"When a person is being evaluated for endometriosis, we base the diagnosis on their person's history. Primarily gives us a suspicion that they may have endometriosis. When you come in stating that you have real bad pain with your menstrual cycle, then it's my job to try to figure out, do you have endometriosis or is it just dysmenorrhea essentially? And or what are the causes of that? Dysmenorrhea is just cramping. Dysmenorrhea is pain with sex, but there are various things that can cause that, but endometriosis is in that line of possibilities. And so the first thing is that we want to get a good history, and then we want to examine you your bimanual exam, which is an exam where the physician places their fingers inside of the vagina and palpate the uterine structures, as well as the adnexa, which are your ovaries. Essentially then we see how you respond to that. And sometimes that can lead us to a possible diagnosis or question that you may have endometriosis. Very commonly what we will do is try you on an anti-inflammatory or birth control to see if that resolves your pain. If that resolves your pain, that may be all that needs to be done. If not, and or in the initial evaluation and ultrasound may also be prudent. If an ultrasound is performed, it may show evidence of an endometrioma or it looks like there may be some adhesions, which is scarring, which very commonly can occur because the implants are not supposed to be there and they can attach different organ systems to different areas. Like your ovaries could be attached to the back of your uterus, which could cause you having pain with intercourse, or your ovaries could be attached somewhere else, or you could have various areas of scarring. And so sometimes that can be identified on ultrasound, but not always. So we always first try conservative management first, if those things don't do not help, and you still are having persistent pain and discomfort, then the only 100% certain diagnostic evaluation for endometriosis is a laparoscopy. And to confirm that you have to have a laparoscopy with biopsy, meaning that if the surgeon identifies what we consider endometriosis implants, that a segment of that tissue is removed and sent to pathology for confirmation that this is endometriosis. Occasionally you can have things that look like endometriosis and they really are not. So we will send that to pathology to confirm that it is an actual diagnosis."