What Is Checked in a Check-Up When Endometriosis Is Suspected?

Endometriosis is a chronic women’s health problem that occurs when tissue similar to the inner lining of the uterus settles outside the uterus and often significantly affects quality of life. It most commonly comes to attention with symptoms such as period pain, pelvic pain, pain during intercourse, bowel or urinary complaints, and difficulty getting pregnant. However, it does not progress in the same way in every woman. While some people have severe symptoms, the disease may progress more silently in others.

The check-up process in suspected endometriosis does not consist only of a blood test or a standard gynecological examination. The person’s pain history, menstrual pattern, fertility plan, bowel and bladder complaints, ultrasound findings, MRI evaluation when necessary, and previous health records should be addressed together. Therefore, endometriosis evaluation is one of the topics that should be planned individually in the women’s health check-up process.

Why Should Endometriosis Be Evaluated Early?

Endometriosis is a condition that can be postponed for a long time by being considered “normal period pain.” However, it can affect the person’s daily life, work performance, sexual life, mental well-being, and fertility plans. Therefore, evaluation should not be delayed, especially if there are recurrent, worsening, or daily life-limiting pains.

Early evaluation may not mean that the disease is immediately recognized definitively; however, it ensures that complaints are addressed within the right framework. If there are findings such as period pain that does not respond to painkillers, a constant feeling of pressure in the groin area, pain during sexual intercourse, pain during defecation, or infertility, the possibility of endometriosis should be considered.

Endometriosis may cause adhesions in the pelvic region, cysts in the ovaries called endometriomas, and involvement in deep tissues over time. Therefore, instead of seeing symptoms only as a natural part of the menstrual cycle, evaluating them within regular women’s health control is a more accurate approach.

The First Step in Suspected Endometriosis Is a Detailed History

One of the first and most important steps in endometriosis evaluation is a detailed patient history. Because endometriosis symptoms may not always become immediately visible through test results. When the person’s pain started, its relationship with menstruation, its severity, duration, location, and how much it affects daily life are guiding in the diagnostic process.

It is important whether the pain occurs only during menstruation or continues throughout the month. While endometriosis appears in some people with severe groin pain during menstruation, in others it may continue as chronic pelvic pain. Whether the pain spreads to the waist, leg, bowel area, or bladder should also be evaluated.

While taking history, painkillers used, birth control methods, previous surgeries, pregnancy history, miscarriages, and family history of endometriosis or infertility may also be asked. This information helps determine which tests will be prioritized in the check-up process and which specialist evaluations will be needed.

How Is Period Pain Evaluated in Terms of Endometriosis?

Period pain can be seen in many women; however, not every period pain should be considered normal. Especially if the pain increases over the years, prevents going to school or work, or occurs together with nausea, vomiting, feeling faint, or intense fatigue, evaluation in terms of endometriosis may be needed.

Pain caused by endometriosis is usually recurrent and may start a few days before menstruation. In some people, it may continue after the period ends. The severity of pain is not always directly related to the extent of the disease. Mild endometriosis can cause severe pain, while advanced involvement may cause fewer symptoms in some people.

It is useful to record period pain regularly during the check-up process. If when the pain starts, how many days it lasts, which medications it responds to, and whether there are accompanying bowel or urinary complaints are noted, physician evaluation can be performed more accurately.

Why Are Pelvic Pain and Pain During Sexual Intercourse Important?

Pelvic pain is an important warning finding in suspected endometriosis. Pelvic pain refers to pain felt in the groin and lower abdominal region. This pain may be related to menstrual periods, or it may continue throughout the month in some people. Chronic pelvic pain may be associated with conditions other than endometriosis, such as fibroids, ovarian cysts, infection, bowel diseases, or bladder problems.

Feeling deep pain during sexual intercourse is also one of the symptoms that should be considered in terms of endometriosis. Especially pain in the groin, rectum, or deep pelvic area during intercourse may be associated with a type of endometriosis that settles in deeper tissues, called deep infiltrative endometriosis.

These symptoms may often be delayed because they are difficult to talk about. However, it is important to share them openly during the check-up process. The physician can create an appropriate examination and imaging plan by evaluating the location, timing, severity, and accompanying symptoms of the pain.

