How Do I Know If I Have Endometriosis?
Quick Answer
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. It affects an estimated 10% of reproductive-age women but is frequently underdiagnosed, with an average delay of 4 to 11 years between symptom onset and diagnosis. Many women have no symptoms at all and only discover it when they have difficulty conceiving.
Markham Fertility Centre now offers routine endometriosis screening for all new infertility patients as part of their initial assessment, at no additional cost.
Common Signs and Symptoms
Endometriosis symptoms vary widely. Some women experience severe pain, while others have no symptoms at all. There is no direct correlation between symptom severity and the extent of the disease.
Symptoms to watch for:
- Very painful menstrual cramps that go beyond normal period discomfort
- Chronic pelvic pain before, during, or between periods
- Pain during intercourse (dyspareunia)
- Pain during bowel movements or urination, especially during your period
- Heavy menstrual bleeding or spotting between periods
- Lower back pain that worsens around your period
- Bloating, nausea, or digestive issues (diarrhea, constipation) that follow a cyclical pattern
- Difficulty getting pregnant after 6 to 12 months of trying
Important: You can have endometriosis with no symptoms. Many women are diagnosed only after seeking help for infertility.
How Endometriosis Affects Fertility
Not all endometriosis impacts fertility, but when it does, the mechanisms can include:
- Inflammation within the pelvic environment that interferes with fertilization and implantation
- Scar tissue or adhesions that distort the anatomy of the fallopian tubes and ovaries
- Endometriomas (ovarian cysts caused by endometriosis) that can damage ovarian tissue and reduce egg quality
- Changes to the uterine lining that may affect embryo implantation
The relevance of endometriosis to your fertility is highly individualized. Some patients with mild endometriosis conceive naturally, while others with minimal visible disease struggle significantly. A fertility specialist can help determine how (or if) it influences your treatment plan.
How Endometriosis Is Diagnosed
Historically, endometriosis has been difficult to detect without surgery. The diagnostic process typically involves several steps:
| Diagnostic method | What it does | Limitations |
| Symptom review and medical history | Identifies pain patterns, cycle changes, and family history | Cannot confirm diagnosis on its own |
| Pelvic exam | Feels for cysts, scar tissue, or tender areas behind the uterus | Smaller areas of endometriosis are difficult to detect |
| Standard transvaginal ultrasound | Assesses ovarian cysts (endometriomas) and uterine structure | Often misses deep endometriosis and subtle disease |
| Specialized endometriosis screening ultrasound | Uses a targeted scanning protocol to assess for superficial and deep endometriosis | Requires trained sonographers and specialized interpretation |
| MRI | Provides detailed images of pelvic structures | More expensive; not always first-line |
| Laparoscopy (surgery) | Direct visualization and biopsy of endometrial tissue | Invasive; requires general anesthesia; considered the gold standard for definitive diagnosis |
The challenge is that many women go through standard ultrasounds that appear normal, even when endometriosis is present. Deep endometriosis and subtle lesions are frequently missed by routine imaging.
Why Screening Matters for Fertility Patients
Recent radiology guidelines recommend that patients undergoing infertility assessment should be evaluated for endometriosis, as it is one of the most commonly underdiagnosed conditions in fertility care.
Advances in ultrasound imaging now allow certain forms of endometriosis to be identified non-invasively, without the need for surgery. This is significant because earlier detection means:
- Potential contributing factors are identified sooner
- More complete information is available at the initial consultation
- Treatment planning can be more personalized from the start
How Markham Fertility Centre Screens for Endometriosis
MFC has incorporated a specialized endometriosis screening ultrasound into its standard initial fertility assessment for all new infertility patients, at no additional cost.
How it differs from a standard ultrasound:
- A routine ultrasound focuses on ovarian reserve (AFC), uterine structure, and ovarian cysts
- The endometriosis screening uses a targeted scanning protocol to evaluate areas where endometriosis is commonly found but often missed
- It requires highly trained sonographers and interpretation by radiologists with expertise in endometriosis imaging
Who is offered the screening:
- All new patients undergoing infertility assessment at MFC whom have not been previously diagnoses with endometriosis
- Patients completing an antral follicle count (AFC) ultrasound
Who is not included:
- Egg donors, gestational carriers, or patients undergoing elective egg freezing
What happens if something is found:
- Many patients will have normal findings
- Even when findings are present, they may not be clinically significant
- Your physician will determine whether the findings are relevant to your care
- If needed, a more detailed endometriosis mapping ultrasound may be recommended for precise information about the location and extent of disease
| Screening ultrasound | Mapping ultrasound | |
| Purpose | First-line screening tool | Detailed comprehensive evaluation |
| When offered | Routinely to all eligible new patients | When clinically indicated by your physician |
| Cost | No additional cost (OHIP) | Associated costs (not OHIP-covered) |
When to See a Specialist
You should consult a fertility specialist or gynecologist if you experience:
- Painful periods that interfere with daily activities
- Chronic pelvic pain that does not improve with over-the-counter medication
- Pain during intercourse that is persistent
- Difficulty conceiving after 12 months (or 6 months if you are over 35)
- A family history of endometriosis (mother, sister, or grandmother)
- Digestive symptoms that follow a cyclical, menstrual pattern
In Ontario, initial consultations and most diagnostic testing are covered by OHIP.
Book a consultation at Markham Fertility Centre →
FAQ
Can I have endometriosis without any symptoms?
Yes. Many women with endometriosis have no pain or noticeable symptoms. The condition is often discovered only during fertility investigation. This is one of the reasons routine screening is valuable for infertility patients.
Does a normal ultrasound mean I do not have endometriosis?
Not necessarily. Standard ultrasounds are good at detecting ovarian cysts (endometriomas) but frequently miss deep endometriosis and subtle disease. A specialized endometriosis screening ultrasound evaluates areas that routine imaging does not.
Is surgery required to diagnose endometriosis?
Laparoscopy has historically been the gold standard for definitive diagnosis. However, advances in ultrasound imaging now allow non-invasive detection of many forms of endometriosis, reducing the need for surgery in some cases.
Does endometriosis always require treatment?
No. Not all endometriosis affects fertility, and not all findings require a change in treatment. Your fertility specialist will assess whether your findings are clinically significant and guide whether any adjustments to your treatment plan are needed.
Is the endometriosis screening at MFC mandatory?
No. The screening is completely optional. Patients can choose whether or not to proceed.