Ultrasound and Blood Tests for Endometriosis Diagnosis

Examination issues

Can ultrasound examination detect endometriosis? When is the best time to perform a blood test for checking endometriosis?

ERTRR, 20~29 year old female. Ask Date: 2012/01/09

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the term "endometriosis" refers to the condition where endometrial tissue grows outside the uterine cavity.
When it occurs in the ovaries, it forms what is known as a "chocolate cyst," and when it grows within the uterine muscle, it is referred to as "adenomyosis." The exact cause of endometrial tissue growing outside the uterus remains unclear; however, various theories suggest potential causes, including retrograde menstruation, transportation via the blood or lymphatic system, and autoimmune deficiencies.
Common diagnostic methods include:
- Physical Examination: During a rectal or vaginal examination, nodules may be felt in the uterosacral ligaments or tenderness may be noted in the rectouterine pouch.
Abdominal palpation may reveal fixed unilateral or bilateral ovarian masses.

- Blood Tests: Measurement of CA-125 levels in the blood can be indicative.
CA-125 is an antigen found in various tissues, which typically does not enter the bloodstream unless there is tissue damage or abnormal proliferation.
Normal CA-125 levels are generally below 35 U/mL; levels above this may warrant consideration of conditions such as endometriosis, pelvic inflammatory disease, adenomyosis, or ovarian cancer.
Although it is not a highly effective screening tool, abnormal results can serve as a treatment indicator.
It is recommended to conduct blood tests 2-3 days after menstruation.
- Laparoscopy: This is the only definitive diagnostic method for endometriosis.
- Ultrasound: This can help identify the location of cysts within the body.
Clinical Symptoms and Complications:
- Dysmenorrhea: Endometrial tissue commonly deposits on the ovaries, the posterior uterus, and the surface of the colon.
While many women may be asymptomatic, menstruation can lead to congestion and an accumulation of white blood cells, resulting in an extremely irritating condition.
Symptoms may include a feeling of heaviness, lower back pain, diarrhea, dizziness, severe menstrual cramps, and even shock.
Many women begin experiencing symptoms from a young age, with the most common onset between 25 and 45 years, the peak reproductive years.
During this time, approximately 1/3 to 1/2 of menstruating women may experience dysmenorrhea due to endometriosis; however, not all women with endometriosis will have painful periods.
- Infertility: Approximately 30%-50% of women with endometriosis may experience infertility.
The reasons for infertility remain inconclusive; however, many patients have patent fallopian tubes during laparoscopy and show minimal endometrial invasion.
Many of these patients can conceive naturally after treatment.
It is evident that even small endometrial deposits located far from the fallopian tubes can lead to infertility.
- Dyspareunia: About 25%-40% of women may experience pain during intercourse, which can also lead to spotting after sexual activity.
In certain positions, such as male superior, the movement of the penis can cause slight shifts in the uterus within the pelvic cavity.
However, if adhesions from endometriosis fix the uterus in place, even simple penetration can be uncomfortable.
Pain may worsen during menstruation due to swelling and bleeding of the endometrial tissue; adopting a female superior position may alleviate discomfort by preventing excessive penetration that could irritate the affected areas.
- Spotting or Heavy Menstrual Bleeding: Approximately 10%-20% of women may experience abnormal bleeding due to hormonal imbalances or cystic gland proliferation.
- Other Symptoms: Non-specific symptoms may include hematuria or dysuria, painful bowel movements, and in rare cases, cyclical hemoptysis or epistaxis if endometriosis invades the lungs or nasal mucosa.
(Taken from the Taiwan Endometriosis Association)
Wishing you peace and health,
Dr.
Zhang

Reply Date: 2012/01/09

More Info

Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, leading to various symptoms and complications. Diagnosing endometriosis can be challenging, and both ultrasound and blood tests play important roles in the diagnostic process.

Ultrasound for Endometriosis Diagnosis:
Ultrasound is a non-invasive imaging technique that can help identify certain manifestations of endometriosis. While it is not definitive for diagnosing endometriosis, it can be useful in detecting cysts associated with the condition, such as endometriomas (often referred to as "chocolate cysts") that form on the ovaries. During a pelvic ultrasound, the technician will look for abnormal masses or cysts, and the presence of these can suggest endometriosis. However, many women with endometriosis may not have visible cysts on ultrasound, especially if the endometrial tissue is not forming cysts or if it is located in less accessible areas, such as behind the uterus or in the pelvic cavity.

Blood Tests for Endometriosis:
Blood tests can also assist in the diagnosis of endometriosis, particularly through the measurement of the CA-125 protein. CA-125 is a substance that can be found in higher levels in the blood of women with endometriosis, although it is not specific to this condition and can be elevated in other diseases, such as ovarian cancer or pelvic inflammatory disease. The normal range for CA-125 is typically below 35 U/mL; levels above this threshold may warrant further investigation. It is important to note that CA-125 is not a definitive diagnostic tool for endometriosis, but it can provide additional information when considered alongside clinical symptoms and imaging findings.

Timing for Blood Tests:
For optimal results, it is generally recommended to conduct blood tests, including CA-125, a few days after menstruation has ended. This timing helps to minimize the influence of menstrual bleeding on the test results, as levels of CA-125 can fluctuate during the menstrual cycle. By testing shortly after the period, clinicians can obtain a clearer picture of the baseline CA-125 levels.

Conclusion:
In summary, while ultrasound can help identify certain physical manifestations of endometriosis, it is not definitive for diagnosis. Blood tests, particularly CA-125 levels, can provide supportive information but are not conclusive on their own. A definitive diagnosis of endometriosis often requires a surgical procedure called laparoscopy, where a physician can directly visualize the endometrial tissue and potentially take biopsies for further analysis.

If you suspect you have endometriosis or are experiencing symptoms such as pelvic pain, heavy menstrual bleeding, or infertility, it is essential to consult with a healthcare provider. They can guide you through the appropriate diagnostic steps, including ultrasound and blood tests, and discuss potential treatment options based on your individual circumstances.

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