Can endometriosis be present with normal ultrasound and MRI?

Yes. It’s very possible to have endometriosis even when an ultrasound and MRI are read as normal, because imaging is not a simple yes-or-no test for all lesion types or locations. Scans are best at spotting certain patterns, like ovarian endometriomas or some deep disease, but superficial implants, small lesions, or disease hidden in harder-to-see areas can be missed. That’s why a normal scan should never automatically lead to dismissing symptoms like cyclical pelvic pain, painful sex, bowel/bladder symptoms, or infertility.

In our evaluation process, we use imaging as one part of the assessment, often more for mapping suspected disease and planning safe surgery than for ruling endometriosis in or out. We give considerable weight to your full symptom history, flare patterns, and a careful exam. We also look for conditions that can mimic or coexist with endometriosis (including adenomyosis, pelvic floor dysfunction, vascular causes of pelvic pain, and other drivers of inflammation). If your symptoms persist despite normal imaging, reach out to our team: our job is to bring these findings together and build a clear, actionable plan toward diagnosis and lasting relief.