Can Bowel and Bladder Complaints Be Related to Endometriosis?

Endometriosis is not a condition that affects only the uterus and ovaries. In some people, involvement may also be seen in different areas such as the bowel, bladder, urinary tract, or rectovaginal region. Therefore, bowel and urinary complaints must also be questioned during the check-up process.

Constipation, diarrhea, pain during defecation, pain radiating to the rectum, bloating, or blood in stool that increase during the menstrual period may suggest bowel involvement. Similarly, pain while urinating, frequent urination, bladder pressure, or blood in urine that increase during the menstrual period may be associated with bladder involvement.

These symptoms may be confused with irritable bowel syndrome, urinary tract infection, or other digestive system problems. Therefore, in suspected endometriosis, attention should be paid not only to gynecological symptoms, but also to bowel and bladder complaints linked to the menstrual cycle.

What Does Gynecological Examination Show in Suspected Endometriosis?

Gynecological examination is an important step in endometriosis evaluation. During the examination, the uterus, ovaries, groin area, tenderness points, and mobility of pelvic structures may be evaluated. In some people, marked tenderness, limitation in uterine mobility, or pain in the pelvic region may be detected during the examination.

Examination does not always definitively show endometriosis. Especially superficial endometriosis foci may not be noticed on examination or imaging. However, examination is important in terms of understanding the source of pain and distinguishing infection, cyst, fibroid, or different gynecological problems.

During check-up, gynecological examination should be interpreted together with the person’s symptoms. A normal examination finding does not completely exclude the possibility of endometriosis. If symptoms strongly suggest endometriosis, advanced imaging or a specialist follow-up plan may come into question.

How Is Ultrasound Used in Endometriosis Evaluation?

Ultrasound is one of the most commonly used first imaging methods in suspected endometriosis. Especially transvaginal ultrasound can provide information about ovarian cysts, endometrioma, uterine and ovarian structure, fibroids, and some deep endometriosis findings. In people for whom transvaginal ultrasound is not suitable, abdominal ultrasound may be preferred.

Endometrioma is known popularly as a chocolate cyst and is an ovarian cyst associated with endometriosis. Ultrasound is very helpful in evaluating these cysts. The size and structure of the cyst, whether it is unilateral or bilateral, and whether it requires follow-up can be monitored with ultrasound.

However, a normal ultrasound result does not completely exclude endometriosis. Especially superficial endometriosis foci may not be seen with ultrasound. Therefore, the ultrasound result should be evaluated together with the person’s symptoms and examination findings. If suspicion of endometriosis is strong, advanced imaging or specialist evaluation may be needed.

In Which Situations May MRI Be Necessary?

Magnetic resonance imaging, or MRI, is an important method used in endometriosis evaluation especially when deep infiltrative endometriosis is suspected. Deep infiltrative endometriosis may affect deeper tissues such as the bowel, bladder, rectovaginal region, uterine ligaments, or pelvic wall. MRI can help evaluate these areas in more detail.

MRI is usually requested when ultrasound does not provide sufficient information, deep involvement is suspected, or surgical planning is needed. Especially if bowel or bladder involvement is considered, MRI may be guiding for the physician. In this way, possible involvement areas can be determined more clearly and the treatment plan can be created more accurately.

MRI does not always give a definitive result on its own in endometriosis diagnosis. However, when performed in experienced centers and with the correct protocol, it provides valuable information in deep endometriosis evaluation. Therefore, the MRI decision should be made together with symptoms and examination findings.

Are Blood Tests Sufficient for Endometriosis Diagnosis?

There is no reliable blood test alone for the diagnosis of endometriosis. In some cases, markers such as CA-125 may be requested; however, this value is not specific to endometriosis. CA-125 may also increase in different gynecological diseases, infections, during menstruation, or in other conditions. It may also be normal in many people with endometriosis.

Therefore, normal CA-125 or similar blood tests do not exclude endometriosis. A high result does not diagnose endometriosis on its own either. Blood tests are used more to evaluate general health status and investigate anemia, inflammation, hormonal problems, or other disease possibilities.

In the check-up process, tests such as complete blood count, iron, ferritin, thyroid tests, pregnancy test, or infection markers may be planned according to the person’s complaints. However, in suspected endometriosis, the main determining factors are the evaluation of clinical history, gynecological examination, and appropriate imaging methods together.

