Medicine has advanced so much, why is surgery still the only way to diagnose this disease that, according to the WHO, affects 10% of women and girls globally.
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Part of the problem is that the nature of testing pretty much requires you to either observe what you’re looking for outright, or observing other conditions that can only come about in the presence of the thing you’re looking for. Endometrial tissue is not dense enough to be seen on an X-ray scans. Normal endometrial tissue grows many blood vessels during the menstrual cycle, but outside the uterus that typically doesn’t happen, so blood dyes used in CT scans typically don’t show it as being particukarly unusual. Some cancers can be detected by looking for signs it leaves in the blood, and diabetes can be detected by looking for signs in the urine, but endometriosis doesn’t appear to leave these kinds of signs.
An ultrasound scan can pick up many different kinds of cysts, including endometriosis, but it can’t distinguish them, so it’s not a conclusive answer either. It is, however, just about the best we currently have in terms of pre-screening before moving on to surgery.
That’s the problem. To get a diagnostic test, we need something that can detect endometriosis but not other things, or at least something that can detect it in a way that makes it look different from other things. Alternatively, we might be able to get a better pre-screening process going if we better understood the exact cause of endometriosis: that’s not exactly what you’re looking for, but it could at least help determine who is at high or low risk. But we currently don’t understand the exact causes.
Areas for possible research include trying to understand what causes endometriosis, trying to find possible biomarkers that endometriosis leaves behind, or devising some kind of scanning technology that makes endometriosis easier to distinguish. It’s not like there are no options, and we certainly shouldn’t be at the point of throwing up our hands and calling it impossible. But it *is* a legitimately hard problem.
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