To be able to determine with some certainty whether you have endometriosis, a surgical procedure (laparoscopy) may be needed. This procedure is usually done with a general anesthetic. A thin tube is inserted into the abdomen. The tube has a tiny camera at the end of it, allowing doctors to see endometrial tissue and adhesions in the abdomen and pelvis. Endometrial implants and samples of tissue can be removed during this procedure too.
Laparoscopy can be used to rule out endometriosis quite reliably: If no implants are found, it is unlikely that you have endometriosis.
If endometrial implants are discovered in the ovaries or nodules are found in the lesser pelvis during laparoscopy, a tissue sample is usually taken and examined under the microscope (biopsy). This can confirm that it is actually endometriosis, and not another disease or a (rare) cancerous tumor.
Like any other kind of surgery performed under anesthesia, a laparoscopy carries risks. Because of this, it should only be considered if a clear diagnosis is needed in order to decide what kind of treatment a woman should have. This is the case if she has serious pain that greatly interferes with her everyday activities and her quality of life, or if the function of nearby organs is affected.
Due to the risk of possible side effects, treatment with hormone drugs like GnRH analogues is usually only started if the diagnosis has been confirmed using laparoscopy.
In women who are finding it difficult to get pregnant, less invasive tests are normally done first. A laparoscopy is only done if the results of these tests aren't clear and endometriosis is likely.