Endometriosis Diagnosis and Management

Clinical Presentation

Endometriosis affects at least one-third of women with infertility and up to 10% of reproductive-aged women, making it the most likely diagnosis when chronic dysmenorrhea and infertility coexist 2
The classic triad of endometriosis pain includes secondary dysmenorrhea, deep dyspareunia, and sacral backache with menses 1
Endometritis is an acute or chronic infection of the endometrial lining, typically presenting with fever, abnormal vaginal discharge, and acute pelvic pain, which is distinct from endometriosis 3
Fibroids can cause dysmenorrhea and may contribute to infertility, but they are focal masses that distort uterine contour rather than causing the diffuse inflammatory process typical of endometriosis 4
Fibroids more commonly present with heavy menstrual bleeding rather than painful menses as the primary complaint 1

Transvaginal ultrasound is the initial imaging modality to evaluate for endometriomas and assess ovarian reserve 2, 4
MRI has high sensitivity and specificity for detecting endometriomas when ultrasound is indeterminate 2
Laparoscopy with biopsy remains the definitive diagnostic method, though it's reserved for cases where empiric therapy fails or immediate diagnosis is necessary 2