Helpful Investigations

There are a number of tests which can be helpful for doctors to look for physical signs of Endometriosis and to also help rule out other conditions. However, often at times these tests can still miss Endometriosis, therefore, multiple diagnostic tools are sometimes required to achieve an accurate diagnosis.

 

Should your specific results return inconclusive or negative results, we would still encourage you to seek further medical assistance or tests if your symptoms are persistent or you still suspect Endometriosis.

Which tests will I find helpful?

Below we have listed several tests you may find helpful throughout your Endometriosis journey. For some people, these tests can cause a feeling of anxiety, especially if it’s your first time. We call this “scanxiety” and while it’s perfectly normal to feel nervous, knowing what to expect can help reduce these feelings.

 

If you would feel more comfortable with a female doctor or nurse, be sure to mention this upon booking your appointment. The expertise of the team is the most important aspect and a female clinician with the correct expertise may not always be possible.

Some of these tests may be uncomfortable, therefore taking somebody along with you for support and scheduling these exams when you can take a day off school or work may be helpful. Do not cancel your appointment if you are having your period as sometimes this makes it easier to make a diagnosis.

Physical exam - Your doctor may measure your height and weigh you to check you have a healthy body mass index (BMI). This is to find out if you are at a healthy weight for your height. Your doctor may also perform a physical exam to manually feel for any abnormalities in your pelvis. What to expect - You will be asked to undress from the waist down and change into a gown or you may be provided with a sheet to cover yourself with. You will then be asked to lay on your back, shuffling your bottom to the end of the examination bed where your feet may be placed in stirrups, allowing your legs to fall open either side. During this examination, using one hand your doctor will place two fingers inside your vagina where they will palpate inside. Using the other hand, your doctor will gently press down on your lower abdomen. Sometimes during this examination, your doctor may choose to use a speculum. This allows them to look deeper inside to look at the vagina and neck of the womb - if you find this uncomfortable, you can ask your doctor to use a smaller sized speculum.

Urine test - Your doctor may request a urine sample test to check for blood or test for infection.

Blood test - Blood tests are used to assess your general health. These tests can be used to check for signs of infection, how well your organs are functioning, your hormones, fertility status, and to also help rule out other medical conditions. What to expect - This test is usually performed by your doctor or a nurse where they will take a blood sample extracted from a vein in the arm or by finger prick. You might feel a slight scratch as the needle is inserted although generally blood tests are not painful, and they are usually over within just a few seconds. If you would feel more comfortable with a numbing spray or cream, be sure to mention this upon arrival to your appointment.

External ultrasound scan - An ultrasound scan is an imaging technique which uses sound waves to create a clear view of the inside of your body. This test is often used to check for any physical changes or abnormalities in your pelvis. What to expect – A cold jelly like substance will be placed on your abdomen where your doctor will use a handheld imaging device, gently rolling it across your abdomen to capture images from inside your pelvis.

Transvaginal scan - A transvaginal scan is a type of ultrasound scan used to create internal images of the uterus, ovaries, and surrounding structures within the pelvis. This gives clearer pictures of your pelvis than an external scan. What to expect – You will usually be asked to empty your bladder, undress from the waist down and position yourself on the exam table, shuffling your bottom to the end of the bed so your feet can be placed in stirrups, allowing your legs to fall open either side. During this examination, your doctor will gently place a probe like camera inside the vagina (around 2-3 inches) allowing a clear assessment of your pelvis. Your doctor may gently press down on your lower abdomen at certain points to ensure specific areas can be seen as clear as possible.

Hysteroscopy - This procedure allows your doctor to look inside your uterus using a hysteroscope (a thin telescope with a camera and light located at the tip). What to expect – Your doctor will gently pass the hysteroscope through the vagina into your uterus where it is used to capture images. This test can last anywhere between 10 - 30 minutes and you're usually awake.

Hysterosalpingography (HSG) - This X-ray examines the uterus and fallopian tubes to check for swelling, blockages, or any other problems likely to affect your fertility. What to expect - This test is carried out in the radiology department where a dye is injected into the uterus which passes into the fallopian tubes, allowing your doctor to see whether the uterus is normal or if the fallopian tubes are blocked. What to expect - This procedure is usually carried out whilst you are awake however it can also be carried out during surgery to remove Endometriosis. A transvaginal scan is a type of ultrasound scan used to create internal images of the uterus, ovaries, and surrounding structures within the pelvis. This gives clearer pictures of your pelvis than an external scan.

Chromopertubation - This procedure is performed during a laparoscopy (keyhole surgery), often in conjunction with removing Endometriosis. Similar to the HSG (although more invasive), Chromopertubation involves inserting a substance dye into the fallopian tubes to check for any blockages and swelling. If the tubes are open, the substance dye will pass through the tubes into the pelvic cavity. If the tubes are blocked, the dye may not enter or drain which can be a good indicator of infertility, in which the fallopian tubes will not allow the egg and sperm to meet.

MRI - Magnetic Resonance Imaging (MRI) is used to scan almost every part of your body. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. Depending on the size of the area being scanned and the number of images taken, this test can last anywhere between 15 and 90 minutes. What to expect - The MRI scanner is a tube which is open both ends. Depending on which body parts are being investigated, some may require you to lie headfirst and others, feet first, and a camera will be placed over you. Your doctor will usually advise you to arrive 1 hour early to your appointment. You may be required not to eat or drink anything usually for up to a few hours prior to your appointment, or you may be asked to carry out a type of bowel prep, this is to allow you time to prepare for the scan. As this scan produces strong magnetic fields, it is important to remove any metal objects before entering the scanning room such as jewellery; hearing aids; and anything else containing metal. You may be asked to change into a gown, or your doctor may allow you to wear your own clothes. The scanning rooms are usually chilly therefore wearing clothing garments which do not have metal zips, fastenings or underwires that will keep you warm is recommended. Your clothes and personal belongings will be placed in a small locker. Some MRI scans involve a contrast dye; this may be given in liquid form or by injection in the arm through a cannula. This allows for certain tissues and body parts to show up, as well as helping identify any blockages. The dye can (sometimes) cause mild side effects, such as a warm feeling – feeling like you’re passing urine, dizziness; feeling nauseas; a headache or skin rash. These effects are usually mild, and they shouldn’t last long.

Flexible cystoscopy - This procedure involves a thin and bendy cystoscope (a type of camera) which is gently inserted into the urethra and bladder. You are usually awake during this procedure.

Rigid cystoscopy - This procedure involves a thin cystoscope (a type of camera) one that does not bend. The cystoscope is gently inserted into the urethra and bladder, allowing your doctor to see the lining of your bladder. This procedure is done with you asleep often as part of other procedures to help diagnose Endometriosis.

Urodynamics - Urodynamics are used to check how well the bladder is working by testing for any leakages or blockages. What to expect - This procedure involves a catheter which is gently passed through your urethra into your bladder. A fine tube is inserted into your back passage (bottom) at the same time. Once inserted, your doctor will fill up your bladder with water. Your doctor will talk through how you are feeling during this examination, including when you first feel the need to pass urine and when your bladder feels as full as it can be, and you can no longer hold your urine. You will be asked to stand to see how this affects your bladder. After a few minutes, your doctor will remove the catheter and tube and instruct you to empty your bladder. During this test, results are logged, and a report will be given to your medical team. Sometimes the results can be discussed with you on the day.

Colonoscopy - This procedure involves a long, thin flexible tube with a small camera inside which is gently passed into your back passage, allowing a clear view of the inside of your bowel. You are usually awake during this procedure and your doctor may advise you to carry out a type of bowel prep or enema to prepare you for this test. You may be offered medications such as a sedative or ‘gas and air’ to help you feel more comfortable.

Sigmoidoscopy - Similar to the colonoscopy, a sigmoidoscopy involves a rigid or flexible tube with a small camera inside which is gently passed into your back passage and into the sigmoid colon to look inside the left side of your large bowel or colon. Your doctor may advise you to carry out a type of bowel prep or enema to prepare you for this test. You are usually awake during this procedure.

Laparoscopy - This procedure is usually performed under general anaesthetic where CO2 gas is pumped into the abdomen, allowing for surgeons to see clearly inside for signs of Endometriosis using the laparoscope (a thin telescope-like instrument). The laparoscope is normally passed through a small incision inside or around the belly button. If Endometriosis is seen then additional small incisions are made to the skin, either side of the pelvis and above the hair line to insert instruments capable of taking a biopsy or removing the Endometriosis. This ‘see and treat’ approach allows surgeons to not only identify areas affected by Endometriosis, but to operate in removing it by either cutting it away or using heat or laser to destroy it.

Laparotomy - A laparotomy is performed under general anaesthetic or sometimes under a spinal anaesthetic. This is a type of surgery is used in instances such when surgeons require different access to the abdomen. It involves creating a large incision (usually around 6 to 12 inches) either from the belly button down to the pubic bone, or across the knicker line.

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