Endometriosis Diagnosis and Treatment

A careful and detailed pelvic exam is always the first step in diagnosing endometriosis. During a pelvic exam, your doctor checks your reproductive organs for endometrial implants, cysts, scar tissue and areas that trigger pain or discomfort.

Following the initial exam, pelvic imaging is often the next step. Depending on the specific areas to be examined, your doctor may recommend one or more procedures, such as transabdominal or transvaginal pelvic ultrasound or pelvic or abdominal MRI.

At UChicago Medicine, your pelvic imaging will be reviewed by one of our physicians who specializes in diagnosing endometriosis. These targeted images help enhance the accuracy of a diagnosis, including the detection of endometrial cysts on the ovary, called endometriomas.

In some cases, doctors may recommend laparoscopic gynecologic surgery to confirm the diagnosis or to inform effective treatment options. Laparoscopy is a minimally invasive technique that allows the surgeon to detect endometrial implants and even biopsy tissue samples for further testing, if necessary. Of the three exams, laparoscopy offers the most information about the size, location and spread of endometrial implants.

Managing and treating endometriosis often starts with pain medication. For some individuals, over-the-counter medications, such as aspirin, ibuprofen and naproxen, may initially offer effective relief for endometriosis pain. If your pain is mild, medication alone may help manage it.

For severe or chronic endometriosis pain, UChicago Medicine offers a more comprehensive approach to help you find relief, including access to physical therapists who teach specialized pain management techniques and our team of experts in the Pain Medicine Clinic. 

Hormone therapy is one of the most common approaches to treat menstrual pain and suppress endometriosis. These medications include estrogen-progesterone combinations, such as birth control pills or isolated progestins taken orally, by injection or through an intrauterine device (IUD).

In certain severe cases, doctors may prescribe additional medications to stop the ovaries from producing estrogen. This strategy is effective in some individuals because estrogen may cause endometrial implant growth and painful inflammation. 

Surgery may be the most effective treatment option, especially when:

• Symptoms do not respond to medical treatment
• Lesions are widespread or deeply embedded
• Implants are found on the ovaries and can affect your ability to conceive within one year

Endometrial implants are destroyed or removed during laparoscopic or robotic gynecologic procedures. The benefits of these minimally invasive techniques include less pain and shorter recovery time compared to traditional surgery. In some cases, the uterus (and sometimes the ovaries) may be removed during a minimally invasive hysterectomy.

Even when traditional open surgery is warranted, our surgeons demonstrate expert precision to support the best possible outcome and recovery.