Review symptoms: cyclic pelvic pain, pain with menstruation, pain with sex, pain with bowel movements or urination during periods, heavy or irregular bleeding, chronic pelvic pain, infertility, fatigue
Track symptoms in a calendar: onset, timing with menstrual cycle, triggers, severity, response to medications
Complete a pelvic exam: assess for uterine tenderness, fixed retroverted uterus, nodularity, pelvic masses, tenderness at the cul-de-sac
Screen for related conditions: rule out pregnancy, urinary tract issues, irritable bowel syndrome, pelvic inflammatory disease, fibroids, ovarian cysts, musculoskeletal pain
Perform pelvic ultrasound (transvaginal if appropriate): evaluate ovarian endometriomas and other causes of pain or masses
Consider MRI pelvis: assess deep infiltrating endometriosis or map disease when ultrasound is limited
Consider referral to a gynecologist experienced in endometriosis
Consider blood tests only as supportive: CA-125 may be elevated in some cases but is not diagnostic
Use empiric treatment trials when appropriate: hormonal therapy to see if symptoms improve (not definitive diagnosis)
Consider laparoscopy with biopsy: confirm diagnosis and stage disease
Use pathology confirmation: histology of endometrial-like tissue outside the uterus
Consider additional evaluation for specific sites: evaluation of bowel/bladder involvement if symptoms suggest involvement
Assess fertility concerns early: infertility evaluation alongside endometriosis workup
Confirm diagnosis with imaging and/or surgical findings based on symptom pattern and exam results