Diagnosis of endometriosis is often difficult because the disease has various presentations. Physical examination of a patient may reveal a fixed retroverted uterus, enlarged ovaries, and nodules on the uterosacral ligaments. Transvaginal sonography is often utilized to access large ovarian, intestinal, or bladder endometriomas. It is less accurate for rectovaginal, vaginal, or uterosacral lesions. CA-125 is a blood test that can indicate the presence of endometriosis, although the test is not utilized often for diagnostic purposes because of its low sensitivity. Laparoscopy with biopsy provides a definitive diagnosis (see the box above entitled "Procedures for Diagnosing Endometriosis'').
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