Endometriosis:

Diagnosis is the science and practice of defining a disease by recognizing its symptoms and manifestations. In this regard, the diagnosis entails differentiating the characteristics of one disease from another disease that may give rise to similar symptoms and signs. Clinicians are in continuous search for ‘definite signs or symptoms’ that make a certain illness distinguishable and hence recognizable. It should also be recognized that diseases and disorders can be classified as entities or as processes. Endometriosis may be better regarded as a process as it is a chronic continuous process that does progressive scarring. Its origins have been extensively explored as described in this book in Chapter 13. This chapter covers the subject of symptomatology of endometriosis with a short overview of the epidemiology to aid in that regard. Getting diagnosed with endometriosis takes some time due to the overlap of symptoms with similar conditions, the slow chronic nature of the disease and the need for invasive procedures to confirm the diagnosis. Diagnosis is an exercise of information-gathering through history and examination with its adjuncts. Then it will be followed by information processing and thinking of possibilities and formulating differential diagnoses. The next step is decision-making and documenting a plan. It is a dynamic process that can be repeated or followed by investigations to further reduce uncertainty and commit to the diagnosis of endometriosis. Good understanding of the values of the combination of findings in history and examinations together with the roles of investigations will enhance the diagnostic accuracy in endometriosis. The ethos of this chapter is to reinforce good practice of having meticulous clinical acumen together with empathy and understanding of the impact of the disease. This will help reduce the delay in diagnosis and shift the paradigm towards an accurate clinical assessment rather than automatic recourse to surgery.