Diagnosing endometriosis isn’t always straightforward, and ultrasound can be a powerful tool—especially when it comes to deeply infiltrating endometriosis.  While it may not detect every case, ultrasound can provide important clues about what’s happening beneath the surface. When performed by an experienced provider, it becomes an essential part of the diagnostic process.

At Pacific Endometriosis we include an ultrasound at every new patient consultation. Why? Because it helps us evaluate for endometriomas (ovarian cysts of endometriosis), bowel lesions, adhesions, and other structural changes that may indicate endometriosis. Even when endo doesn’t show up directly, certain subtle findings—like ovaries that appear “stuck” in place—can suggest its presence and guide further evaluation.

Another important way ultrasound helps us assess for endometriosis is by identifying areas of tenderness. By applying gentle pressure with the ultrasound probe, we can pinpoint specific locations that reproduce a patient’s pain, which can correlate with areas of suspected endometriosis. This allows us to gather more diagnostic information, with the ultrasound essentially becoming an extension of our physical exam.  If certain areas are consistently tender—such as the uterosacral ligaments or a segment of the bowel—it raises our suspicion that endometriosis may be present.

That said, a “normal” ultrasound doesn’t mean endometriosis isn’t there. Superficial peritoneal disease is generally not seen on ultrasound, though advances in this area are still being made.  That’s why a comprehensive evaluation, including a detailed history and symptom review, is crucial. Endometriosis doesn’t always make itself obvious, but when we put together all the available information, we can build a much clearer picture.

For those experiencing chronic pelvic pain, painful periods, or other symptoms of endometriosis, ultrasound is a valuable first step in the diagnostic process. At Pacific Endometriosis, we take a thorough and individualized approach to care, ensuring that no detail is overlooked.  Including an ultrasound at each initial consult helps us take a deeper look—both literally and figuratively—so we can provide the most thorough assessment possible and make well-informed treatment recommendations.