Table of ContentsView AllTable of ContentsReliabilityHow It LooksTypes of UltrasoundUnremarkable EndoEndometriosis Ultrasound and StagingOther Endometriosis Diagnostic TestingDetermining the “Right” Testing
Table of ContentsView All
View All
Table of Contents
Reliability
How It Looks
Types of Ultrasound
Unremarkable Endo
Endometriosis Ultrasound and Staging
Other Endometriosis Diagnostic Testing
Determining the “Right” Testing
Atransvaginal ultrasoundcan detect certain types ofendometriosisbut not superficial forms. No ultrasound candiagnose endometriosis.
Nevertheless, some surgeons who treat endometriosis may recommend ultrasounds to provide further information about the severity of suspected endometriosis or to guide surgical planning.
Endometriosis ultrasounds help providers:
In this article, learn more about the benefits and limitations of ultrasounds for endometriosis.
Ivan-balvan / Getty Images
Reliability of Endometriosis Ultrasounds: What Can They Detect?
Ultrasoundscan be a valuable tool in the endometriosis diagnosis process. However, healthcare providers need more than the results of an ultrasound to diagnose endometriosis since ultrasounds do not reliably show all types of endometriosis.
The three phenotypes (physical appearances) of endometriosis are:
Of these three types of endometriosis, an ultrasound can sometimes identify two of them: endometriomas and deep infiltrating endometriosis.
But ultrasounds cannot detect superficial endometriosis.This can be a barrier to diagnosis because superficial endometriosis is the most common type, making up 80% of all endometriosis cases.
Although the term “superficial” may sound less serious than the other types of endometriosis, this form can be equally debilitating. The type or stage of endometriosis usually is not based on the level of symptoms.
Are Ultrasounds Used to Diagnose Endometriosis?
How Endometriosis Looks on an Ultrasound
An ultrasound uses high-frequency sound waves to visually scan inside the body. The images often are grainy and black-and-white.
Identifying endometriosis on an ultrasound can be tricky. There are certain signs of endometriosis that a trained technician or endometriosis specialist may be able to locate.
An ultrasound for endometriosis can detect the following:
Most ultrasound lab technicians aren’t trained to recognize these subtle signs of endometriosis on ultrasounds.
How to Find Relief for Endo Belly
Normal vs. Abnormal Findings
You may be told that your endometriosis ultrasound is normal or abnormal. In a normal ultrasound, the pelvic organs are mobile and freely move when probed. There are no signs of cysts or masses and no areas of unusual thickening of tissue.
In an abnormal ultrasound, your technician may observe that specific organs seem “stuck” and don’t move when probed. This could be a sign of adhesions from endometriosis. They may also notice organs in abnormal locations, masses or cysts, focal areas of thicker tissue, and more.
Types of Endometriosis Ultrasounds
You may only be familiar with ultrasounds in the context of pregnancy, in which a cold gel is applied to the abdomen before a wand is manually moved over it and pressed into it to display a video of what is inside. That type of ultrasound is called an abdominal ultrasound.
Abdominal ultrasounds usually are not used for endometriosis because they don’t provide enough detail of the pelvic organs. The most common type of ultrasound for endometriosis is transvaginal, though a transrectal ultrasound may be used in some cases.
Transvaginal
A lubricated probe is gently inserted into the vagina during a transvaginal ultrasound. Some technicians may let you insert the probe yourself to aid in comfort.
Then, the technician will move the probe in a systematic method.As the probe is moved, you may experience some discomfort. It is typically not a painful procedure, but pain is a possibility due to the location and nature of endometriosis. Let your technician know if you are in pain so they can adjust the probe.
You can see thesonogram(ultrasound visuals) displayed on a video screen during the procedure. The technician will take screenshots for a doctor to analyze.
Transrectal
Less frequently, atransrectal ultrasoundis performed to investigate endometriosis. This is usually offered if transvaginal ultrasound is painful or not a possibility.
A small, lubricated probe is inserted into the rectum during a transrectal ultrasound. This may feel like having a bowel movement, but it is typically not painful.
Preparing for an Endometriosis UltrasoundIf you are to get an endometriosis ultrasound, your provider may request that you drink fluids beforehand and not go to the bathroom. Having an ultrasound with a slightly filled bladder can help reduce the chances of false negative results (results that read as negative, but the condition is actually present).
Preparing for an Endometriosis Ultrasound
If you are to get an endometriosis ultrasound, your provider may request that you drink fluids beforehand and not go to the bathroom. Having an ultrasound with a slightly filled bladder can help reduce the chances of false negative results (results that read as negative, but the condition is actually present).
How Do I Know If I Have Bowel Endometriosis?
“Unremarkable” Endometriosis Ultrasound Results: What to Do Next
After your ultrasound, you may be told that your “findings are unremarkable.” Healthcare providers may use this phrase when they don’t find any signs of endometriosis.
Some people may feel distressed upon receiving negative results, especially those who experiencesymptoms of endometriosisand want answers to explain their pain and other symptoms.
