasound or magnetic resonance imaging (MRI), can be helpful in ruling out other pelvic diseases, but still cannot accurately diagnose endometriosis.
  During a vaginal ultrasound, a wand-shaped scanner (transducer) is inserted into your vagina.
  In an ultrasound of the pelvis via the abdomen, a small scanner is moved across your abdomen.
  Both tests use sound waves to provide a video image of your reproductive organs.
   
• Because endometrial implants often cannot be felt or clearly seen in indirect tests, for an accurate diagnosis, a direct visual inspection inside of the pelvis and abdomen, as well as tissue biopsy of the implants are necessary.
  A common way a doctor can make the definitive diagnosis of endometriosis is through  laparoscopy or open standard laparotomy.
  Laparoscopy is the most common surgical procedure for the diagnosis of endometriosis.
  It will provide you and your doctor with information about the

• location,
• extent
• size

of the endometrial implants.
This information will help your doctor guide you through treatment options.

Laparoscopy is a minor surgical procedure done under general anesthesia or in some cases local anesthesia.
It is usually performed as an out-patient procedure (the patient going home the same day).
Using a special needle, your abdomen is infladed (distended) with carbon dioxide gas so that the reproductive organs are easier to see.
A tiny incision is made near your navel, and a slender viewing instrument (laparoscope) is inserted into the inflated abdominal cavity to inspect the abdomen and pelvis.
By moving the laparoscope around, the surgeon can view the pelvic and other abdominal organs, looking for signs of endometrial tissue outside the uterus.
Endometrial implants can then be directly seen.

During the laparoscopy, the doctor may remove a tiny piece of peritoneal tissue biopsy from the outer layer of the lining of the uterus for examination under a microscope to confirm the presence of endometrium elsewhere in your body.
Sometimes biopsies obtained during laparoscopy show endometriosis even though no endometrial implants are seen during laparoscopy
This is recommended by the American College of Obstetricians and Gynecologists (ACOG), which notes that only an experienced surgeon familiar with the appearance of endometriosis should rely on visual inspection alone to make the diagnosis.

Pelvic ultrasound and laparoscopy are also important in excluding malignancies (such as ovarian cancer) that can cause symptoms that mimic endometriosis symptoms.

• Blood test.
  Unfortunately, no blood tests can accurately diagnose endometriosis.
  
  Cancer antigen 125 (CA 125) is a blood test often used to detect tumor markers for certain cancers is sometimes used to detect a certain protein found in the blood of women with endometriosis.
  Although this antigen reveals an elevation in the special  blood protein in advanced endometriosis, it's not as sensitive to mild or moderate disease.
  As with cancer, CA 125 doesn't perform well as a screening test for endometriosis, because it's sensitivity is not high when the disease is in its earliest stages.

Next:  How is endometriosis treated?