New Guidelines Could Change How Endometriosis is Diagnosed, Here’s What You Need to Know

Endometriosis is a painful condition that affects millions of women. However, the condition has historically been difficult to diagnose and treat. The American College of Obstetricians and Gynecologists (ACOG) is trying to change that with new guidelines aimed at helping women find relief from endometriosis symptoms faster. 

According to Jocelyn A. Carlo, M.D., director of gynecology at Jersey Shore University Medical Center, the new guidelines mark a shift in how gynecologists approach diagnosing endometriosis. 

“The guidelines recognize the long diagnostic journey many women face and provide clinicians with tools to act sooner, so we can treat the disease earlier, prevent complications and improve their quality of life,” says Dr. Carlo. 

If you believe you have endometriosis, Dr. Carlo has some tips on how the new guidelines could help you receive a diagnosis and start treatment. 

Advocate For Yourself 

The new ACOG guidelines are shaking up how doctors diagnose endometriosis. In the past, surgical confirmation was necessary, but now, doctors are encouraged to diagnose endometriosis based on symptoms and a physical examination. 

When you see a doctor, Dr. Carlo says not to downplay symptoms and even encourages keeping a log of suspected endometriosis symptoms. Some examples include: 

• Painful periods
• Chronic pelvic pain
• Painful intercourse
• Painful bowel movements
• Painful urination

According to Dr. Carlo, one reason that endometriosis has been difficult to diagnose is because of the range of symptoms. 

“Endometriosis is not a one-dimensional disease. It presents differently from patient to patient, can affect multiple organ systems and often overlaps with other pain symptoms,” she says. 

Discuss Imaging Options

The new guidance also lays out a clear path for imaging. Dr. Carlo suggests discussing the imaging options with your doctor, including the recommended first step: a transvaginal ultrasound. 

“A transvaginal ultrasound is a non-invasive first-line imaging tool. It can identify endometriomas (ovarian cysts associated with endometriosis) and may suggest deep infiltrating disease or features of adenomyosis in the uterus. It will miss small nodules and lesions. A normal ultrasound does not exclude the diagnosis of endometriosis,“ she says.

Dr. Carlo says that when an ultrasound is unclear, an MRI may be used to help obtain a diagnosis and for preoperative planning. 

Push for a Diagnosis

Because a major shift in the guidance is the move away from requiring surgery for diagnosis, a clinical diagnosis based on your symptoms and a physical exam is now considered sufficient to begin medical treatment. Dr. Carlo says that this should encourage women to talk to their doctor about a diagnosis. 

“Tell your doctor you're aware of the new ACOG guidance and that a clinical diagnosis is now sufficient to recommend treatment without surgery. This can open the door to discussing starting treatment to manage your symptoms sooner," she says. 

Dr. Carlo also cautions against the wait-and-see approach. The goal of the new guidance is to reduce the delays, ranging from 4 to 11 years, that patients face in obtaining a diagnosis. She says that if you feel your symptoms are being dismissed, you can refer to the new guidelines.

Overall, Dr. Carlo says the new guidelines are an important step in bringing awareness to endometriosis. 

“Increased awareness on the national level helps shift both patient and physician perspectives towards this complex and challenging disease. Most importantly, this new guideline reflects that ACOG is hearing the voices of patients who have been advocating for better recognition and more responsive care,” she says. 

Next Steps & Resources

• Meet our expert: Jocelyn A. Carlo, M.D.
• Make an appointment online, or call 800-822-8905. 
• Learn more about our gynecology services.