Endometriosis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Endometriosis is a cause of dysmenorrhea and dyspareunia, it must be differentiated from other conditions presenting with similar features such as adenomyosis, pelvic inflammatory disease, pelvic congestion syndrome and sub mucosal uterine fibroids.
Differential Diagnosis
Endometriosis is a cause of abnormal uterine bleeding and can result in infertility. There are several diseases which can result in excessive uterine bleeding and the following table is a description of various causes of excessive uterine bleeding.
| Clinical Features | Physical Examination | Diagnostic Findings | |
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| Endometriosis |
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| Adenomyosis[1] |
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| Submucous uterine leiomyomas[2] |
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| Pelvic Inflammatory disease[3] |
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| Pelvic congestion Syndrome[4] |
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Endometriosis should also be differentiated from conditions that present with lower abdominal pain in young women. The following is a list of diseases that present with acute onset severe lower abdominal pain:
| Disease | Findings |
|---|---|
| Ectopic pregnancy | History of missed menses, positive pregnancy test, ultrasound reveals an empty uterus and may show a mass in the fallopian tubes.[5] |
| Appendicitis | Pain localized to the right iliac fossa, vomiting, abdominal ultrasound sensitivity for diagnosis of acute appendicitis is 75% to 90%.[6] |
| Rupturedovarian cyst | Usually spontaneous, can follow history of trauma; mild chronic lower abdominal discomfort may suddenly intensify, ultrasound is diagnostic.[7] |
| Ovarian cyst torsion | Present with acute severe unilateral lower quadrant abdominal pain, nausea and vomiting, tender adnexal mass palpated in 90%, ultrasound is diagnostic.[8] |
| Hemorrhagic ovarian cyst | Presents with localized abdominal pain, nausea and vomiting. Hypovolemic shock may be present; abdominal tenderness and guarding are physical exam findings, ultrasound is diagnostic.[8] |
| Endometriosis | Present with cyclic pain that is exacerbated by onset of menses and during the luteal phase; dyspareunia, transvaginal ultrasound is suggestive, laparoscopic exploration is diagnostic.[8] |
| Diverticulitis | Present with bowel symptoms in older women |
| Acute cystitis | Features with increased frequency and urgency, dysuria, and suprapubic pain.[9][10]
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References
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