Endometriosis is a disorder in which the tissue that normally lines the inside of the uterus (called endometrium) grows outside the uterus, intruding into the pelvic organs (the ovaries and fallopian tubes) and other tissue lining the pelvis. This tissue grows, thickens, and bleeds with a woman’s normal menstrual cycle, but cannot exit the body like normal menstrual blood. Instead, it becomes trapped, causing painful irritation, scarring, adhesions, and cysts called endometriomas. It can be very painful and frequently goes undiagnosed for many years. Global support groups designate March for events to raise awareness of this disease and help reduce the number of women suffering worldwide.
Symptoms of Endometriosis
Many women don’t realize they have endometriosis, since the symptoms are often mistaken for menstrual pain. They include serious, significant pelvic, lower back, and abdominal pain and cramping before and during your period, pain during or after sex, pain with bowel movements or urination (especially during your period), heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia), fatigue, diarrhea, constipation, and bloating or nausea.
One of the most significant symptoms or effects of endometriosis is difficulty conceiving. Many women looking for an explanation or cause of their infertility discover that they have endometriosis. Left untreated, the adhesions and scarring can cause fertility issues. It’s possible for the displaced growth of the endometrium to obstruct the fallopian tubes, directly preventing an egg and sperm from uniting. Endometriosis also seems to affect fertility in less direct ways, including possible damage to the sperm or egg. An early diagnosis can help you manage your symptoms and mitigate conception problems.
Diagnostic Tools: Sonohysterogram & Hysterosalpingogram (HSG)
A sonohysterogram is a minimally invasive ultrasound imaging procedure that allows a radiologist to examine the endometrium and identify any abnormalities. While it isn’t dispositive in diagnosing endometriosis, it can allow your physician to identify and evaluate endometriomas—abnormal cysts associated with the condition. After a standard transvaginal ultrasound, sterile saline is injected through a catheter to enlarge the uterine cavity and enable the radiographer to obtain clearer images. The saline outlines the endometrium and allows better visualization and measurement of any polyps, masses, cysts, or other abnormal endometrial growth within the cavity. Saline and air may also be injected into the uterus so that the physician can look for air bubbles passing through the fallopian tubes, which would indicate the fallopian tubes are clear with no blockages.
If it seems that your fallopian tubes are blocked by endometrial tissue or some other obstruction, your doctor may recommend a follow up hysterosalpingogram (HSG). In this test, your radiologist will insert a speculum into your vagina to access the cervix and inject a contrast material (like a dye) through a flexible catheter. Then, he or she will take X-ray images that show the path of the contrast material. If your fallopian tubes are clear, the contrast material will fill the uterus, flow easily through the fallopian tubes, and dissipate into the abdominal cavity around each ovary. If there are any blockages or abnormalities, the flow of the contrast material will be interrupted and visible to your radiologist on the X-rays. This can help identify the presence, location, and size of blockages in the fallopian tubes.
Diagnosis & Treatment
Like a sonohysterogram, an HSG is an important test used to reveal abnormalities, but neither test alone can definitively diagnose endometriosis. These tests are just some of the tools your doctor may use to diagnose this condition, in addition to evaluating your symptoms and performing pelvic exams. He or she may also recommend laparoscopic surgery after these diagnostic imaging tests to further investigate abnormalities, reveal more about the location, extent, and size of any endometrial implants, and help decide on the best treatment plan for you. Treatment options include hormone therapy, conservative surgery to remove adhesions or cysts, or a complete hysterectomy. Women who struggle to conceive may be advised to try assisted reproductive techniques like IVF (in vitro fertilization). Having the most comprehensive diagnostic results can help your medical professional determine what treatment options will be most effective and appropriate for your situation.
Iowa Radiology provides a wide range of women's imaging services in the Des Moines metro area, including sonohysterography, hysterosalpingography, breast imaging and biopsy, and bone density scanning. We want you to have all the information you need about your health care. Our dedicated team members are available to answer any questions you have about procedures at our clinics. Don’t hesitate to reach out and contact us if you have questions or concerns.
Click the links below to download our free eBooks, which contain helpful information about what to expect and how to prepare for common imaging procedures.
The information contained in the Iowa Radiology website is presented as public service information only. It is not intended to be nor is it a substitute for professional medical advice. You should always seek the advice of your physician or other qualified healthcare provider if you think you may have a medical problem before starting any new treatment, or if you have any questions regarding your medical condition.
Iowa Radiology occasionally supplies links to other web sites as a service to its readers and is not in any way responsible for information provided by other organizations.