Health is Wealth

The two most common symptoms associated with endometriosis are pain and infertility. In most cases, pain is initially menstrual (Dysmenorrhea) and distinguished from primary dysmenorrhea, which is usually shorter in duration and well responsive to nonsteroidal anti-inflammatory drugs (NSAIDs). The dysmenorrhea may progress to include non-menstrual and chronic pelvic pain, deep dyspareunia, and infertility. Less commonly, any of these three symptoms can be found without dysmenorrhea. Deep endometriosis can also lead to cyclic dyschezia and dysuria. Moreover,  diaphragmatic or thoracic implants in the extrapelvic clinical presentation of endometriosis can cause dyspnea, chest or shoulder pain, hemoptysis, and pneumothorax. Less specific symptoms are reported among women with diagnosed endometriosis, such as fatigue, abdominal pain, and bloating.

Laparoscopy for the visualisation of endometriosis lesions, with histopathological confirmation, is the gold standard for diagnosing the disease. However, the surgical and invasive nature of this diagnosis method is often the reason behind delays from symptom onset to diagnosis, ranging from 4 to 11 years. Several other factors exacerbate this delay, like the normalisation of symptoms and misdiagnosis.

Dysmenorrhea, for example, despite being a major symptom of endometriosis, is often overlooked in the diagnosis of the disease in adolescents.

The reluctance to conduct a laparoscopy leads to an urgent need for non-invasive diagnosis methods based on a clinical approach that views endometriosis as a menstrual, cycle-dependent, chronic, and inflammatory systemic disease rather than by the presence or absence of lesions in the pelvis. The non-surgical diagnosis, currently advocated by recent guidelines, focuses on symptoms, patient history, findings on physical examination, and imaging. Transvaginal ultrasound can be a particularly sensitive approach for detecting ovarian endometriomas and deep endometriosis. Magnetic resonance imaging is an option for imaging; however, it is expensive, lacks sensitivity, and is not universally available, which makes it less frequent for diagnosis. As of now, no biomarker has been established for diagnosing endometriosis.