Diagnosestellung der Endometriose

Sebastian Daniel Schäfer
In: Die Gynäkologie · 2026 · vol. 59(8) , pp. 516–522 · doi:10.1007/s00129-026-05526-3 · W7170032549
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Endometriosis diagnosis requires medical history, gynecological exam, and ultrasound, with MRI and surgery for select cases, and quantitative pain assessment using scales and questionnaires.

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This paper outlines the diagnostic framework for endometriosis, emphasizing that a thorough medical history and clinical gynecological examination are foundational. It highlights transvaginal ultrasonography as the primary imaging modality, while reserving MRI and diagnostic surgery for complex or selected cases. The authors stress the necessity of quantitatively assessing pain and associated symptoms like dyspareunia and dyschezia using validated scales to monitor treatment efficacy. This paper is centrally about endometriosis — specifically focusing on the clinical guidelines and diagnostic algorithms for establishing the diagnosis.

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Zusammenfassung Die Diagnosestellung bei Endometriose erfordert Kenntnisse im Bereich der Anamnese, der klinisch-gynäkologischen Untersuchung und der transvaginalen, ggf. auch transabdominellen Sonographie. Ergänzende diagnostische Methoden wie das MRT (Magnetresonanztomographie) und die diagnostische Operation sind ausgewählten Situationen vorbehalten. Schmerzen und Symptomatiken, wie Dyspareunie, Dyschezie, Dysurie, zyklisch auftretende Schulterbeschwerden oder Dyspnoe, sollten nicht nur qualitativ, sondern auch quantitativ erfasst werden, ebenso Angaben zu vegetativen Begleiterscheinungen und zu Sexualfunktion. Eine dezidierte Schmerzanamnese ist essenziell, für eine strukturierte quantitative Erfassung und Monitoring. Im Behandlungsverlauf lassen sich verschiedene Fragebögen einsetzen wie auch numerische oder visuelle Analogskalen. Andere diagnostische Maßnahmen, beispielsweise Zystoskopie, Koloskopie, transrektale Endosonographie und Nierenszintigraphie, erfordern eine gesonderte, ggf. unabhängig von der Endometriose zu stellende Indikation. Abstract In addition to knowledge of medical history and thorough clinical and gynecological examination, diagnosis of endometriosis requires transvaginal and, in some cases, transabdominal ultrasonography. Complementary diagnostic methods like MRI and diagnostic laparoscopy are reserved for selected situations. Pain and symptoms such as dyspareunia, dyschezia, dysuria, cyclically recurring shoulder pain, or dyspnea should be qualitatively and quantitatively assessed, as should details regarding autonomic symptoms and sexual function. A dedicated pain history is essential; for structed evaluation and monitoring during the treatment course, various questionnaires as well as numeric and visual analog scales are available. Other diagnostic procedures, for example cystoscopy, coloscopy, transrectal ultrasound, and renal scintigraphy, require another indication, potentially unrelated to endometriosis. Similar content being viewed by others Datenverfügbarkeit Alle dieser Arbeit zugrunde liegenden Daten sind in diesem Artikel enthalten. Literatur (2025) Diagnosis and therapy of endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k-Level, AWMF Registry No. 045/015, March 2025). http://www.awmf.org/leitlinien/detail/ll/015-045.html Hirsch M, Duffy JMN, Kusznir JO, Davis CJ, Plana MN, Khan KS (2016) Variation in outcome reporting in endometriosis trials: a systematic review. American journal of obstetrics and gynecology 214:452–464 Barbara G, Facchin F, Buggio L, Somigliana E, Berlanda N, Kustermann A, Vercellini P (2017) What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature. Reproductive sciences (Thousand Oaks, Calif) 24:1566–1576 Keckstein J, Hoopmann M, Merz E, Grab D, Weichert J, Helmy-Bader S, Wölfler M, Bajka M, Mechsner S, Schäfer S, Krentel H, Hudelist G (2023) Expert Opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Acta Obstet Gynecol Scand 307:5–19 Keckstein J et al (2021) The #Enzian classification: A comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand 100:1165–1175 Guerriero S et al (2016) Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements; a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 48(3):318–332 Guerriero S et al (2023) Addendum to consensus opinion from International Deep Endometriosis Analysis (IDEA) group: sonographic evaluation of the parametrium. Ultrasound Obstet Gynecol 64(2):275–280. https://doi.org/10.1002/uog.27558 Harmsen MJ et al., Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol 2022 Palla VV, Karaolanis G, Katafigiotis I, Anastasiou I (2017) Ureteral endometriosis: A systematic literature review. Indian journal of urology : IJU : journal of the Urological Society of India 33:276–282 Pedrassani M et al (2023) Superficial Endometriose at ultrasound examination – a diagnostic criteria proposal. Diagnostics 13(11):1876. https://doi.org/10.3390/diagnostics13111876 Scioscia M et al (2020) Differential diagnosis of endometriosis by ultrasound: a rising challenge. Diagnostics 10(10):848. https://doi.org/10.3390/diagnostics10100848 Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, Alcazar JL (2016) Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 47:281–289 Medeiros LR, Rosa MI, Silva BR, Reis ME, Simon CS, Dondossola ER, da Cunha Filho JS (2015) Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Archives of gynecology and obstetrics 291:611–621 Li Y, Chen Q (2019) Circulating non-coding RNAs as non-invasive diagnostic markers of endometriosis: a comprehensive meta-analysis. Archives of gynecology and obstetrics 300:1099–1112 Ronsini C, Fumiento P, Iavarone I, Greco PF, Cobellis L, De Franciscis P. Liquid Biopsy in Endometriosis: A Systematic Review. International journal of molecular sciences 2023; 24 Bendifallah S, Suisse S, Puchar A, Delbos L, Poilblanc M, Descamps P, Golfier F, Jornea L, Bouteiller D, Touboul C, Dabi Y, Darai E. Salivary MicroRNA Signature for Diagnosis of Endometriosis. Journal of clinical medicine 2022; 11 Förderung Für diese Arbeit wurde keine Förderung erhalten. Author information Authors and Affiliations Corresponding author Ethics declarations Interessenkonflikt S.D. Schäfer gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Additional information Redaktion Stefanie Burghaus, Erlangen Tanja Fehm, Düsseldorf Sebastian D. Schäfer, Münster Uwe A. Ulrich, Berlin Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Schäfer, S.D. Diagnosestellung der Endometriose. Gynäkologie (2026). https://doi.org/10.1007/s00129-026-05526-3 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s00129-026-05526-3

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