How Is Endometriosis Diagnosed?
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Understanding how endometriosis is diagnosed is an important step to help you feel more confident and clear when you’re at the start of your journey.
If you’ve ever found yourself curled up in bed with period pain that feels unbearable—or dismissed by doctors who say it’s “just part of being a woman”—you’re not alone.
For so many women endometriosis is a silent condition that hides in plain sight. One of the most common questions I hear as a women’s health coach is: “How is endometriosis diagnosed?”
The truth is, getting an endometriosis diagnosis can be a long and frustrating journey. But understanding how diagnosis works is a huge step forward.
In this post, I’ll explain how endometriosis is diagnosed, what signs and symptoms to look out for, what tests are used, and how to prepare for your doctor’s visit—so you can feel confident, informed, and supported every step of the way.
What is Endometriosis?
Endometriosis is a chronic, often painful condition where tissue similar to the lining of the uterus (called the endometrium) starts to grow outside the uterus—on the ovaries, fallopian tubes, bladder, bowel, and other pelvic organs.
I should also mention here that endometriosis has also been found in many other areas in the body outside of the pelvic area. But this is where it’s most commonly found.
These endometrial-like cells respond to the menstrual cycle by thickening and bleeding each month. But with nowhere to go, they can cause inflammation, pain, scarring, and adhesions.
Common Symptoms of Endometriosis
Before I explain how endometriosis is diagnosed, it’s helpful to recognize and understand the most common endometriosis symptoms:
• Severe period pain (dysmenorrhea)
• Chronic pelvic pain (not just during your period)
• Pain during sex (dyspareunia)
• Painful bowel movements or urination, especially during your period
• Heavy or irregular bleeding
• Fatigue and low energy
• Difficulty getting pregnant (infertility)
• Bloating (often called “endo belly”)
If any of these sound familiar, you might be wondering if endometriosis could be the reason—and how to get answers.
Why Is Endometriosis So Hard to Diagnose?
Here’s the frustrating part: endometriosis is notoriously difficult to diagnose. In fact, the average time from someone first experiencing symptoms to them getting a diagnosis is currently 7 to 10 years. That’s a full decade of pain, confusion, and being told your symptoms are “normal.”
So why the delay? There are a few reasons:
• Symptoms can be very similar to other conditions, such as IBS, ovarian cysts, or pelvic inflammatory disease.
• Pain is often normalized in women, especially around periods.
• A definitive diagnosis usually requires surgical investigation, which many doctors hesitate to recommend early on.
• Awareness among healthcare providers can still be limited.
This is exactly why knowing what to ask and what to expect is so important.
How Is Endometriosis Diagnosed?
There are several stages in the diagnostic process. Let’s walk through each one step by step, so you know what to expect and how to advocate for yourself:
1. Tracking Your Symptoms
The first step in getting a diagnosis is to track your symptoms. I always recommend keeping a menstrual health journal or using a period tracking app to record:
1. Dates and length of your period
2. Pain levels and location (rate them 1-10)
3. Any pain during sex, bowel movements, or urination
4. Bloating, fatigue, or nausea
5. Mood changes or fatigue
6. How your symptoms impact your daily life
This log is absolute gold when it comes to your doctor’s appointment—it helps paint a clear picture of what’s happening in your body.
2. Seeing a Doctor Who Will Listen
Not all doctors are trained in recognizing endometriosis symptoms right away. So it’s crucial to find someone who specializes in women’s health, gynecology, or ideally, endometriosis.
At your appointment, share your symptom journal and be as honest and specific as possible. Use phrases like:
1. “I experience pelvic pain every day, not just during my period.”
2. “The pain is so severe it affects my ability to work or function.”
3. “I suspect endometriosis based on my symptoms—can we explore that possibility?”
Being assertive isn’t always easy (especially if you’ve felt dismissed before), but your voice really matters and will help to push your case forward.
3. Pelvic Exam
Your doctor might start with a pelvic exam to feel for cysts, tender areas, or abnormal masses. While this can be uncomfortable, it’s often a necessary first step.
However, it’s important to know that many cases of endometriosis won’t show up on a pelvic exam. If nothing is found, that doesn’t mean you’re imagining your symptoms. Trust your body.
4. Ultrasound Scans
The next step is usually a transvaginal ultrasound or abdominal ultrasound. This can help detect endometriomas (a type of ovarian cyst linked to endometriosis) or other abnormalities like fibroids.
But here’s a key fact: Ultrasounds cannot rule out endometriosis.
Endometrial implants that are small or located in tricky spots like the bladder, bowel, or behind the uterus often won’t show up on an ultrasound scan. This is why some people will have normal scan results but still have endometriosis.
5. MRI (Magnetic Resonance Imaging)
In some cases, a pelvic MRI may be used to look for deep infiltrating endometriosis (DIE), which affects organs like the bladder, bowel, or ligaments. This test gives a more detailed look at the pelvic area.
However, like ultrasounds, MRIs aren’t definitive. They can help guide surgery, but they can’t confirm or exclude endometriosis entirely.
6. Laparoscopy: The Gold Standard for Diagnosis
The only definitive way to diagnose endometriosis is through a laparoscopy—a minimally invasive surgery where a camera is inserted into the pelvic area to look for endometriosis lesions.
If endo lesions are found, they can often be removed or biopsied during the same procedure. This is known as laparoscopic excision surgery.
Laparoscopy is usually done under general anesthetic and it involves small incisions in the abdomen. Recovery times vary, but most people feel they can return back to normal activities within 1-2 weeks.
What Happens After Diagnosis?
Getting an endometriosis diagnosis can bring a mix of emotions: relief, anger, grief, and validation. Many people feel a sense of “finally being seen.” This is now where the journey to healing and management begins.
How a Naturopathic Approach Can Help You
As someone who lived with stage 4 endometriosis for years before receiving proper care, I know firsthand how lonely and exhausting this journey can feel.
That’s why I created my women’s health coaching practice—to help women like you feel heard, empowered, and equipped to heal on a deeper level.
I offer support with:
1. Natural symptom relief through nutrition, herbs and lifestyle changes
2. Cycle syncing to reduce pain and balance hormones
3. Nervous system regulation to support emotional wellbeing and reduce flare ups
4. Mindset coaching to shift out of survival mode
5. Self-care rituals that prioritize your rest and body wisdom
Whether you are newly diagnosed or still searching for answers, you deserve to feel supported.
Final Thoughts: Trust Yourself
I really hope this post has helped you to get a better understanding of how endometriosis is diagnosed.
If you’re dealing with persistent period pain, pelvic discomfort, or other signs of endometriosis, please know this: your pain is real, and your voice matters.
You don’t need to wait years for validation. You deserve to work with practitioners who take your symptoms seriously and explore all paths to healing—whether you choose a medical approach, natural, or a combination of both.
If you’re ready for deeper support, I’d love to help you. I offer 1:1 coaching for women navigating endometriosis, painful periods, and hormonal health challenges, with a blend of nutrition, lifestyle tools, and guidance from someone who has truly walked in your shoes and come out the other side.
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