Endometriosis: Ultrasound and Blood Test Insights

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Does a transvaginal ultrasound examination detect endometriosis? Does a pelvic ultrasound examination detect endometriosis? Can blood tests detect endometriosis? When is the blood test most accurate?

WEEREWR, 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.
If it grows on the ovaries, it forms what is known as a "chocolate cyst," and if it grows within the uterine muscle, it is referred to as "adenomyosis." The exact cause of endometrial tissue growing outside the uterus is still not fully understood; however, various theories suggest several potential causes: retrograde menstruation, transportation via the blood or lymphatic system, and autoimmune deficiencies.
Common diagnostic methods include:
- Physical examination: During a rectal or vaginal examination, there may be nodules on the uterosacral ligaments, tenderness in the rectovaginal pouch, or palpation of fixed unilateral or bilateral ovarian masses during abdominal examination.

- Blood tests: Measuring the level of CA-125 in the blood.
CA-125 is an antigen found in various body tissues that typically does not enter the bloodstream unless there is tissue damage or abnormal proliferation.
Normal levels of CA-125 are generally considered to be below 35 U/mL; levels above this may indicate conditions such as endometriosis, pelvic inflammatory disease, adenomyosis, or ovarian cancer.
Although it is not a highly effective screening method, abnormal results can serve as a treatment indicator.
It is recommended to conduct blood tests 2-3 days after menstruation ends.
- Laparoscopy: This is the only diagnostic method that can confirm the diagnosis of 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, often without symptoms.
During menstruation, increased blood flow and white blood cell accumulation, combined with retrograde menstrual flow, can create a highly irritating state, leading to sensations of heaviness, lower back pain, diarrhea, dizziness, severe menstrual cramps, and even shock.
Many women experience symptoms from a young age, with the most common age range being 25 to 45 years, the peak reproductive years.
During this time, approximately 1/3 to 1/2 of menstruating women with dysmenorrhea have endometriosis; however, not all women with endometriosis experience menstrual pain.
- 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.
Clearly, even small endometriotic lesions located far from the fallopian tubes can lead to infertility.
- Dyspareunia: About 25%-40% of women may experience pain during intercourse, which can lead to post-coital spotting.
In certain sexual positions, such as male-superior, slight movement of the uterus can occur, but if adhesions from endometriosis fix the uterus in place, even simple penetration can be uncomfortable.
Pain during intercourse may worsen during menstruation due to swelling and bleeding of the endometrial tissue; adopting a female-superior position may alleviate pain by preventing excessive penetration that could irritate endometriotic areas.
- Spotting before menstruation or heavy menstrual bleeding: About 10%-20% of women may experience abnormal bleeding due to hormonal imbalances or cystic gland proliferation.
- Surgical scar tissue: Periodic pain may occur, and in rare cases, endometriosis can invade the lungs or nasal mucosa, leading to symptoms such as hemoptysis or epistaxis.
- Other non-specific symptoms: Such as hematuria or dysuria, and pain during bowel movements.
(Taken from the Taiwan Endometriosis Association)
Wishing you peace and health,
Dr.
Zhang

Reply Date: 2012/01/09

More Info

Endometriosis is a complex condition characterized by the growth of endometrial tissue outside the uterus, leading to various symptoms such as pelvic pain, dysmenorrhea, and infertility. Diagnosing endometriosis can be challenging, and several diagnostic methods are employed, including ultrasound and blood tests.

Ultrasound Examination
Ultrasound is a non-invasive imaging technique that can be utilized to identify certain aspects of endometriosis. There are two main types of ultrasound used in this context: transvaginal ultrasound and abdominal ultrasound.
1. Transvaginal Ultrasound: This method is often more effective for visualizing pelvic organs, including the uterus and ovaries. It can help identify cysts associated with endometriosis, such as "chocolate cysts" (endometriomas) that form in the ovaries. However, while transvaginal ultrasound can reveal the presence of cysts, it may not detect smaller endometrial implants or lesions that are not cystic in nature. Therefore, while it can provide valuable information, it is not definitive for diagnosing endometriosis.

2. Abdominal Ultrasound: This method is less commonly used for diagnosing endometriosis but can still provide some insights. It may help visualize larger masses or abnormalities in the pelvic region, but similar to transvaginal ultrasound, it has limitations in detecting smaller lesions.

Blood Tests
Blood tests, particularly the measurement of the cancer antigen 125 (CA-125), can provide additional information. CA-125 is a protein that can be elevated in various conditions, including endometriosis, pelvic inflammatory disease, and ovarian cancer.
- Timing for Blood Tests: It is generally recommended to perform blood tests, including CA-125, a few days after menstruation has ended (typically 2-3 days post-menstruation). This timing helps ensure that the results are not influenced by menstrual bleeding, which can artificially elevate CA-125 levels.

Limitations of Diagnostic Methods
While ultrasound and blood tests can provide useful information, they have limitations. For instance, elevated CA-125 levels are not exclusive to endometriosis and can be seen in other conditions. Additionally, many women with endometriosis may have normal CA-125 levels. Therefore, these tests cannot definitively diagnose endometriosis.

Definitive Diagnosis
The only definitive way to diagnose endometriosis is through a surgical procedure called laparoscopy. During this minimally invasive surgery, a surgeon can directly visualize the pelvic organs and any endometrial tissue outside the uterus. If endometriosis is suspected, the surgeon can also take biopsies of any suspicious lesions for histological examination.

Conclusion
In summary, while ultrasound and blood tests can provide valuable insights into the possibility of endometriosis, they are not definitive diagnostic tools. Transvaginal ultrasound can help identify cysts associated with endometriosis, while CA-125 blood tests can indicate the presence of the disease but are not specific. For a conclusive diagnosis, laparoscopy remains the gold standard. If you suspect you have endometriosis or are experiencing symptoms, it is essential to consult with a healthcare provider who can guide you through the appropriate diagnostic process and discuss potential treatment options.

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