A Q&A with Dr. Melissa McHale, Endometriosis Excision Specialist in Washington DC
We asked Dr. Melissa McHale, MD to weigh in on confusion surrounding endometriosis diagnosis and if endometriosis can be found during unrelated tests, procedures, and surgeries. At PRM, we want to ensure that endometriosis patients have up to date and accurate information to find the care they need.
Can endometriosis be diagnosed by a procedure called a “hysteroscopy” or a “D&C”?
No. These are procedures that evaluate the inside of the uterine cavity, and look for other pathologies such as endometrial abnormalities such as:
- polyps
- overgrowth
- chronic infection
- cancer
or structural issues of the uterus (such as fibroids that distort the cavity or congenital abnormalities of the uterine structure).
Endometriosis is a condition where tissue similar to the endometrium exists outside of the uterus, and there is currently no evaluation of the endometrial cavity that would indicate whether similar tissue is located outside of that space. Such an evaluation is performed via laparoscopy, a procedure in which the camera is introduced into the abdomen and pelvis, and the surfaces outside of the uterus are thoroughly evaluated both visually and with removal of tissue sent to pathology for confirmation of the diagnosis.
As the appearance of endometriosis is quite variable, this laparoscopic evaluation is best performed by someone who specializes in endometriosis to ensure that more subtle appearing disease is not missed.
How often is endometriosis discovered during routine gynecological exams or tests for other conditions?
Endometriosis is missed far more often than it is actually suspected in routine gynecologic care. Unfortunately, even among primary care providers, there is minimal education regarding the symptoms of endometriosis and therefore most doctors miss the unifying diagnosis of endometriosis. The patients who have endometriosis that is missed in routine care far outnumber the patients who have endometriosis diagnosed “incidentally”.
Can endometriosis be found in areas outside the reproductive organs during imaging procedures, and what does this mean for diagnosis?
Endometriosis can appear in imaging results in other parts of the body, but as with clinical diagnosis, endometriosis is very commonly missed on imaging results. I routinely see endometriosis on MRI that radiologists miss or diagnose as something else.
I find that transvaginal ultrasound performed by an expert is more sensitive for endometriosis of other locations such as the rectum than MRI is, but in truly complex cases I find that comparing the two imaging modalities is most effective.
Why might endometriosis be discovered during surgeries for conditions unrelated to reproductive health, such as appendectomies or hernia repairs?
Because endometriosis can travel to many different locations, the pathology results for any surgery could be positive for endometriosis – and when this happens, it generally is found in other locations.
What are the implications of finding endometriosis in uncommon areas during or after surgical procedures?
The implications entirely depend on what location it is identified. This is why having a thorough diagnostic workup with an expert prior to surgery is essential to surgical planning. Your endometriosis expert is the person who is responsible for ensuring that all aspects of your endometriosis are addressed appropriately.
Schedule a Consultation with an Endometriosis Expert
Seeking Treatment for Endometriosis
Endometriosis is a complex disease that requires a multidisciplinary approach. As Dr. McHale mentioned, a laporoscopy is the best way to find where endometriosis has grown within the body and to excise the lesions.
If you are struggling with endometriosis and are seeking care for your symptoms, meet with our team of pelvic pain and endometriosis specialists.
