Will endometriosis show up on ultrasound?

Sometimes—but a normal ultrasound does not rule out endometriosis. Ultrasound is best at detecting certain signs of endometriosis, especially ovarian endometriomas (endometriosis cysts) and, in skilled hands, patterns that can suggest deep infiltrating disease or scarring/adhesions. Many endometriosis lesions—especially superficial peritoneal implants—are too small or subtle to be seen on standard imaging.

When we review imaging, we focus on what ultrasound can realistically tell us and what it cannot, and we interpret it in the context of your full symptom story and exam. If your symptoms strongly fit endometriosis but the ultrasound is “normal,” that’s a common scenario and still warrants a thoughtful, endometriosis-informed evaluation. In some cases, additional imaging like an expertly interpreted MRI can add useful detail, and for many patients, minimally invasive excision surgery remains the most definitive way to diagnose and treat endometriosis at the same time—reach out to our team if you’d like help making sense of your results and next steps.