Endometriosis is one of the most common — and most under-diagnosed — gynaecological conditions in the UK, affecting an estimated 1 in 10 women of reproductive age. Despite its prevalence, the average time from first symptoms to diagnosis is around 7–8 years. This guide explains how a private endometriosis diagnosis works, what to expect from a consultant gynaecologist appointment, and how AristoGp in Central London approaches assessment.
Why Endometriosis Takes So Long to Diagnose
Endometriosis occurs when tissue similar to the uterine lining (endometrium) grows outside the uterus — on the ovaries, fallopian tubes, pelvic peritoneum, or, less commonly, the bowel or bladder. Because symptoms overlap with so many other conditions (irritable bowel syndrome, urinary tract infections, ovarian cysts, painful periods that are sometimes considered “normal”), a definitive diagnosis often takes years.
Common reasons for diagnostic delay include:
- Symptoms being attributed to “normal period pain”
- Endometriosis not being visible on ultrasound in early or superficial cases
- Long NHS waiting lists for specialist gynaecology referral
- The need for diagnostic laparoscopy (a small surgical procedure) for definitive diagnosis
- Variable symptom severity that doesn’t always match the extent of disease
A private gynaecology assessment can shorten this pathway considerably — particularly the initial diagnostic workup and pelvic ultrasound, which can often be completed in a single visit.
Symptoms That Should Prompt Assessment
The most common symptoms of endometriosis include:
- Painful periods (dysmenorrhoea) — pain that disrupts work, school, or daily activities, or that is not relieved by standard painkillers
- Chronic pelvic pain outside of periods
- Pain during or after sex (deep dyspareunia)
- Heavy or irregular menstrual bleeding
- Pain with bowel movements or urination, particularly during periods
- Difficulty conceiving (subfertility)
- Chronic fatigue often associated with the above
If you have several of these symptoms, particularly if they have lasted more than six months, a consultant gynaecology assessment is appropriate.
The Private Diagnostic Pathway at AristoGp
An initial endometriosis assessment with Dr Anastasia Mermigka follows a structured approach:
1. Detailed History (15–20 minutes)
Dr Mermigka takes a thorough history covering your menstrual cycle, pain pattern (timing, location, severity), bowel and bladder symptoms, sexual symptoms, fertility history (if relevant), previous treatments and their effects, and any family history of endometriosis or related conditions. This typically takes longer than NHS consultations allow, and is the most important diagnostic step.
2. Examination
A focused gynaecological examination is performed where appropriate, with full explanation of each step beforehand. This may include abdominal palpation and a gentle pelvic examination, looking for signs of pelvic tenderness, nodules, or fixed pelvic structures that can indicate endometriosis.
3. Pelvic Ultrasound
Where clinically appropriate, a same-day pelvic ultrasound is performed. Transvaginal ultrasound is the most useful first-line imaging for endometriosis. It can identify:
- Endometriomas (chocolate cysts on the ovaries)
- Adenomyosis (endometriosis within the muscular wall of the uterus)
- Fixed or tethered pelvic anatomy suggesting deep infiltrating disease
- Other pelvic conditions that mimic endometriosis (fibroids, ovarian cysts)
Importantly, a normal ultrasound does NOT rule out endometriosis — superficial peritoneal disease often cannot be seen on imaging. However, ultrasound is essential for ruling out other conditions and identifying patients who would benefit from further investigation.
4. Diagnosis and Management Plan
Based on the history, examination, and ultrasound findings, Dr Mermigka discusses the most likely diagnosis and outlines management options. For many patients, a clinical diagnosis (suspected endometriosis based on symptoms and imaging) is enough to start treatment. For others, definitive diagnosis requires laparoscopy.
When Laparoscopy Is Needed
Diagnostic laparoscopy — a keyhole surgical procedure to look directly at the pelvic organs — remains the gold-standard test for confirming endometriosis. However, it is not always necessary. Indications for laparoscopy include:
- Severe symptoms not responding to medical treatment
- Suspected deep infiltrating endometriosis
- Endometriomas requiring surgical excision
- Subfertility where endometriosis is suspected as a contributing factor
- Need for a definitive diagnosis to plan further care
AristoGp does not perform laparoscopy on-site. If laparoscopy is indicated, Dr Mermigka discusses the options with you and arranges a referral to a recognised endometriosis specialist or accredited NHS endometriosis centre.
Treatment Options After Diagnosis
Endometriosis treatment is tailored to your symptoms, plans for fertility, and disease extent. Options discussed at your consultation may include:
- Pain management — anti-inflammatory medications, lifestyle adjustments, pelvic physiotherapy
- Hormonal treatments — combined oral contraceptive, progestogen-only pill, the Mirena coil, or GnRH analogues for more severe cases
- Surgical options — laparoscopic excision of endometriotic deposits, ovarian cystectomy for endometriomas (via referral)
- Fertility-focused approaches — for women trying to conceive, including referral to fertility specialists when appropriate
Dr Mermigka takes time to discuss the trade-offs of each option, including any side-effects, so you can make an informed choice. There is no expectation that you will agree to any treatment at the first appointment.
Pricing for Endometriosis Assessment
Typical fees at AristoGp:
- Initial gynaecology consultation (45 min): £180
- Consultation + same-day pelvic ultrasound: £270
- Follow-up consultation: £100
For full pricing across all services, see the pricing guide. For our dedicated endometriosis information, visit our endometriosis service page.
Why Choose AristoGp for Endometriosis Assessment
- Consultant-led from start — every consultation is with Dr Mermigka, GMC-registered consultant gynaecologist
- 45-minute appointments — time to discuss complex symptoms properly
- Same-day pelvic ultrasound — diagnosis and imaging in one visit
- Calm, considerate approach — particularly important for patients whose symptoms have been dismissed elsewhere
- Multilingual — consultations available in English, Greek, and Italian
- Same-week availability — most patients seen within 7 days of booking
Frequently Asked Questions
Can endometriosis be diagnosed without surgery?
A clinical diagnosis (suspected endometriosis based on symptoms, examination, and ultrasound) can guide treatment without surgery. Definitive diagnosis still requires laparoscopy, but many women with mild to moderate symptoms can be treated effectively based on clinical assessment alone.
Will an ultrasound show endometriosis?
Ultrasound can show endometriomas (chocolate cysts), adenomyosis, and signs of deep infiltrating disease. However, superficial peritoneal endometriosis is often invisible on ultrasound. A normal scan does not rule out endometriosis if symptoms are suggestive.
Do I need a GP referral?
No. You can book directly with AristoGp without a GP referral. Online booking is available 24/7 with same-week appointments.
How long does an endometriosis consultation take?
The initial consultation is 45 minutes. If a same-day pelvic ultrasound is included, allow 60–75 minutes for the full appointment.
Can endometriosis affect fertility?
Yes — endometriosis is associated with subfertility in some women. The relationship is complex and depends on the location and severity of disease. If fertility is a concern, this can be discussed at your consultation and onward referral arranged where appropriate.
Book an Endometriosis Assessment
Book a 45-minute consultation with Dr Mermigka, with same-day pelvic ultrasound where appropriate.