Why May Hormone Tests Be Requested in Suspected Endometriosis?

Endometriosis is not a disease diagnosed directly with a hormone test. However, if there is menstrual irregularity, heavy bleeding, ovulation problem, infertility, or accompanying hormonal symptoms, hormone tests may be requested during the check-up process. These tests help evaluate similar or accompanying problems rather than showing endometriosis.

Tests such as TSH, prolactin, FSH, LH, estradiol, AMH, and progesterone may be planned according to the person’s complaints. Especially in people planning pregnancy, ovarian reserve, ovulation pattern, and thyroid functions are important. Since endometriosis may affect ovarian reserve and fertility in some people, this evaluation is also important.

Hormone tests should be considered as a helpful part in endometriosis diagnosis. They do not confirm or exclude the disease on their own. However, they can provide important information in terms of the person’s general women’s health and fertility plan.

How Is Endometriosis Evaluated in Infertility?

Endometriosis may make it difficult to get pregnant in some people. The presence of endometrioma in the ovary, pelvic adhesions, involvement of the tubes, or inflammatory processes may affect fertility. Therefore, in the case of infertility, that is, when pregnancy does not occur despite regular unprotected intercourse, the possibility of endometriosis should be evaluated.

In infertility evaluation, it is important to address not only tests for the woman but also the couple together. Ovulation pattern, ovarian reserve, the condition of the uterus and tubes in the woman, sperm analysis in the male partner, and the couple’s general health history are evaluated together. If endometriosis is suspected, ultrasound, MRI, or advanced gynecological evaluation may be planned.

In the presence of endometriosis, the treatment approach varies according to the person’s age, pain level, ovarian reserve, presence of cysts, and pregnancy desire. Therefore, it is important for people with suspected endometriosis together with infertility to receive specialist evaluation without losing time.

When Does Laparoscopy Come Into Question in Endometriosis Diagnosis?

Laparoscopy is a surgical method in which pelvic organs are directly visualized by entering the abdomen with a camera. Although it was accepted as the gold standard in endometriosis diagnosis in the past, today it does not need to be applied as the first step in every suspected case. Clinical findings and imaging methods can provide sufficient information for diagnosis and treatment planning in many people.

Laparoscopy may generally come into question in people who do not respond to treatment, whose severe pain continues, who have suspected endometrioma or deep involvement, who are undergoing infertility evaluation, or for whom surgical treatment is planned. During this procedure, endometriosis foci can be seen, tissue samples can be taken when necessary, and some lesions can be treated.

Since laparoscopy is a surgical procedure, the decision should be made carefully. The person’s age, symptoms, pregnancy plan, imaging findings, and response to previous treatments should be evaluated together. Therefore, the laparoscopy decision must be made individually by a gynecology and obstetrics specialist.

For Whom Is the Endometriosis Check-Up Process a Priority?

The endometriosis check-up process is a priority especially for people who have severe period pain, whose daily life continues to be affected despite painkillers, who have chronic pelvic pain, who feel pain during sexual intercourse, or whose bowel or urinary complaints increase during the menstrual period. If these symptoms have been continuing for a long time, they should not be considered “normal” and evaluation should not be postponed.

People who have difficulty getting pregnant, who have previously been diagnosed with chocolate cysts, who have a family history of endometriosis, or who have had previous pelvic surgery may also be evaluated more closely. Since endometriosis does not always cause obvious symptoms, it may be noticed during infertility investigation in some people.

In the check-up process, not only the person’s current complaints but also long-term women’s health and fertility plans should be taken into account. Therefore, regular follow-up, correct imaging, and specialist evaluation are of great importance in suspected endometriosis.

Manage Your Check-Up Process for Women’s Health With Happ Health

In suspected endometriosis, correct evaluation is possible by carefully listening to symptoms, gynecological examination, appropriate imaging methods, and advanced specialist opinion when necessary. Happ Health, with its digital health platform structure, offers a solution that provides easier access to check-up and screening processes for women’s health. With the Liv Silver Cancer Screening Women Package, you can evaluate your women’s health controls in a more planned way and manage the next steps suitable for you more consciously by following your results together with specialist opinion.