What Happens at the First Consultation?
Dr Groenewald begins with a detailed history of your symptoms, your cycle and your general health, followed by a physical examination that includes a pelvic exam.
An ultrasound scan is usually performed at this visit as well. Where your symptoms suggest endometriosis, a structured mapping scan is used, either at this visit or at a dedicated follow-up appointment, to look for endometriomas, cysts formed by endometriosis on the ovary, along with deeper disease that a routine scan can easily miss.
Is Imaging Now the First Step in Diagnosis?
Yes. Current international consensus, reflected in the 2022 endometriosis guideline from the European Society of Human Reproduction and Embryology (ESHRE), recognises imaging as the first-line way to diagnose endometriosis.
A detailed transvaginal ultrasound in 2D and 3D, performed by a gynaecologist trained in endometriosis imaging, can identify deep infiltrating endometriosis and ovarian endometriomas with a high degree of accuracy. It is particularly reliable for the more severe forms of the disease. This structured assessment is known as endometriosis mapping.
MRI is added where ultrasound cannot give the full picture, for example when disease extends higher into the bowel or towards the diaphragm. Beyond confirming the diagnosis, mapping shows exactly where endometriosis sits, which is what allows the right treatment to be chosen and any surgery to be planned properly.
Why Is Laparoscopy Sometimes Needed?
Laparoscopy remains an important tool, but its role has changed. It is now recommended mainly when imaging is negative, but symptoms strongly suggest endometriosis, or when symptoms persist despite medical therapy. This matters because superficial endometriosis, the thin patches that sit on the lining of the pelvis, is often too fine to show on any scan.
During laparoscopy, a narrow camera is passed through a small incision to view the pelvic organs directly. A small tissue sample may be taken for biopsy, and visible endometriosis can usually be excised during the same procedure.
Not everyone needs laparoscopy straight away. Where symptoms and scan findings are clear enough, treatment can often begin first, with surgery kept as an option if symptoms persist.
What Determines the Diagnosis I Receive?
Once endometriosis is confirmed, its extent is described using a staging system, which helps guide the conversation about which treatment options make the most sense for you. Findings from mapping, and from laparoscopy where it is performed, are considered together with your own symptoms and priorities to shape the recommendations that follow.
It is worth remembering that an endometriosis diagnosis is a starting point rather than an endpoint. Many women feel a sense of relief simply in having a name for what they have been experiencing, even before treatment begins.
