This fact frequently surprises couples but is commonly seen by infertility specialists. There are no reliable nonsurgical diagnostic tests for endometriosis. The diagnosis of pelvic endometriosis requires surgery. Ultrasonography shows no specific pattern for pelvic endometriosis, but is often helpful in diagnosing persistent nonfunctioning ovarian cysts that may represent endometriomas. Although some specialists seem to think that they can diagnose an endometrioma with certainty using ultrasound, there are abundant scientific reports confirming the nonspecific nature of the ultrasound for this purpose.
Endometriotic lesions depend upon stimulation by estrogens.
Endometriosis discovered after menopause is almost always associated with hormone replacement medication containing estrogens. The incidence of endometriosis is not known, since the only reliable way of determining its presence is through surgery or at autopsy. Surgical incidence is biased by the selection process bringing the patient to the operating room. No large cadaver study examining autopsy specimens for endometriosis has reported data that has been widely accepted. There are three main theories for the mechanism causing endometriosis.