Endometriosis Ultrasound

What is an endometriosis ultrasound?

An endometriosis ultrasound is an imaging procedure that helps your provider determine if you could have endometriosis. With endometriosis, pieces of tissue similar to those that line your uterus (endometrium) can appear in places outside your uterus, like your ovaries, bladder and intestines. This out-of-place tissue can become inflamed, develop cysts or masses, and cause unpleasant symptoms, like painful menstrual cramps.

An ultrasound doesn’t provide enough information to diagnose endometriosis because it only shows larger cysts or masses, not smaller ones. But it does offer clues that your provider can use to decide next steps when it comes to making a diagnosis. An ultrasound can provide information that your provider uses to suggest treatments, too. An endometriosis ultrasound is typically transvaginal (a probe is inside your vagina).

Can endometriosis be found on ultrasound?

Ultrasounds can show large clumps of tissue or scarring that are likely signs of endometriosis. Ultrasounds are very good at identifying endometriosis in your ovaries. But ultrasounds can’t show tiny pieces of tissue which are the most common type of endometriosis.

An ultrasound can show:

• Endometrial tissue that’s turned into cysts (endometriomas), most commonly found on your ovaries.
• Endometrial tissue that’s embedded deeply in your bowel or bladder (deeply infiltrating endometriosis, or DIE). These lesions tend to grow 5 millimeters (mm) or deeper.

An ultrasound can’t show:

• Endometriosis tissue that’s tiny and on the surface of an organ (superficial endometriosis). The lesions are smaller than 5 mm. This is the most common type of endometriosis.

The tricky part is that even if the ultrasound shows tissue that doesn’t belong, there’s no way to be 100% sure it’s endometriosis. The only way to know for sure is to remove the tissue and test it. This requires surgery, a procedure called a laparoscopy. But an ultrasound can let your provider know that you likely have endometriosis, which lets them plan your surgery more effectively.

Why would I need an endometriosis ultrasound?

Your provider may recommend an ultrasound to:

• Get closer to a diagnosis. An ultrasound is just one tool that your provider can use to find out if you have endometriosis. It can help your provider rule out conditions that share symptoms with endometriosis or take a closer look at a mass they noticed during a pelvic exam. An ultrasound can help guide your provider’s recommendations about next steps that get you closer to the right treatment.
• Monitor possible endometriomas or deeply infiltrating endometriosis. An ultrasound can help your provider keep track of how a cyst is responding to treatment. You don’t need an official diagnosis to receive common treatments for endometriosis, like birth control pills and progesterone, that help ease symptoms.
• Prepare for a laparoscopy. An ultrasound can show your provider where your endometriosis and cysts are so that they’re easier to remove during a laparoscopy. If the tissue is near a sensitive organ like your bladder or intestines, your provider can be sure the right specialist is there to assist, such as a urologist or a colorectal surgeon.

How do I prepare for an endometrial ultrasound?

Your healthcare provider will give you the instructions you need to prepare for your ultrasound. Your provider may ask that you come to the procedure with an empty bladder or a full one. Follow your provider’s directions and review any pre-procedure checklists carefully so that you’re all set once it’s time for your ultrasound.

What happens during an endometriosis ultrasound?

An endometriosis ultrasound allows your provider to see inside your pelvic cavity, which offers a close-up view of your organs most affected by endometriosis, like your ovaries, bladder and bowel. For a transvaginal ultrasound:

• An ultrasound technician will insert a lubricated, wand-like device inside your vagina.
• The wand will release sound waves that record the structures and shapes inside your pelvic area.
• The technician will move the wand gently so that it can record structures from different angles while it’s inside your body.
• The images recorded by the wand will show up on a screen that the technician can see. You may be able to see the screen, too.

An endometriosis ultrasound lasts anywhere from 30 minutes to an hour.

What are the risks of an endometriosis ultrasound?

Ultrasounds are safe. One of the benefits of having an ultrasound is that there’s no radiation involved during the procedure. The sound waves used to record what the structures inside your body look like are harmless. Ultrasounds can be uncomfortable when you have endometriosis. Let your healthcare provider know if you’re experiencing pain during the ultrasound.

What type of results do you get from an endometriosis ultrasound and what do the results mean?

Your results may be normal. The ultrasound can also show signs of endometriosis (like scarring) or show an endometrioma or bowel mass. Your healthcare provider can help you understand your results and, most importantly, what these results mean for your care. Depending on your results, your provider may suggest further procedures, like magnetic resonance imaging (MRI) or a laparoscopy, to better identify a mass that showed up during your ultrasound. Your provider may recommend that you begin treatment for endometriosis symptoms.

What does an endometrioma look like on ultrasound?

Endometriomas are a form of endometriosis that mainly occurs on your ovary. Their appearances can vary, but most often, they’re between 2 and 5 centimeters wide. Healthcare providers sometimes call these lesions “chocolate cysts” because of the thick, dark brown appearance of the fluid inside them.

When should I know the results of the test?

You’ll likely hear from your provider a few days after your ultrasound. Allow time for your provider to receive and review the radiologist’s report.

Why would someone with endometriosis have a normal ultrasound?

If your endometrial tissue is tiny and appears on the surface of your organs instead of inside them, the ultrasound won’t detect it. Your results could come back normal even though you have endometriosis.

How accurate is ultrasound for an endometriosis diagnosis?

It’s important to remember that an ultrasound alone doesn’t diagnose endometriosis. Healthcare providers use ultrasound because it’s low risk and can help them get closer to a diagnosis. The only definitive way to diagnose endometriosis is through surgery. This doesn’t mean your provider won’t treat your symptoms, it just means the only way they know for sure is by examining the tissue.

When should I call my healthcare provider?

Contact your healthcare provider if you have questions about the results of your ultrasound. They can help explain what they mean and what your treatment options are.

Remember, an official diagnosis can only come from a laparoscopy. But ultrasound is a valuable tool your provider uses to help make a diagnosis. It also allows them to begin treating your symptoms so you don’t have to live in pain.