You may still have endometriosis, even if endometriosis tissues weren’t found during a laparoscopy. You could also have a different underlying condition that causes symptoms similar to endometriosis.

There are additional tests that are sometimes used to give a healthcare professional information about the likelihood of endometriosis.

But there aren’t any other surgeries that can be done to determine whether endometriosis tissues are present. A laparoscopic biopsy is the only way to confirm an endometriosis diagnosis.

However, because a laparoscopic biopsy is an invasive procedure, there has been a push for clinicians to recognize endometriosis by its clinical symptoms and to lean on less-invasive tests, explains Hugh Taylor, MD, OB-GYN, a Yale School of Medicine expert who specializes in endometriosis and fibroids.

“This would lead to earlier diagnosis and treatment, which could prevent the progression of the disease,” he explains.

Ahead, take a look at some of the less-invasive tests occasionally used.

Pelvic exam

During a pelvic exam, a clinician will look for obvious signs of abnormalities.

Endometrial tissue-induced cysts, scars, and adhesions can cause the pelvic organs to have irregular shapes or textures that the clinician may be able to see or feel.

Ultrasound

Ultrasound involves using sound waves to create an image of your pelvic region.

“An ultrasound can only determine if endometrioma may be present, which is endometriosis of the ovaries,” says Heather Jeffcoat, a doctor of physical therapy who specializes in sexual dysfunction, pain, and incontinence, and author of “Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve.”

In other words, ultrasound can’t rule out endometriosis entirely.

“If your doctor says ‘I did an ultrasound and you don’t have endometriosis,’ then that doctor does not understand how endometriosis is diagnosed,” she says.

Magnetic resonance imaging (MRI)

Another imaging test, MRI, uses magnets and radio waves to make a picture of your pelvis.

“An MRI determines if deep infiltrating endometriosis may be present, but does not rule out other types of endometriosis,” says Jeffcoat.

Yes, misdiagnosis is possible.

“There is no single diagnostic tool that can completely rule endometriosis in or out,” says Jeffcoat.

And that stands for a laparoscopy, too.

In order to confirm an endometriosis diagnosis during a laparoscopy, a surgeon may take a sample of endometriosis tissue for biopsy, she explains.

It’s possible that the surgeon didn’t biopsy all of the tissue growths that they saw, missing one or more that indicated endometriosis. It’s also possible that the surgeon didn’t see the growths that are present.

Ultimately, it depends on your particular set of symptoms.

If your symptoms are primarily gastrointestinal — such as abdominal pain, constipation, and nausea — you may have a condition like irritable bowel syndrome or interstitial cystitis.

But if your symptoms are marked by penetrative pain, you may have a pelvic floor condition, vulvodynia, or vaginismus.

According to Jeffcoat, most people with endometriosis have another condition, too.

Endometriosis is often associated with:

It’s possible that you have one of these other conditions *and* endometriosis, even if you’ve been previously told that you don’t have endometriosis.

How long does it take to recover from a laparoscopy?

“The recovery varies so much from patient to patient,” says Jeffcoat. “Some patients return to Pilates at week 6, and others will only be able to walk a couple of blocks by week 3 or 4.”

Of course, these are extremes.

“Most patients feel pretty good to walk around outside within 5 days and gradually increase their activity level from there,” she says.

“If you have a physical job, you should probably be out for at least 6 weeks to work on regaining your strength,” says Jeffcoat. “If you have a desk job, most patients are okay to return to work after 2 weeks.”

What does symptom management entail after a laparoscopy?

Before and after a laparoscopy, exactly how endometriosis is treated will vary based on your particular set of symptoms and concerns.

“Depending on the severity, treatment for endometriosis can range from pain medications to hormone therapy or surgery,” says Laura Purdy, MD, OB-GYN, and chief medical officer at Wisp, a telehealth platform focused on sexual and reproductive health.

“In a more severe case, a doctor might recommend ‘conservative surgery,’ which can save the uterus and ovaries while removing endometrial-like tissue,” she says.

However, this may result in the return of endometriosis tissue and related pain in the future.

“In extreme cases where a patient is not trying to get pregnant, a doctor may also recommend a hysterectomy,” says Purdy.

What symptoms are used to differentiate an endometriosis diagnosis from other conditions?

Every person with endometriosis will have a different set of symptoms. Some people may not have any noticeable symptoms at all.

That means there isn’t any one set of symptoms clinicians can use to immediately diagnose or rule out the condition.

According to Jeffcoat, the most common endometriosis symptom is abdominal and pelvic pain. However, the following can also occur:

What questions should you ask a clinician about potential next steps?

For starters, Jeffcoat recommends making sure that the clinician specializes in endometriosis.

“Unfortunately, there are too many physicians that don’t understand endometriosis who are treating people with the disease,” she says.

You can use The American End of Endo Project Provider Directory or iCare Better Expert Search to find an endometriosis healthcare professional near you.

Once you have chosen a healthcare professional, here are some questions you might ask, depending on your particular set of symptoms:

  • “What is your approach to pain relief?”
  • “What treatment plan do you recommend for me?”
  • “How will we know if this treatment is working?”
  • “What would happen if I choose not to pursue this treatment plan?”
  • “Will I need additional procedures or treatments moving forward?”

Endometriosis can be tricky to diagnose and also to treat. But with the help of the right team of healthcare professionals, symptom relief is possible.

As Jeffcoat puts it, “Never let a provider turn you away claiming that your symptoms are normal.”

Instead, seek a specialist that will take a look at your history and recommend the proper tests to determine the health condition(s) you’re navigating.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad in Bed. Follow her on Instagram @Gabriellekassel.