Endometriosis: diagnosis and misdiagnosis

After hitting puberty, a woman’s body undergoes many changes. These changes affect your physical as well as mental health - thus, it is quite important for a woman to be aware of all the changes her body is undergoing - and if she feels anything wrong, we advise you to consult your doctor as soon as possible.

 Many women during their childbearing years are diagnosed with a condition called Endometriosis. In this condition, a tissue that lines a woman’s uterus also starts growing outside it. Usually it doesn’t have any symptoms and isn’t considered dangerous. However, sometimes it causes tremendous pain followed by other problems. The lumps which grow outside the uterus are called implants and they usually grow on the fallopian tubes, the ovaries, the outer wall of the uterus or other organs located in the abdomen region. In some rare cases, they have also been found in the area beyond the abdomen or in the belly region. 

Endometriosis can be diagnosed through the following tests:

• Pelvic Exam – In this test, the doctor manually checks the pelvis region for any signs of abnormalities like cyst on the reproductive organ or scars behind the uterus. Often, the doctor is not able to diagnose endometriosis unless the implants have resulted in cyst formation.
• Ultrasound – In this test, a device called transducer is used which produces high-frequency sound waves to create images inside of the body. This device is used in two ways, either it is pressed again the belly or it is inserted inside your vagina. It is done to get the best possible view of the reproductive organ. But, ultra sound images can only help the doctor in identifying cyst that is related with endometriosis and not whether you actually have it or not.
• Laparoscopy – Laparoscopy is a surgical procedure usually conducted after the first two tests to ensure whether you have endometriosis or not. In this procedure, when under general anesthesia a tiny incision is made near your navel and a laparoscope (slender viewing instrument) is inserted to look for endometrial tissue outside the uterus. This is followed by sample tissues being taken for biopsy. This test provides the accurate information about the location, extent as well as the size of the implants to help in determining the best treatment options. 

However, it is quite often women having endometriosis are misdiagnosed as having different diseases such as interstitial cystitis and polycystic ovaries, or the abdominal and bowel endometriosis, which are considered to be inflammatory bowel syndrome while the pelvic endometriosis is diagnosed as pelvic inflammatory disease or pelvic congestion. 

It was reported by the Endometriosis Association that over 70 percent of women were initially told that “there was no physical cause for their pain” and later diagnosed with endometriosis. In a qualitative interview- based study done by Karen Ballard, it was discovered that the main reason for not diagnosing was the non-awareness amongst the doctors and the patients, as well as their misguided contempt of these issues. 

Reasons for misdiagnosis: 

• Most of the time a women having endometriosis experiences pain on during her menstrual cycle i.e. periods. These painful periods are considered to be normal and thus ignored by the patient. Even if the patient goes to the doctor, they are often told that these symptoms are normal part of being a woman. 
• Sometimes a doctor misdiagnoses the patient as he confuses this condition with some other, he prescribes medicines which suppresses the symptoms and thus delays in diagnosis.
• Also, due to unawareness, inadequate diagnostic methods such as transvaginal sonograms, although the endometriomas can be identifies but endometriosis cannot be diagnosed. Thus this leads to delay in diagnosis as well as incorrect treatment.

Misdiagnosis or failed diagnosis can lead to excruciating pain and suffering. Sometimes, this pain can also arise during sexual intercourse making it difficult for women to indulge in it. It can also cause painful bowel movement. Other than this, it can also create problems in conceiving as sometimes they block the fallopian tube and the ovaries leading to infertility. According to survey, 50-80% women suffer from infertility due to endometriosis. Also, they are more likely to have miscarriages, premature birth, malpresentation, caesarian section, etc. 

Now it is our duty to educate ourselves and the people around us about this disease. We have to create awareness. You may be surprised to know that not all doctors and nurses have knowledge about endometriosis. They superficially grasp wrong information on the internet and attempt to medicate, based on hypotheses. Thus, the more we know about our body and health, the more we can understand ourselves and our own lives more clearly.