Why endometriosis is hard to diagnose: Can't be felt on exam, found on an x ray or an ultrasound

Endometriosis can't be felt on exam, but it needs to be found on an x ray or an ultrasound, so what you have to have happen in order to make the diagnosis of endometriosis? For most, this challenge means that there are significant delays in the diagnosis of endometriosis. The average delay has been said to be 7-9 years between the start of symptoms and the diagnosis. This has frustrated physicians and patients alike as the only way to diagnose endometriosis has been surgery. Even the diagnosis of endometriosis by surgery has been frustrating for patients as there is no way to figure out at what rate the disease will progress for women who want children and even more importantly, for all patients with endometriosis, what puts them at risk for disease progression is still unknown. And for women who's symptoms worsen, exactly how this translates into actual disease load, is not known either. We try with pelvic examinations and ultrasounds and symptom scoring to give patients the information they need, but much is still lacking. It would be nice if we could get a blood test that could predict the diagnosis of endometriosis accurately. CA-125 is elevated in some patients with endometriosis, but it's not specific nor a recommended test for this group. Recently a research team  headed by A. Mihalyi1 and O. Gevaert from Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven University Fertility Centre, Herestraat 49, B-3000 Leuven, Belgium.the the reported their results in Human Reproduction of a new study looking at the blood of endometriosis patients and seeing if they could use the blood test measurements of inflammation and biomarkers of surface proteins of the ovaries to correctly diagnosis women with endometriosis. Indeed they found that levels of IL-6, IL-8 and in their study even CA-125 were increased in all women with endometriosis. They think they will be able to use a panel of six blood tests, called biomarkers, to determine within 90% accuracy if a patient has endometriosis even in the mild to minimal stages (Stages I or II out of IV). Caution has to be exercised in interpreting these initial results. These biomarkers are also biomarkers of stress, and patients were studied in context of their surgeries. So how much the physical stress of surgery altered their findings cannot be said. None-the less, if we could find a panel of tests to use, like the screening blood tests that are used to screen some women for ovarian cancer, many women could be helped significantly. And in a study published in the American Journal of Obstetrics & Gynecology researchers from Utah used MRI's non-invasively to diagnose endometriosis. Do you think you need additional testing because of symptoms of pelvic pain?


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