Endometriosis is often one of the most underdiagnosed, misdiagnosed, and mistreated diseases in reproductive-aged women. Because the first step to receiving successful treatment is a proper diagnosis, it is imperative to find an endometriosis surgeon who will use and review all diagnostic tools to his or her disposal. This includes imaging techniques such as sonography, MRI, and laparoscopy. However, another crucial diagnostic tool that often goes underappreciated is a physical exam, which entails the patient providing a thorough overview of their symptoms and past medical history. It is important to find a surgeon who will listen to these symptoms as painful periods, painful sex (dyspareunia), gastrointestinal distress (which can often be seen in young age women in the form of constipation), painful bowel movements, and diarrhea can be highly suggestive indicators for a presumptive endometriosis diagnosis. It is key to find a surgeon who is not only knowledgeable, but also compassionate and patient enough to listen to your full story, as these elements can help to make up a highly accurate, but still speculative, diagnosis.
Diagnosing endometriosis requires three levels of diagnostic evaluation:
Endometriosis exists in different forms with different symptoms, signs, and prognoses. Though an increased awareness of the disease has given rise to an increase in diagnoses, endometriosis remains a seldom recognized and poorly understood illness. Confusion about appropriate management continues to surround the disease.
Despite advances in diagnostic technology and other presurgical imaging tests that help determine whether or not a patient may have endometriosis, a confirmation of endometriosis requires surgical biopsy. This is commonly obtained through minimally invasive laparoscopy.
The use of ultrasounds, magnetic resonance imaging (MRI), computerized tomography (CT scan), and certain endometrial biopsy samples may be used as part of a diagnostic workup, but to date, anything less than surgical confirmation of endometriosis is considered uncertain. There are also no specific blood tests to diagnose endometriosis.
Physical Exam: There are a variety of tests that we perform to diagnose endometriosis before a patient has surgery. After your symptoms, history, and complaints are well noted during an examination, we will conduct a thorough physical exam. A thorough physical exam consists of a comprehensive pelvic exam which includes inspecting the cervix, checking for neuropathy in your lower back and legs, assessing costovertebral angle (CVA) tenderness, and evaluating the upper vagina with digital palpation. We evaluate the nodularity, thickening, and shortening of the uterosacral ligament, rectovaginal, cul-de-sac, and lateral vaginal walls in this manner. The tenderness of these areas is significant in measuring the extent of the disease. We will also perform a gentle, single digital pelvic bimanual examination as well as note the mobilization and tenderness of the cervix to touch during this exam (CMT, or cervical motion tenderness). We will then evaluate the anterior and posterior cervix and the upper vagina with digital palpation.
Transvaginal Ultrasound: For patients experiencing painful bowel movements, we perform a transvaginal rectovaginal sonogram (transvaginal ultrasonography or transvaginal ultrasound) on top of a physical exam. Transvaginal ultrasound performed after a bowel preparation improves the ability to properly diagnose intestinal lesions and provides invaluable details including which layers of the intestine are affected and the distance between the lesion(s) and the anal border. We carefully evaluate the uterine walls, endometrial canal, and endometrial cavity for the presence of adenomyosis, fibroids, and polyps. We then scan the cul-de-sac and rectovaginal septum. Finally, it is important to inspect the ovaries. Having treated women with endometriosis for nearly three decades, we strongly believe that ovarian cancer is directly associated with endometriosis. Transvaginal ultrasounds have consistently proven to be the most promising imaging method for the routine screening of ovarian cancer. It is also very effective in screening for endometriosis.
Sonohysterography: We use sonohysterography along with an ultrasound to produce detailed images of the uterine cavity in order to aid in identifying endometrial lesions of submucosal fibroids and polyps, particularly in patients with a history of infertility and heavy periods, regardless of their pain.
Hysteroscopy: Before any excision surgery, we will conduct a hysteroscopy in order to visualize the lining of the uterus (endometrium), allowing us to see if there is any uterine cause for heavy menstrual bleeding, pelvic pain, or infertility.