Remember that healthcare providers cannot use ultrasound to diagnose or rule out endometriosis definitively. When certain signs are found, it may indicate the presence of two types of endometriosis. But when no signs are found, it does not rule out the existence of endometriosis.
Your ultrasound results should be used to help plan the following steps, whether that’s surgical planning or something else.
Reasons to Seek a Second OpinionSuperficial endometriosis is the most common presentation of the disease, making up 80% of all cases, yet it cannot be identified on ultrasound.If a healthcare provider treats a negative ultrasound as proof that you do not have endometriosis or you feel dismissed, consider seeking a second opinion from an endometriosis specialist.
Reasons to Seek a Second Opinion
Superficial endometriosis is the most common presentation of the disease, making up 80% of all cases, yet it cannot be identified on ultrasound.If a healthcare provider treats a negative ultrasound as proof that you do not have endometriosis or you feel dismissed, consider seeking a second opinion from an endometriosis specialist.
Endometriosis is staged via theAmerican Society of Reproductive Medicine (ASRM) staging system, which signifies the impact of the disease on fertility but does not correlate to symptoms.
It is not possible to stage endometriosis from an ultrasound alone. For a healthcare provider to diagnose and stage endometriosis, you must undergoexcision surgery.
During the procedure, a surgeon will record all instances of superficial endometriosis, deep endometriosis, and endometriomas. Excised samples will be sent to a pathologist to confirm the diagnosis.
A healthcare provider may recommend other scans to look for signs of endometriosis, such asmagnetic resonance imaging (MRI). Similar to ultrasound, healthcare providers use these methods to gather information about the extent of your disease or assist in surgical planning. They are not used to diagnose endometriosis.
You may wonder if an ultrasound for endometriosis is valuable since it cannot diagnose the disease.
Diagnostic tests, including ultrasounds and MRIs, can be costly, averaging $12,118 per patient each year in the United States.Furthermore, getting either a positive or negative ultrasound does not mean a (potentially expensive) endometriosis surgery is not needed.
Many people with suspected endometriosis find that tests that don’t provide definitive information contribute to their anxiety and feelings of a lack of validation for their symptoms and lived experience, possibly contributing to the seven- to nine-year diagnostic delay.
However, many endometriosis surgeons recommend ultrasounds because they provide clues to the severity of endometriosis and assist in surgical planning. For example, if your ultrasound reveals a mass in the bowels, your surgeon may plan for a colorectal surgeon to be on call.
Collaborate with a healthcare provider to determine if an ultrasound is right for you.
Summary
Transvaginal and transrectal ultrasounds are valuable tools when investigating possible endometriosis. However, healthcare providers cannot use ultrasound to diagnose endometriosis. Two of the three types of endometriosis (endometriomas and deep infiltrating endometriosis) are visible with ultrasound, while superficial endometriosis, which represents 80% of cases, is not.Ultrasound does not replace excision surgery and pathology as the gold standard for endometriosis diagnosis.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Robinson AJ, Rombauts L, Ades A, Leong K, Paul E, Piessens S.Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments.Journal of Endometriosis and Pelvic Pain Disorders. 2018;10(1):10-17. doi: 10.1177/2284026518767259Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML.Imaging modalities for the non-invasive diagnosis of endometriosis.Cochrane Database Syst Rev. 2016;2(2):CD009591. doi: 10.1002/14651858.cd009591.pub2Leonardi M, Condous G.How to perform an ultrasound to diagnose endometriosis.Australasian Journal of Ultrasound in Medicine. 2018;21(2):61-69. doi: 10.1002/ajum.12093International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.Johnson NP, Hummelshoj L, Adamson GD, et al.World Endometriosis Society consensus on the classification of endometriosis.Hum Reprod. 2017;32(2):315-324. doi:10.1093/humrep/dew293McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. DOI: 10.3390/jpm12091519Collins BG, Ankola A, Gola S, McGillen KL.Transvaginal us of endometriosis: looking beyond the endometrioma with a dedicated protocol.RadioGraphics. 2019;39(5):1549-1568. doi: 10.1148/rg.2019190045Alimi Y, Iwanga J, Loukas, Tubbs RS.The clinical anatomy of endometriosis: A review.Cureus. 2018;10(9):e3361. doi:10.7759/cureus.3361Soliman AM, Yang H, Du EX, et al.The direct and indirect costs associated with endometriosis: a systematic literature review.Hum Reprod. 2016;31(4):712-722. DOI: 10.1093/humrep/dev335Bontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: results from an online national survey.Diagnosis. 2020;7(2):97-106. doi: 10.1515/dx-2019-0020
