Diagnosis

A definitive diagnosis is made by laparoscopy or laparotomy.34 Typical endometriotic lesions range from the early, active petechial lesions to the older and less active powder-burn, fibrotic lesions.35 Clinical diagnosis of endometriosis is accurate approximately 50 percent of the time.30 Deep infiltrating lesions are most prevalent in the pouch of Douglas and the uterosacral ligaments and may cause pain by infiltrating nerve endings.36 Sensory innervation of endometriotic implants may also contribute to pain sensations.37 Other diagnostic options include ultrasound (however this is limited to diagnosis of ovarian endometriomas), and an elevated CA-125 and ESR (however the specificity is low).

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