What is an Endometriosis Ultrasound?

An endometriosis ultrasound is a safe imaging procedure that can help your healthcare provider identify the abnormal growth of tissue in or on the pelvic organs. By providing more information for a diagnosis, an endometriosis ultrasound can also help women consider treatment options, as well as monitor the progression of the condition, and asses their response to suggested treatment. 

What is Endometriosis? 

Endometriosis is diagnosed when the tissue that is similar to that which lines the uterus, called endometrial tissue, begins to grow on parts of the body outside of the uterus. Endometrial-like tissue has been found to grow on the ovaries, fallopian tubes, bladder, intestines, rectum, and sometimes the diaphragm or chest.  

Symptoms of Endometriosis can include: 

  • Heavy menstrual bleeding
  • Painful menstrual cramps
  • Light bleeding (spotting) between periods 
  • Pelvic Floor Dysfunction
  • Pain during sex
  • Painful bowel movements
  • Difficulties becoming pregnant 

What Happens During an Endometriosis Ultrasound?

When it comes to ultrasounds, most women probably associate it with pregnancy. This is an abdominal ultrasound, where gel is applied to the skin and a wand is slowly moved over the abdomen showing a grainy black-and-white image of the growing fetus. An endometriosis ultrasound may be performed via the vagina, and in some cases via the rectum, for a more detailed view of the pelvic organs. 

Ultrasounds are typically performed by a professional known as a sonographer or by a physician who specializes in endometriosis. 

Transvaginal Endometriosis Ultrasound

During a transvaginal ultrasound, a lubricated wand is gently inserted into the vagina by the sonographer and moved in a systematic pattern to detect abnormal tissue growth, and/or ovarian cysts. It is not a painful procedure but some women can experience discomfort depending on where endometrial-like tissue is growing. 

Transrectal Endometriosis Ultrasound

If a transvaginal ultrasound is too painful for the patient, a transrectal ultrasound is usually performed. In these cases, a smaller lubricated wand is gently inserted into the rectum. While often described as a feeling similar to a bowel movement, the procedure is not usually painful.  

During both a transvaginal and transrectal ultrasound, the patient can see the grainy black-and-white image on a screen, and the sonographer will record screenshots of the pelvic area and any abnormalities for the patient's doctor to analyze and explain after the procedure. 

Endometriosis Ultrasound Purpose

Endometriosis ultrasounds can detect cysts on the ovaries, which are also referred to as endometriomas. Ultrasounds can also reveal large masses of tissue in the pelvic area that are possible signs of endometriosis, including tissue that is deeply implanted within pelvic organs.

Additionally, a physician may perform special tests under ultrasound to determine if there are adhesions between the pelvic organs. They will compress the abdomen with the wand and monitor the response which may show evidence of the uterus and bowel stuck together. 

However, neither a transvaginal nor transrectal ultrasound can successfully show tiny endometrial-like tissue on the surface of a pelvic organ, this can only be observed in a laproscopic procedure. Unfortunately, tiny amounts of endometrial-like tissue on pelvic organs, known as Superficial Endometriosis, is the most common type, affecting as many as 80% of women with endometriosis.

Due to this an endometriosis ultrasound cannot provide all the necessary information to diagnose endometriosis for every case. However, the procedure can offer helpful clues that healthcare providers can use to advise patients on the most effective treatment options for their personal needs.  

Benefits of an Endometriosis Ultrasound 

The results of an endometriosis ultrasound mean doctors can better determine if endometriosis can be confirmed. Depending on the results, healthcare providers are also better informed to suggest the best treatment options.

If surgery is the next step, for instance, ultrasounds can help ensure that patients are referred to the right surgeon. A clearer picture of where endometrial-like tissue is located outside of the uterus is also helpful for surgeons to plan in a more effective way.  

Alternatively, the results from an endometriosis ultrasound can arm patients with more knowledge about their condition and enable them to consider treatment options other than surgery. Furthermore, after treatment commences, a follow-up ultrasound can assess whether the treatment is proving successful or not.  

Treatment Options for Endometriosis

Although endometriosis ultrasounds can detect abnormal tissue growth on the ovaries or deeply implanted in pelvic organs, the only way to confirm that it is endometrial tissue is to remove it and test it. This is done during a procedure called a laparoscopy, which is also known as keyhole surgery. 

Although removing the abnormal tissue from organs outside of the uterus can provide relief from endometriosis for some women, symptoms often return for others. When this occurs, over-the-counter pain medication to treat pelvic pain is often prescribed.

Hormone therapy to balance monthly hormone fluctuations, or birth control to prevent both menstruation and the growth of endometrial tissue is another form of endometriosis treatment. When symptoms are life-altering to the point of causing psychological distress, a hysterectomy may be recommended and performed.  

Treating Endometriosis While Trying to Conceive 

When women suffering from endometriosis are hoping to become pregnant, less invasive and non-hormonal treatments are recommended. Doctors often prescribe fertility medication that helps endometriosis patients produce eggs and several additional natural remedies that help to alleviate additional symptoms.  

Pelvic health physical therapy, for example, can be extremely beneficial in relieving the pain, pelvic floor dysfunction, and discomfort during sex that is associated with endometriosis. Pelvic health physical therapists also tend to recommend helpful stretches for endometriosis patients to perform at home to alleviate painful menstrual cramps and tight pelvic muscles.  

Vaginal dilators are incredibly helpful to alleviate pain during sex which is often a symptom of endometriosis. When purchased as a set, endometriosis patients are advised to start with the smallest dilator (the size of a pinkie finger) and slowly work toward the larger sizes as they feel comfortable. The Intimate Rose Vaginal Dilators are cleared to treat the symptoms of Vaginismus such as painful intercourse, known as dyspareunia.

By taking the time to slowly and gently relax tight vaginal muscles, pelvic dysfunction improves and penetration during sex, or with a tampon, becomes more comfortable. The dilators from Intimate Rose are made from smooth and soft but adequately firm medical-grade silicone and are currently the only FDA-approved dilators on the market. 

Another helpful tool for endometriosis patients is a pelvic wand combined with wand therapy. Shaped ergonomically to fit comfortably into the vaginal or rectal canal, pelvic wands are used to massage tender trigger points, scar tissue, and adhesions deep within the pelvic muscles and organs.

For endometriosis patients who are trying to conceive and do not want to take hormone therapy, pelvic wands are known to successfully relieve pelvic pain like no other product on the market. 

Warm baths and heat packs against the abdomen and lower back can also provide relief, along with over-the-counter pain medication.   


An endometrial ultrasound is a non-invasive way of detecting the abnormal growth of tissue on organs outside of the uterus. Although an ultrasound cannot definitively diagnose endometriosis, it can help healthcare providers determine the best treatment option to relieve a patient’s symptoms. Follow-up ultrasounds can also help to monitor the progression of each patient's condition and determine if suggested treatments are successful. 


Contemporary OB/GYN - Noninvasive ultrasound of Endometriosis - https://www.contemporaryobgyn.net/view/noninvasive-ultrasound-diagnosis-endometriosis

Verywell Health - What Endometriosis Ultrasounds Detect - https://www.verywellhealth.com/endometriosis-ultrasound-7485966

National Library of Medicine - Transvaginal Ultrasound in Deep Endometriosis: Pictorial Essay - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808616/

Healthline - What Does Endometriosis Look Like on Ultrasound? - https://www.healthline.com/health/endometriosis/endometriosis-ultrasound

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