What is endometriosis? Can endometriosis be diagnosed on a scan?

Endometriosis is a common, yet still poorly understood gynecological condition. It affects millions of women, typically between adolescence and the end of reproductive years. Symptoms range from mild to debilitating, such as pelvic pain, heavy periods and painful intercourse. Medical imaging scans like MRIs and ultrasounds give us insight into what’s going on in your body, so that you can get proper treatment sooner rather than later. In this post, we will discuss what endometriosis is, symptoms to look out for and how it is typically diagnosed.

What is endometriosis?

Endometriosis, is a word derived from the Greek endo ”inside”, metra ”uterus” and osis ” disease”.

Endometriosis occurs when the tissue that typically lines the uterus, the endometrium, grows outside of the uterus in other organs and areas within the pelvic cavity.

During a typical monthly menstrual cycle, the uterine lining grows and expands. It then breaks down and is shed and removed from your body when you get your period. This cycle repeats month after month.

With endometriosis, this tissue grows outside the uterus. Similar to uterine lining, the endometrial-like tissue expands and bleeds in response to hormone changes that occur during the menstrual cycle. The difference is that this tissue isn’t shed and removed from the body. It has nowhere to go.

Endometriosis creates inflammation in the body, that can contribute to the development of scar tissue and adhesions. Adhesions occur when thick bands of scar tissue build up and bind other tissues and organs together.

Endometriosis has been shown to lead to a significant number of lost work days due to pain and other symptoms associated with it. Diagnosis can be made through imaging tests such as MRI or ultrasound.

Risk factors for endometriosis

Risk factors for developing endometriosis include family history and early menarche. Knowing the average age for diagnosis and these risk factors is key for understanding the condition and taking preventive measures if needed.

Symptoms of endometriosis

Symptoms of endometriosis can vary significantly in severity and type, with pelvic pain being the most prominent and common symptom. The pelvic pain is usually linked to menstruation, although it may also be experienced during non-menstrual times.

Other endometriosis symptoms include dyspareunia (painful intercourse) as well as dysmenorrhoea (painful periods). The severity of endometriosis symptoms can range from mild to severe, but the condition itself can vary widely amongst individuals.

Endometriosis can also affect fertility, due to damage to fallopian tubes and/or ovaries.

Imaging tests – MRI and Ultrasound

Imaging tests, such as ultrasounds and MRIs, are among the most important techniques used to diagnose endometriosis. What are we looking for on scans?

Endometriomas, or “chocolate cysts,” are cysts filled with menstrual blood, often found in the ovaries. These can damage normal ovarian tissue.

Deep endometriosis deposits are areas of endometriosis on the organs of the pelvis, such as fallopian tubes, bowel or bladder. In severe endometriosis, in the bladder or bowel, the endometriosis can invade through the wall of the organ, into the lumen. The endometriosis deposits can also be found on the ligaments or peritoneal folds in the pelvis, that keep the organs in place, for example, the uterosacral ligaments.

MRI is better than ultrasound at identifying endometriosis and its severity.

Staging of endometriosis severity

The American Society of Reproductive Medicine (ASRM) defines four stages of endometriosis severity.

As per the ASRM, the I–IV staging system is a point system. The stage of endometriosis depends on the location, extent, and depth of implants; the presence and severity of adhesions; the presence and size of ovarian endometriomas

Stage I: This is also known as minimal endometriosis. In stage I, superficial implants and mild adhesions may grow outside the uterus. The point score for minimal endometriosis is between one to five.

Stage II: This is also known as mild endometriosis. With stage II, the implants may be superficial or deep, with mild adhesions. Endometriosis may be widespread in stage II, and deep implants may be present. The point score for mild endometriosis is six to 15.

Stage III: This is also known as moderate endometriosis. With stage III, deep implants are present. Also, adhesions may be dense instead of filmy and thin. As a result, endometriosis is more widespread than in Stage II. The point score for moderate endometriosis is between 16–40.

Stage IV: This is also known as severe endometriosis. With stage IV, deep implants and dense adhesions are present. There may be superficial endometriosis and filmy adhesions, but the disease is more widespread than in Stage III. Any score greater than 40 indicates severe endometriosis.

If you are experiencing any of the symptoms associated with endometriosis, don’t ignore them – take action by arranging for a scan or speaking to your doctor about it. This way you can get the medical help that you need and reduce discomfort going forward!

Dr. Khalid Enver

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