As a Minimally Invasive Gynecological Surgeon with years of experience treating endometriosis cases on a daily basis, I sometimes feel that some cases of endometriosis surgery can be postponed, particularly in adolescents and in women who have already undergone surgery a few times.

It is great that nowadays there are more endometriosis awareness programs and public knowledge about endometriosis than ever before. On the bright side, this somewhat shortened the typical delay of 7 to 10 years in diagnosis of this condition, but on the downside side, many women with pelvic pain being scheduled for diagnostic laparoscopy before trying with proper medical line of treatment. There are several posts on social media from a variety of professional and public groups, most of which advocate laparoscopy as the gold standard for diagnosing endometriosis. I do agree with this, but not always.

Most endometriosis cases can be detected using ultrasound or MRI because to increased awareness among gynecologists and radiologists educated in endometriosis. But ultrasonography or MRI are unable to determine early peritoneal endometriosis or deposits.

In my perspective, a young woman with dysmenorrhea or pelvic pain who lacks any endometriosis-related imaging shouldn’t be directly advised for a laparoscopy. In these situations, medical therapy should be attempted first, and surgery should be deferred and only be considered if medical management fails. I should emphasize that not all radiologists and gynecologists are experts at using ultrasonography to diagnose endometriosis unless they have had particular training or have a keen interest in doing so. Therefore, if the scan is not performed by specialists in that subject, there is a good potential that the diagnosis of endometriosis might even be missed.