In short
Endometriosis is diagnosed from your symptoms, an examination and imaging. A specialised pelvic ultrasound or MRI can show some types, such as endometriomas and deep endometriosis. A normal scan doesn’t rule it out. Surgery is no longer the only way to diagnose it, and treatment can start based on symptoms.
On this page
Why diagnosis has changed
For many years, keyhole surgery (laparoscopy) was seen as the only way to diagnose endometriosis. That contributed to long delays. The European guideline on endometriosis, published in 2022, recommends that imaging and symptoms be used to diagnose it, and that treatment can begin without surgical confirmation. Australian guidance also supports earlier diagnosis and treatment.
Step 1: your history
A doctor will ask about:
- your periods, how painful they are, and how they affect daily life
- pain at other times, with sex, with bowel movements or passing urine
- bowel and bladder symptoms
- fertility and plans for pregnancy
- what you’ve tried, and family history
Keeping a symptom diary for a few cycles helps.
Pain that stops you living your life isn’t normal.
Talk it through with an Australian doctor online. No referral needed.
Step 2: examination
An internal examination can sometimes find tenderness, nodules or a fixed uterus that suggests endometriosis. It’s only done with your consent, and isn’t always needed at the first visit.
Step 3: imaging
- Specialised pelvic ultrasound. A transvaginal ultrasound performed by someone experienced in endometriosis can detect endometriomas (cysts on the ovary), deep endometriosis and signs of adenomyosis. A standard pelvic ultrasound may miss these.
- MRI is sometimes used, particularly for deep endometriosis or planning surgery.
Superficial endometriosis, a common type, usually can’t be seen on scans. A normal scan doesn’t rule out endometriosis.
Step 4: laparoscopy, when needed
Laparoscopy lets a gynaecologist see and remove endometriosis, often in the same operation. It’s considered when imaging is normal but symptoms persist despite treatment, when imaging shows disease that needs surgery, or for fertility reasons. See endometriosis surgery.
Starting treatment before a diagnosis is confirmed
If endometriosis is suspected, guidelines support starting treatment for symptoms, such as hormonal treatment and pain management, while tests and referrals are arranged. If symptoms improve, surgery may not be needed. See endometriosis treatment options.
Why delays matter
Earlier diagnosis means earlier treatment and less time living with untreated pain. An Australian data linkage study also found that a delayed diagnosis was associated with poorer outcomes for women going through IVF.
How a GP can help
A GP can take a detailed history, start treatment, arrange a specialised ultrasound and refer you to a gynaecologist with an interest in endometriosis.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009.
- Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256.
- Moss KM, Doust J, Homer H, et al. Delayed diagnosis of endometriosis disadvantages women in ART: a retrospective population linked data study. Hum Reprod. 2021;36(12):3074-3082.
- Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411.
- RANZCOG. Endometriosis Clinical Practice Guideline.
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.