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The diagnosis of endometriosis is challenging and an important reason for the delay in diagnosis.

The GDG (Guideline development group) recommends that the diagnosis of endometriosis must be considered in women with any of the following:

1. Gynecological symptoms like dysmenorrhea, chronic pelvic pain, deep dyspareunia, infertility, and fatigue
2. Decreased sperm and egg quality
3. Non gynecological cyclical symptoms like dyschezia, dysuria, hematuria, shoulder pain or rectal bleeding in a women of reproductive age.

Diagnosis of endometriosis

1. Clinical examination - A per vaginal/ per rectal examination may be normal. Painful induration and/or palpable rectovaginal nodules or nodules seen in the posterior vaginal fornix are suggestive of endometriosis. There may be an adnexal mass suggestive of an endometrioma.
2. Investigations
   2. a) Transvaginal Scan. An endometrioma may be visible. A typical endometrioma is an oval mass with hypoechoic contents, a hyper echoic wall with no papillae within. However, an atypical endometrioma can also be seen on scan and this has septae, papillae, with inhomogeneous content and an irregular internal wall. Hilus sign -is the presence of vessels between the cyst capsule and ovarian parenchyma, seen in endometrioma. Other differentia diagnosis for and endometrioma is a cystadenoma, dermoid cyst, hemorrhagic cyst and luteinized unruptured follicle. #Dultrasound for the diagnosis of an endometrioma is a well-established tool.
   2. b) MRI maybe useful in the diagnosis if extraovarian endometriosis
   2. c) Biomarkers / CA-125 must not be used for the diagnosis of endometriosis.
3. Laparoscopy and histopathology are the gold standard for diagnosis of endometriosis.
   However according to ESHRE 2022 guidelines, laparoscopy is no longer the diagnostic gold standard but must be reserved when there is negative imaging and/or when empirical treatment was unsuccessful or inappropriate.

For more info, Visit : www.medlineacademics.com