Endometriosis Ultrasound

Overview

What is an endometriosis ultrasound?

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

An ultrasound doesn’t provide all the information needed to diagnose endometriosis. But it can 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.

Can endometriosis be seen on an ultrasound?

Ultrasounds can show large clumps of tissue that are likely signs of endometriosis. Ultrasounds are also very good at identifying endometriosis of the ovaries. But ultrasounds can’t show tiny pieces of tissue that may also be signs of endometriosis. Not all tissue is the same with endometriosis. Ultrasounds can show some, but not all, types of tissue.

An ultrasound can show:

  • Endometrial tissue that’s turned into cysts (endometriomas).
  • Endometrial tissue that’s embedded deeply in an organ (Deeply infiltrating endometriosis, or DIE).

An ultrasound can’t show:

  • Endometrial tissue that’s tiny and on the surface of an organ.

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 endometrial tissue. 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, without surgery, and allows them to plan your surgery more effectively.

When would an endometriosis ultrasound be needed?

Your provider may recommend an ultrasound in order 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. It can help your provider 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 much out-of-place endometrial tissue you have and how it’s 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 and prevent tissue from growing. An ultrasound can show your provider if these treatments are working.
  • Prepare for a laparoscopy. An ultrasound can show your provider where your endometrial tissue 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, like a urologist or a colorectal surgeon.

Who performs an endometriosis ultrasound?

Your provider will order the ultrasound, and an ultrasound technician (sonographer) will perform the procedure. An experienced ultrasound technician can make all the difference when it comes to correctly identifying endometrial tissue on an ultrasound. The technician will share the results with a radiologist, who will write a report that communicates findings with your provider.

Test Details

How does an endometriosis ultrasound work?

An endometriosis ultrasound allows your provider to see inside your pelvic cavity, where your reproductive organs are. Your provider may order a transrectal ultrasound, which can show endometrial tissue on the back of your bladder. Usually, your provider will order a transvaginal ultrasound, which offers a close-up view of your organs most affected by endometriosis, like your ovaries, bladder, and intestines. 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, including your organs and cysts like endometriomas.
  • 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.

A transvaginal ultrasound lasts anywhere from 30 minutes to an hour.

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. You may be asked to empty your bowels to prepare for your ultrasound. 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 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 completely harmless.

Results and Follow-Up

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

Your healthcare provider can help you understand your results and, most important, 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. Your provider is your best resource for determining next steps.

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 thoroughly review the radiologist’s report.

Additional Details

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 endometriosis?

How accurate your ultrasound is depends in part on how skilled your ultrasound technician is and where the endometrial tissue is located in your body. Skilled technicians can usually tell if tissue that appears on an ultrasound is endometriosis. Transvaginal ultrasounds are especially good at showing more advanced endometriosis, which involves endometriomas (endometriosis of the ovaries).

What scan can detect endometriosis?

Ultrasounds and MRIs can both find masses that are likely signs of endometriosis. Each has its pros and cons. For example, while they both allow your provider to see inside your pelvic cavity, they show different views of your internal organs and different levels of detail. Your provider is your best resource for deciding which imaging procedure is best for your diagnosis.

A note from Cleveland Clinic

An endometrial ultrasound can get you one step closer to experiencing relief from your endometriosis symptoms. Ultrasounds are safe, quick and effective when it comes to revealing signs of endometriosis. They can help your provider decide that endometriosis is the likely cause of your pain and discomfort, without you having to go through surgery.

Last reviewed by a Cleveland Clinic medical professional on 09/20/2021.

References

  • Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. (https://pubmed.ncbi.nlm.nih.gov/15287057/) Ultrasound Obstet Gynecol. 2004;24(2):180-185. Accessed 9/3/2021.
  • Holland TK, Yazbek J, Cutner A, Saridogan E, Hoo WL, Jurkovic D. Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. (https://pubmed.ncbi.nlm.nih.gov/20503231/) Ultrasound Obstet Gynecol. 2010;36(2):241-248. Accessed 9/3/2021.
  • Hsu AL, Khachikyan I, Stratton P. Invasive and noninvasive methods for the diagnosis of endometriosis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880548/) Clin Obstet Gynecol. 2010;53(2):413-419. Accessed 9/3/2021.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy