Can You See Endometriosis on an Ultrasound?

When endometrial-like tissue grows outside the uterus, endometriosis forms. Women can experience a range of symptoms such as unusually painful periods, heavy periods, sex may become painful, reduced fertility, inflammation, fatigue, painful bowel actions and more. In extreme cases, these symptoms can be debilitating, severely affecting one’s quality of life. This gynaecological condition can be challenging to diagnose. If you’ve had an ultrasound you may wonder, can you see endometriosis on an ultrasound? The good news is that it can be detected using ultrasound. Ultrasound is safe and non-invasive, which is why it is the go-to diagnostic and imaging tool used by gynaecological specialists in endometriosis.

Types of Ultrasound Used To Detect Endometriosis

Ultrasound machines create sound waves, which bounce off the organs and bones, and translate them into images used to diagnose various conditions. Ultrasounds can be carried out in three ways: transabdominally, transvaginally, and transrectally. A transabdominal ultrasound is typically carried out on a pregnant woman from about eight weeks into the pregnancy. The doctor will apply a water-based gel to the abdominal area and drag the ultrasound transducer along the skin, allowing the ultrasound machine to produce images.

transvaginal ultrasound is conducted using a wand which is inserted into the vagina. This method is used in the early weeks of pregnancy and to diagnose various gynaecological conditions. A transvaginal ultrasound tends to produce more detailed images. Transrectal ultrasounds are conducted by inserting the wand into the rectum. Though this method is less commonly used to diagnose gynaecological conditions.

How Ultrasound Detects Endometriosis

In the hands of an experienced gynaecologist sonologist or sonographer, ultrasound is a powerful imaging tool. Doctors typically opt for a detailed expert transvaginal ultrasound to detect ‘deep endometriosis’ in the pelvic region because it provides more detailed imagery. The doctor will examine the front and back of the pelvis, uterus, ovaries, and fallopian tubes for growths and abnormalities. They will apply gentle pressure to various areas to look for ovarian mobility and movement, as well as tenderness. Endometrial-like tissue may present as hypoechoic lesions (dark areas) on the ultrasound, and endometriomas or endometriosis cysts can also be visible on the ovaries during an ultrasound.

Types of Endometriosis

The four most common types of endometriosis are superficial endometriosis, ovarian, deep endometriosis and adenomyosis.

Endometriosis can grow in the fallopian tubes, uterus, ovaries, bladder, and rectum, and its severity can range from mild to severe.

Superficial endometriosis presents as deposits of endometriosis over the surface of organs in the pelvic region and also in the layer of tissue (called the peritoneum) which lines the pelvic and abdominal cavities. They are typically only a few millimetres wide and deep.

Ovarian endometriosis occurs when endometriosis grows in the ovary, causing an ovarian cyst called an endometrioma.

Deep endometriosis can grow throughout the pelvis; it may be found in the bladder, bowel (rectum and sigmoid), back of the cervix and uterosacral ligaments.

Overall pelvic endometriosis is when all three types of endometriosis are present.

Adenomyosis occurs when the endometrium grows into the muscular wall (myometrium) of the uterus.

A basic pelvic ultrasound will only pick up endometriomas of the ovary and adenomyosis.

Deep endometriosis ultrasound performed by an expert at OMNI Ultrasound can detect not only endometriomas and adenomyosis but also deep endometriosis of the bladder, bowel (rectum and sigmoid), back of cervix and uterosacral ligaments. This imaging technique can also pick up adhesions between the cervix and the rectum which is a sign of severe endometriosis. If the deep endometriosis ultrasound is performed in the second half of the menstrual cycle, it can be even possible to see subtle forms of superficial endometriosis.

If you are experiencing endometriosis symptoms, it’s essential to speak to your gynaecologist or an endometriosis specialist to get a diagnosis. Contact OMNI Ultrasound. The sooner you get a diagnosis, the sooner you can get treatment. Imaging is the key to the diagnosis of endometriosis. You can minimise potential complications and improve your quality of life with treatment.

OMNI Ultrasound & Gynaecological Care

Condous performs Advanced Endosurgery procedures for women needing intervention for pelvic masses, adnexal pathology, severe endometriosis or hysterectomy. He also runs ‘Hands on’ Live Sheep Laparoscopic Workshops for gynaecologists at Camden Veterinarian School.
Having completed an undergraduate degree with the University of Adelaide, he left Australia in 1993 and moved to London where he completed his training in Obstetrics and Gynaecology. From 2001 to 2003 Condous worked as a Senior Research Fellow at St George’s Hospital, London. At St George’s he set up the Acute Gynaecology Unit, the first in the United Kingdom. It was also during this time that he developed an interest in Early Pregnancy and especially the management of pregnancies of unknown location (PULs). Condous has developed many mathematical models for the prediction of outcome of PULs which have been featured in numerous peer review journals. In 2005, he returned to Australia where he completed his Laparoscopic Fellowship at the Centre for Advanced Reproductive Endosurgery, Royal North Shore, Sydney.

Condous was appointed as a Consultant Gynaecologist and Senior Lecturer at Nepean Hospital in 2006 and soon was made Associate Professor. In 2010, he was made Departmental Head of Obstetrics and Gynaecology at Nepean Hospital. He obtained the MRCOG in 1999 and was made FRANZCOG in 2005. In 2009, he was awarded his Doctorate in Medicine (MD), University of London, for his thesis entitled: “The management of pregnancies of unknown location and the development of new mathematical models to predict outcome”.

Condous has edited three books including the “Handbook of Early Pregnancy Care”, published over 100 papers in international journals and is internationally renowned for his work in Early Pregnancy. He is the Associate Editor for Gynaecologic Obstetric Investigation, which is a European based journal, as well as the Australasian Journal of Ultrasound in Medicine (AJUM). He is on the organising committee and is an invited speaker at the International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG) Scientific meeting in Sydney 2013. His current research interests relate to the management of ectopic pregnancy, 1st trimester growth, PULs and miscarriage and the use of transvaginal ultrasound (in particular sonovaginography, to predict posterior compartment deep infiltrating rectovaginal endometriosis).Condous is also actively involved with post-graduate education including the annual running of the Early Pregnancy and Gynaecological Ultrasound Interactive Courses for Sonologists, Radiologists, Sonographers and Gynaecologists in Australia.