Laparoscopy: Following your hysteroscopy, we make small incisions into the abdominal and pelvic region. We then insert a laparoscope into the incision sites and the images are depicted on two monitors, one for the surgeon and one for the attending resident. All surgeries we conduct are done via laparoscopy. This allows us to clearly visualize any suspected endometriosis lesions.
ABC technique (™): The Aqua Blue Contrast Technique (ABC) is a patented surgical technique that we use during laparoscopic excision surgery in order to clearly visualize endometriosis scar tissue with an aqua blue contrast solution. While some lesions may be invisible to the typical surgeon using a laparoscopic light, the ABC technique eliminates light reflection in order for the surgeon to visualize, and thus identify and fully excise endometriosis lesions. This method ensures that we identify all areas of endometriosis development throughout the body. This diagnostic tool is strictly unique to us.
So many patients diagnosed with endometriosis undergo multiple surgeries, only for their symptoms to return. Often this occurs because every endometriosis lesion has not been identified and a considerable amount of scar tissue is left behind. In order to ensure a thorough and successful surgery, it is crucial for you to ask the right questions about your surgery, and to learn how your surgeon will identify and excise endometriosis lesions.
Using common diagnostic tools such as ultrasound, MRI, and hysteroscopy, in combination with our unique method of laparoscopy using the ABC technique, we ensure that no visible endometriosis lesion goes undetected. But on top of these diagnostic tools, the first step in identifying your endometriosis is through proper communication.
Medically reviewed by Dr. Karli Goldstein on September 20, 2019
There aren’t enough stars for Seckin Endometriosis. They deserve 100/ 5. I want to make sure every woman right now who is looking for help, who is looking for a doctor and is scared and confused knows this is where you need to be. It doesn’t matter if you have to come from the other side of the United States or from the other side of the world, I can guarantee it will be worth it. Every member of their…
I’ve seen many obgyns over the years explaining my monthly symptoms during my period...but eventually it became a daily struggle with these pain. It feels like a poke here and there near my right pelvic region. I was given birth control pills for the past ten years but honestly, it didn’t help at all. I was in bed whenever I had my period. I was previously sent to GI doctors for possible appendicitis but it was ruled out from imagings…
Dr.Seckin is so much more than a surgeon. His passion for helping endometriosis sufferers and determination to improve the quality of life in all of his patients is undeniable. I remember when my gynecologist first told me I needed a laparoscopy. Her exact words were "I can do the surgery, but if you were MY daughter- I'd send you to him." From the first day I met him he took the time to explain endometriosis to me since I knew…
I was there for hysterectomy but then I found out that I also had endometriosis.My both surgeries went excellent and I feel great!.I am so thankful to Dr.Seckin and all his team for making my journey smooth!
I am a physician who suffered from deep infiltrative endometriosis. I needed laparoscopic surgery, so I went to see my former gynaecologist and he performed the procedure (a surgery which he supposedly does hundreds of times a year) last November. I had severe pain again when I had my period in January and was advised to go on taking a low hormone dose anticoncipient pill. My symptoms came back quickly and got worse in a few months’ time. I went…
After years of excessively painful periods, a serious loss of quality of life, and a series of uninformed and uninterested doctors, Dr. Seckin and Dr. Goldstein turned my life around. I was told I woke up from my surgery almost a year ago with a smile on my face, and I haven't stopped since. Before I heard of Dr. Seckin, I was experiencing almost daily terrible pain to the point where I had difficulty walking, inability to eat, inexplicable weight…
Dr Seckin and his team gave me back my life! Tomorrow will be 1 month since my surgery and I feel great. Dr. Seckin, Dr Liu, and Dr Goldstein are not only beyond words talented and amazing Doctors, but they are also genuinely wonderful and caring people. I cannot say enough great things about Holly, Asiye and Kim as well. They were all caring, kind, patient, and took the time to listen to me and explain anything I needed to…