How is endometriosis diagnosed?

1. Your symptom history

Diagnosis starts with what you can describe: pain during periods, pain during sex, pain when going to the toilet, heavy bleeding, exhaustion, digestive trouble, difficulty getting pregnant.

A written log of a few cycles carries more weight than memory. Note the date, the pain score from 0 to 10, where it hurts, what you took, and how the day went. fuchcia can keep that log on your phone and turn it into a one page summary for your appointment.

2. Pelvic examination

A gynaecologist may perform a pelvic exam to feel for tender spots, nodules behind the uterus, or ovaries that move less than they should.

A normal exam does not rule endometriosis out. Many women with confirmed disease have an unremarkable examination.

3. Pelvic and endovaginal ultrasound

Ultrasound is usually the first imaging test. In experienced hands an endovaginal ultrasound can show ovarian cysts (endometriomas) and deep nodules in the bowel, bladder or the space behind the uterus.

Operator experience matters more than the machine. Ask whether the person scanning you regularly looks for endometriosis.

4. Pelvic MRI

MRI maps deep endometriosis before surgery and looks at places ultrasound reaches poorly, such as the bowel wall and the ureters.

It is painless, uses no radiation, and usually takes 20 to 40 minutes. As with ultrasound, a radiologist who reads endometriosis often will see more.

5. The saliva test (Endotest) in France

Endotest is a saliva based test developed in France that looks at microRNA signatures associated with endometriosis. It is offered in a growing number of French hospitals to women with suggestive symptoms whose imaging has not settled the question.

It is not a universal replacement for imaging or for the clinical picture, and access, eligibility and reimbursement rules keep changing. Our Endotest page lists current eligibility criteria and the hospitals that offer it.

6. Laparoscopy

Keyhole surgery was long considered the only certainty. It lets a surgeon see and, if needed, remove lesions and take samples.

International guidance no longer requires surgery to confirm the diagnosis. Treatment can start on the strength of symptoms and imaging, which spares many women an operation.

What to bring to the appointment

A cycle by cycle symptom log, the pain scores, what relieves and what worsens the pain, the treatments already tried, and the questions that matter most to you.

Ask directly: do you think this could be endometriosis, and what is the next test? Writing the answer down protects you if you have to start again with another doctor.

Common questions

Can a blood test detect endometriosis?

No blood test can confirm endometriosis today. CA-125 is sometimes raised but it is neither sensitive nor specific enough to diagnose or exclude the disease.

Can endometriosis be diagnosed without surgery?

Yes. Current international guidance accepts a diagnosis based on symptoms and imaging, and allows treatment to begin without laparoscopy.

How long does it take to get diagnosed?

Studies across Europe report an average of seven to nine years between the first symptoms and the diagnosis. A precise symptom log and a clear request for imaging shorten that delay.

Is the saliva test available outside France?

It is mainly deployed in France for now. Elsewhere, ultrasound and MRI performed by clinicians used to looking for endometriosis remain the usual route.