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Endometriosis ultrasound types and limitaion

Ultrasound imaging is considered a valuable non-invasive tool in the screening, diagnosis and monitoring of endometriosis. In this blog post we’ll explore the role of ultrasound in diagnosing and managing endometriosis.

What is endometriosis?

Endometriosis is a complex and often painful medical condition that affects millions of women worldwide. It is characterized by the growth of tissue similar to the lining of the uterus outside of the uterus. The inner lining of the uterus is called the endometrium, this is what is shed during a menstrual period. When a person has endometriosis, endometrial-like tissue grows on other organs and structures in the body. This tissue is hormonally sensitive and behaves like it would in the uterus, thickening and breaking down with each menstrual cycle, this in turn leads to inflammation and may lead to cysts called endometriomas. When this tissue grows in the wrong place it can cause a range of symptoms, like pelvic pain. Some women with endometriosis have issues with fertility. 

Ultrasound for endometriosis

An endometriosis ultrasound is a non-ionising imaging procedure which uses high frequency sound waves that can help conclude a diagnosis of endometriosis. An ultrasound doesn’t provide all of the information needed for a definitive diagnosis, but is a good indicator, and provides valuable information.

Ultrasounds are able to show large clumps of tissue present which are likely to be endometriosis, and are good at identifying endometriosis of the ovaries. An ultrasound scan is able to show endometrial tissue that has turned into cysts (endometriomas) and endometrial tissue that is deeply embedded in an organ.

However, ultrasound is not able to show endometrial tissue that is tiny and on the surface of an organ.



Diagnostic Ultrasound scans are considered valuable in assessing the pelvis and reproductive organs. The lack of ionising radiation makes it favourable in assessing such sensitive organs. 

There are different ultrasound scans which, coupled together, provide comprehensive information on the health of the reproductive organ:

  • Pelvic ultrasound: A pelvic ultrasound scan is done externally with the probe pressed over the abdomen. It is usually done first while the patient’s bladder is full to get the best look at the organs. Pelvic ultrasound is not considered to be as sensitive as Transvaginal ultrasound.
  • Transvaginal ultrasound: Transvaginal ultrasounds are the most common scan used in evaluating endometriosis and is often coupled with a pelvic ultrasound scan. This scan involves the insertion of the ned of a slender ultrasound probe into the vagina, this allows for a close up look at the pelvic organs. The transvaginal scan detects the presence of endometriomas (Cysts filled with endometrial tissue) and other abnormalities which may not be clearly visualised with the pelvic scan.
  • Colour doppler ultrasound: This is a feature that is often used in assessing blood flow. Sonographers can implement colour doppler during an of the scans listed above. The use of colour doppler allows for the assessment of blood flow in the pelvic region.

What are the benefits of ultrasound in evaluating endometriosis?

  • Non-invasive: Ultrasound is a completely non-invasive procedure and doesn’t require any incisions to be made. This makes it a quick, easy and more accessible option in the initial screening and follow-up of endometriosis. 
  • Timely and convenient: Ultrasound imaging is typically a quick and convenient procedure which can usually be performed in an outpatient setting. The entire process in carried out in timely manner, with little to no preparation and recovery period. This makes it a favourable option for many patients who may not have the time or want to undergo lengthy diagnostic procedure in the initial period.
  • Effective for detecting endometriosis: The NICE guidelines recommend ultrasound be used in the primary stages of investigation into endometriosis. Transvaginal ultrasound is considered effective in identifying endometriomas and deep endometriosis involving the bladder, bowel and ureter.
  • Monitoring disease progression: Ultrasound is considered valuable in monitoring the progression of endometriosis over time. Healthcare providers may recommend regular ultrasounds to track changes in size and appearance of lesions and cysts.


While ultrasound is a valuable tool in the diagnosis and management of endometriosis, it does present limitations in the extents of the information it can provide:

  • Limited sensitivity: Ultrasound may not detect all instances of endometriosis, especially is the lesions are small and deeply located within the pelvis. In such cases, laparoscopy is often the gold standard in confirming a diagnosis.
  • Operator dependent: The diagnostic quality of an ultrasound scan is often dependent on the skill and expertise of the operator. A highly skilled sonographer or doctor is essential to attaining high quality diagnostic images.
  • Some scans require a bit of preparation so that the operator can get a good look at the anatomy. The pelvic scan requires a full bladder, so if th bladder is not sufficiently full this may interfere with the quality of information provided.


Ultrasound is a valuable component in assessing endometriosis

While ultrasound may not replace laparoscopy in providing a definitive diagnosis, it does serve as a safe and convenient option for the initial screening and monitoring of endometriosis. If endometriosis is suspected, appropriate diagnostic and treatment options should be explored, which will often include diagnostic ultrasound.