Summary: Endometriosis, affecting over 11% of women of reproductive age, is challenging to diagnose early due to the limitations of current imaging methods like MRI and ultrasound, though promising technologies like electroviscerography are under investigation but remain unproven.

Key Takeaways

  • Diagnostic Challenges: Endometriosis, affecting over 11% of women of reproductive age, is difficult to diagnose early, often taking an average of seven years from symptom onset due to the complexity of symptoms and limitations of current diagnostic methods.
  • Current Diagnostic Methods: The most accurate methods for diagnosing endometriosis include pelvic exams, ultrasound, MRI, and laparoscopy, with laparoscopy being the gold standard but carrying risks and depending on the surgeon’s expertise.
  • Emerging Technologies: New diagnostic tools like electroviscerography (EVG) show promise but are unproven, and there is currently no FDA-approved non-invasive test, highlighting the need for further research to develop effective early diagnostic criteria.

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Endometriosis is a common, burdensome, chronic disease that affects more than 11% of women of reproductive age in the United States and 190 million women worldwide. Early diagnosis remains a major clinical and public health challenge. The average time to diagnose endometriosis is seven years after the onset of symptoms, which include abdominal pain and cramping before, during and after menstruation, among others.

Endometriosis occurs when tissues normally found inside the lining of the uterus migrate and grow in other locations, most commonly the ovaries, fallopian tubes and other organs. These circumstances may cause life-altering consequences such as chronic pain, infertility and quality of life.

New Approaches for Early Endometriosis Diagnosis

In a commentary published in The Journal of Reproductive Medicine, Gynaecology & Obstetrics, researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators, conducted a PubMed search to identify promising approaches for early diagnosis of endometriosis.

“Currently, diagnosing endometriosis involves a thorough review of the patient’s medical history and physical examination,” said Panagiota “Yiota” Kitsantas, PhD, first and corresponding author as well as  professor and chair of the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. 

“The most commonly used and accurate diagnostic methods are pelvic exams, abdominal ultrasound, MRI, and laparoscopy. Laparoscopic surgery is considered the gold standard for diagnosing endometriosis by gynecologists, but it can be expensive and carries potential risks of surgical complications. Moreover, the accuracy of laparoscopy can vary based on the surgeon’s experience and the stage of the disease.”

The authors suggest that the ideal early diagnosis test for endometriosis should use symptom-based criteria to identify candidates for testing, with optimized sensitivity and specificity. A highly predictive test would confirm or rule out endometriosis accurately, while even less precise tests could help reduce the need for invasive procedures like laparoscopy.

MRI and Ultrasound Limited in Endometriosis Detection

Endometriosis involves hormonal imbalances that trigger angiogenesis, apoptosis, immune responses, and inflammation. Diagnostic tools for endometriosis have been developed to detect biomarkers, such as mRNA fragments in blood and saliva, but these have shown low accuracy.

“Non-invasive methods like MRI and transvaginal ultrasound are only effective for advanced stages of endometriosis,” says Charles H. Hennekens, MD, co-author, the first Sir Richard Doll Professor of Medicine and Preventive Medicine in the Departments of Medicine and Population Health and Social Medicine and  senior academic advisor, FAU Schmidt College of Medicine. “Recent research has focused on a novel noninvasive method of detecting myoelectric activity in the gastrointestinal tract as a potential diagnostic tool. Electroviscerography or EVG could detect unique myoelectric patterns associated with endometriosis, though this approach is promising but unproven.”

Currently, there is no FDA-approved non-invasive test for endometriosis, and further analytic studies leading to peer-reviewed publications are needed to refine these emerging technologies and establish effective diagnostic criteria.

“Early diagnosis of endometriosis remains a challenge, with a succession of promising approaches ultimately not bearing fruit thus far,” said Kitsantas. “Once new technologies such as EVG are more fully evaluated, they may give clinicians the post-test certainty they need to transition from symptom-based to diagnosis-based treatment.”