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Robinson AJ, Rombauts L, Ades A, Leong K, Paul E, Piessens S.Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments.Journal of Endometriosis and Pelvic Pain Disorders. 2018;10(1):10-17. doi: 10.1177/2284026518767259Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML.Imaging modalities for the non-invasive diagnosis of endometriosis.Cochrane Database Syst Rev. 2016;2(2):CD009591. doi: 10.1002/14651858.cd009591.pub2Leonardi M, Condous G.How to perform an ultrasound to diagnose endometriosis.Australasian Journal of Ultrasound in Medicine. 2018;21(2):61-69. doi: 10.1002/ajum.12093International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.Johnson NP, Hummelshoj L, Adamson GD, et al.World Endometriosis Society consensus on the classification of endometriosis.Hum Reprod. 2017;32(2):315-324. doi:10.1093/humrep/dew293McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. DOI: 10.3390/jpm12091519Collins BG, Ankola A, Gola S, McGillen KL.Transvaginal us of endometriosis: looking beyond the endometrioma with a dedicated protocol.RadioGraphics. 2019;39(5):1549-1568. doi: 10.1148/rg.2019190045Alimi Y, Iwanga J, Loukas, Tubbs RS.The clinical anatomy of endometriosis: A review.Cureus. 2018;10(9):e3361. doi:10.7759/cureus.3361Soliman AM, Yang H, Du EX, et al.The direct and indirect costs associated with endometriosis: a systematic literature review.Hum Reprod. 2016;31(4):712-722. DOI: 10.1093/humrep/dev335Bontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: results from an online national survey.Diagnosis. 2020;7(2):97-106. doi: 10.1515/dx-2019-0020
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Robinson AJ, Rombauts L, Ades A, Leong K, Paul E, Piessens S.Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments.Journal of Endometriosis and Pelvic Pain Disorders. 2018;10(1):10-17. doi: 10.1177/2284026518767259Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML.Imaging modalities for the non-invasive diagnosis of endometriosis.Cochrane Database Syst Rev. 2016;2(2):CD009591. doi: 10.1002/14651858.cd009591.pub2Leonardi M, Condous G.How to perform an ultrasound to diagnose endometriosis.Australasian Journal of Ultrasound in Medicine. 2018;21(2):61-69. doi: 10.1002/ajum.12093International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.Johnson NP, Hummelshoj L, Adamson GD, et al.World Endometriosis Society consensus on the classification of endometriosis.Hum Reprod. 2017;32(2):315-324. doi:10.1093/humrep/dew293McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. DOI: 10.3390/jpm12091519Collins BG, Ankola A, Gola S, McGillen KL.Transvaginal us of endometriosis: looking beyond the endometrioma with a dedicated protocol.RadioGraphics. 2019;39(5):1549-1568. doi: 10.1148/rg.2019190045Alimi Y, Iwanga J, Loukas, Tubbs RS.The clinical anatomy of endometriosis: A review.Cureus. 2018;10(9):e3361. doi:10.7759/cureus.3361Soliman AM, Yang H, Du EX, et al.The direct and indirect costs associated with endometriosis: a systematic literature review.Hum Reprod. 2016;31(4):712-722. DOI: 10.1093/humrep/dev335Bontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: results from an online national survey.Diagnosis. 2020;7(2):97-106. doi: 10.1515/dx-2019-0020
Robinson AJ, Rombauts L, Ades A, Leong K, Paul E, Piessens S.Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments.Journal of Endometriosis and Pelvic Pain Disorders. 2018;10(1):10-17. doi: 10.1177/2284026518767259
Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML.Imaging modalities for the non-invasive diagnosis of endometriosis.Cochrane Database Syst Rev. 2016;2(2):CD009591. doi: 10.1002/14651858.cd009591.pub2
Leonardi M, Condous G.How to perform an ultrasound to diagnose endometriosis.Australasian Journal of Ultrasound in Medicine. 2018;21(2):61-69. doi: 10.1002/ajum.12093
International Society of Ultrasound in Obstetrics and Gynecology.Superficial endometriosis.
Johnson NP, Hummelshoj L, Adamson GD, et al.World Endometriosis Society consensus on the classification of endometriosis.Hum Reprod. 2017;32(2):315-324. doi:10.1093/humrep/dew293
McKinnon BD, Nirgianakis K, Ma L, et al.Computer-aided histopathological characterisation of endometriosis lesions.J Pers Med. 2022;12(9):1519. DOI: 10.3390/jpm12091519
Collins BG, Ankola A, Gola S, McGillen KL.Transvaginal us of endometriosis: looking beyond the endometrioma with a dedicated protocol.RadioGraphics. 2019;39(5):1549-1568. doi: 10.1148/rg.2019190045
Alimi Y, Iwanga J, Loukas, Tubbs RS.The clinical anatomy of endometriosis: A review.Cureus. 2018;10(9):e3361. doi:10.7759/cureus.3361
Soliman AM, Yang H, Du EX, et al.The direct and indirect costs associated with endometriosis: a systematic literature review.Hum Reprod. 2016;31(4):712-722. DOI: 10.1093/humrep/dev335
Bontempo AC, Mikesell L.Patient perceptions of misdiagnosis of endometriosis: results from an online national survey.Diagnosis. 2020;7(2):97-106. doi: 10.1515/dx-2019-0020
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