Ways to diagnose endometriosis


        WAYS TO DIAGNOSE ENDOMETRIOSIS

For a number of years researchers have sought ways to diagnose and monitor endometriosis that would avoid the need for a laparoscopy. Various methods have been tried, including examining the blood and endometrium for the presence of antibodies and testing for a substance known as the CA-125 antigen. Other methods are still being investigated. So far, most of the tests tried have been unsuccessful because they have not produced consistent and accurate results, especially in the early stages of the disease. Work is continuing and it is likely that a reliable test will be developed in the future. In particular, work on the CA-125 antigen looks promising but it is likely to be several years - at the earliest - before this or any other tests are fully developed and available for general use.

CA-125
CA-125 is a substance known as cancer antigen 125 which is produced by the endometrium and is found in the blood. It was discovered while researchers were trying to find a test for ovarian cancer.
Researchers found although it was present in extremely high levels in some women with ovarian cancer, raised levels were also found in some women with a range of gynecological conditions, including endometriosis, adenomyosis, pelvic inflammatory disease, unexplained infertility and during pregnancy and menstruation. In an attempt to find a reliable blood test for endometriosis researchers have been investigating the levels of CA-125 in women with endometriosis. They have found that the levels in women with minimal and mild endometriosis are no different to those found in women in general but the levels in women with moderate and severe endometriosis are generally significantly higher.
Unfortunately, the CA-125 test is not yet sufficiently accurate to replace laparoscopy as a general test for the diagnosis of endometriosis because the levels are not raised in all women with endometriosis and because the levels are raised in a range of conditions other than endometriosis.
It may soon be useful as an aid for the diagnosis of endometriosis and could be used to help decide who needs a laparoscopy. For example, if the gynecologist only vaguely suspects that a woman has endometriosis he may decide to perform a laparoscopy if the CA-125 levels are raised, but not if the levels are normal.
For now, the most useful role of the CA-125 test appears to be in monitoring the progress of the disease after a definite diagnosis has been made. The levels of CA-125 appear to rise as the disease worsens and fall as the disease improves. Therefore, it may be possible to use repeated CA-125 tests to help determine the real effectiveness of drug treatment or to determine whether or not the underlying disease has worsened, improved or recurred, thereby avoiding the need for repeat laparoscopics.
The CA-125 test offers the most promise as a diagnostic test for endometriosis but further work is necessary before it will be accurate and reliable enough to be used by gynecologists for the diagnosis and monitoring of endometriosis.

Kylie's story
I started menstruating at the age of 13. For the first 12 months everything was fine, but I then started to develop acute pain in my right side. I went to my GP who referred me to a surgeon and I was then rushed to hospital to have my appendix removed. Strangely, my appendix was quite normal. I felt well for three months, but then the pain started up again. After having an ultrasound, I was admitted to hospital with a suspected ovarian cyst. A laparoscopy was performed, but everything appeared normal. I was sent home, having been told that it was quite normal to suffer some discomfort when having a period.
For the next year I tried to put up with the pain because I was sure the doctors would tell me it was 'all in my head'. After another bout of severe pain my GP referred me to another specialist who ordered a barium enema. He said that I had an irritable bowel and to eat more fibre. Unfortunately, this made no difference to the pain. My GP then thought that perhaps I was suffering from pelvic inflammatory disease - a course of antibiotics made no difference. My mother wasn't happy with the doctor's explanations and so took me to another GP who immediately suspected I may have endometriosis even though I was only 17 years old. He sent me to a gynecologist who immediately performed a laparoscopy and diagnosed endometriosis.
During the laparoscopy the gynecologist 'burnt off' all the endometrial deposits that he could find. He explained to me that because there could still be microscopic endometrial deposits in the pelvis, I was to take Provera 30 milligrams a day for nine months. I am now pain free and have just finished the course of tablets. I am looking forward to starting university next year and enjoying life.

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