Differential Diagnosis: Health Conditions with Similar Symptoms to Endometriosis

When you visit a provider to discuss issues you've been having, you will give them your personal medical and symptom history. As you're giving this history to your provider, they will begin to speculate on what might be going on. In some cases, the issue at hand may be quite obvious, such as if a child whose siblings have been diagnosed recently with the chicken pox comes in with the definitive chicken pox rash themselves. In this situation, there are probably few, if any, other conditions that their doctor may consider. In other cases, some symptoms may be indicative of a variety of underlying conditions, such as shortness of breath being a potential sign of asthma, COPD, pneumonia, airway obstruction, and more. Endometriosis is an example of a condition that shares some of its hallmark symptoms, including pelvic or abdominal pain, pain during sex, infertility, painful urination, and period pain, with a variety of other conditions.

What is a differential diagnosis?

When an individual describes having symptoms that could be related to several different conditions, a differential diagnosis is used. When your provider is performing a differential diagnosis, they are forming a list of all of the potential conditions that your symptoms may be related to, and then weighing the possibility of each condition against one another. The differential diagnostic process may take some time, and may be constantly evolving as an individual is describing their medical and symptom history.

As a simplified example, a female may present with pelvic pain to her doctor. Pelvic pain is a sign of many conditions, including endometriosis, pelvic inflammatory disease (PID-often caused by sexually transmitted infections), and ectopic pregnancy (where a fertilized egg is growing outside of the uterus). If this woman is not pregnant, her provider will determine that she is not experiencing an ectopic pregnancy. If she has never been sexually active, her provider will most likely eliminate PID. This process will continue throughout the diagnostic process until a single diagnosis has been found.

Tests to diagnose endometriosis

The differential diagnostic process may lead your doctor to ordering specific diagnostic tests based on the list of possible diagnoses. If your doctor is concerned that you may have a life-threatening condition, they may pursue diagnostic tests for that issue first. If the conditions they suspect are relatively similar in their severity, they will generally pursue the least-invasive tests first. Since the only way to officially diagnose endometriosis is through a laparoscopy, a minimally invasive procedure, your doctor may pursue other options first, that aren't procedural in nature (such as imaging exams or blood tests). Since so many conditions have similar symptoms to endometriosis, and all of these possibilities need to be investigated, accurate diagnosis may take a significant amount of time. It's also possible that an individual may have more than one of these similar conditions at once, potentially prolonging the diagnostic process further.^1-3

Other conditions with similar symptoms to endometriosis

Some common conditions your doctor may need to rule out during the differential diagnostic process and some of their shared symptoms with endometriosis include, but are not limited to:

• Pelvic inflammatory disease (PID): An infection within the female reproductive system that is often caused by bacteria from a sexually transmitted infection such as chlamydia. PID and endometriosis share similar symptoms of pelvic pain, period pain, pain during sex, and painful urination.
• Inflammatory bowel disease: Long-term inflammation within the digestive tract that is often accompanied by abdominal pain or cramping, and difficult or painful bowel movements.
• Ovarian cysts: Solid masses in the ovaries that are usually filled with fluid. Although one type of ovarian cyst, endometriomas, are a sign of endometriosis, there are other ovarian cyst types that can occur as a result of different causes. Common symptoms shared by both ovarian cysts and endometriosis are period pain, pain during sex, frequent urination, and abdominal bloating.
• Fibromyalgia: Chronic, widespread pain throughout the body, with a cause that is not well understood. Fibromyalgia can lead to pain in many areas of the body, including the abdomen, pelvis, back, and legs, similar to endometriosis.
• Interstitial cystitis: A condition that affects the bladder and is thought to be caused by irritation within the lining of the bladder. Like endometriosis, women with interstitial cystitis may also experience pain when urinating, chronic pelvic pain, or pain during sex.
• Adenomyosis: Occurs when endometrial tissue grows into the wall of the uterus. Adenomyosis and endometriosis share many symptoms, including abnormal menstrual bleeding, painful periods (dysmenorrhea), pain during sex, and chronic pelvic pain.
• Uterine fibroids: Benign (non-cancerous) growths within the uterus that can cause abnormal menstrual bleeding and menstrual cycles, pelvic pain, back pain, leg pain, and bladder and bowel difficulties.
• Polycystic ovary syndrome (PCOS): A hormonal disorder that affects the ovaries and can lead to ovarian cysts, abnormal menstrual cycles, or infertility.
• Urinary tract infection (UTI): An infection within the urinary tract that can lead to painful urination and pelvic pain.^1-6

As mentioned, this is not a complete list of all potential conditions that share symptoms with endometriosis, nor all of the specific symptoms shared. If you are concerned about your risk of developing any of these conditions, or if you are concerned you have one of these conditions, consider talking with your provider. They may be able to walk you through the differential diagnostic process that they used in your specific case.