If you’ve been experiencing painful periods, pelvic pain, pain during sex or difficulty falling pregnant, you may have had an ultrasound to look for a possible cause.
And sometimes the result comes back as “normal”.
For many women, that can be reassuring. But if your symptoms are continuing, it can also leave you wondering: If my ultrasound is normal, does that mean I definitely don’t have endometriosis?
The short answer is no.
A normal ultrasound does not always rule out endometriosis.
What is endometriosis?
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus.
It can occur in different areas of the pelvis, including around the ovaries, fallopian tubes, pelvic lining, bowel and bladder.
Endometriosis can cause inflammation, scarring and adhesions, although the way it affects each person varies considerably.
Some people have extensive endometriosis with relatively few symptoms. Others can have significant pain despite having only small or superficial areas of disease.
This is one of the reasons endometriosis can sometimes be difficult to diagnose.
What can an ultrasound detect?
A pelvic ultrasound is an important part of investigating pelvic pain and suspected endometriosis.
When performed by an experienced sonographer, particularly using transvaginal ultrasound, it can sometimes identify features associated with endometriosis.
These may include:
ovarian endometriomas, sometimes called “chocolate cysts”
deeper areas of endometriosis involving structures within the pelvis
signs that pelvic organs are not moving freely because of adhesions
other conditions that may be contributing to symptoms, such as fibroids or ovarian cysts.
For some patients, ultrasound can provide very useful information and help guide treatment or surgical planning. However, ultrasound has limitations.
Why can endometriosis be missed on ultrasound?
Not all forms of endometriosis are easy to see on imaging.
In particular, superficial endometriosis can involve small or thin areas on the surface of the pelvic lining. These changes may not be visible on a standard pelvic ultrasound.
This means it is possible to have symptoms consistent with endometriosis even when your ovaries, uterus and other pelvic structures appear normal on the scan.
The quality of the ultrasound also matters.
A routine pelvic ultrasound and an ultrasound specifically assessing for endometriosis are not always the same thing. Specialist imaging may involve a more detailed assessment of the way pelvic organs move and a closer examination of areas where deep endometriosis commonly occurs. Even with specialist imaging, however, not every case can be identified.
Does the severity of my pain tell you how much endometriosis I have?
Not necessarily.
One of the frustrating things about endometriosis is that the amount of disease seen on imaging or during surgery does not always match the severity of someone’s symptoms.
A person with relatively limited endometriosis can experience significant pain, while another person with more extensive disease may have few symptoms.
Pain can also become more complex over time.
Endometriosis may be one contributor, but pelvic floor muscle tension, bladder or bowel conditions, nerve sensitivity and other causes of pelvic pain can sometimes occur alongside it.
That is why we treat the person and their symptoms, not simply the scan result.
What symptoms might suggest endometriosis?
Endometriosis can present differently from person to person, but symptoms may include:
periods that are significantly painful or interfere with normal activities
pelvic pain at other times of the month
pain during or after sex
pain with bowel movements, particularly around your period
pain when passing urine around your period
heavy or irregular bleeding
difficulty falling pregnant
ongoing abdominal or pelvic discomfort.
Period pain that regularly causes you to miss work, school, exercise or social
activities is worth discussing with your doctor.
Severe pain should not simply be dismissed as something you have to put up with.
What happens if my ultrasound is normal but my symptoms continue?
A normal scan is one piece of information. It should not be the end of the
conversation if your symptoms are continuing to affect your quality of life.
Your doctor may talk with you about your symptoms in more detail, including when the pain occurs, whether it changes throughout your menstrual cycle and whether you have bladder, bowel or fertility concerns.
Depending on your individual circumstances, management may include pain relief, hormonal treatment, pelvic physiotherapy or further assessment.
Some people may also benefit from specialist imaging or referral to a gynaecologist with experience in endometriosis.
Historically, laparoscopy — keyhole surgery — was often considered necessary to confirm endometriosis. Today, diagnosis and treatment are increasingly based on a combination of symptoms, clinical assessment and imaging, and surgery is not automatically required for everyone.
For some patients, however, laparoscopy may still be appropriate, particularly when symptoms remain significant despite treatment, fertility is a concern, imaging suggests more complex disease or there are other reasons surgery may be beneficial.
The decision is individual.
Could something else be causing my symptoms?
Yes. Absolutely. This is another reason a thorough assessment is important.
Pelvic pain can have many possible causes, including adenomyosis, ovarian cysts, fibroids, pelvic floor dysfunction, bladder conditions and gastrointestinal disorders such as irritable bowel syndrome.
Sometimes more than one condition is contributing at the same time.
Investigating pelvic pain is therefore not simply about finding, or ruling out, endometriosis. The aim is to understand what may be driving your symptoms and find a management approach that works for you.
The important thing to remember
If your ultrasound is normal but you are still experiencing significant pelvic pain or other symptoms associated with endometriosis, your symptoms still deserve to be investigated.
A normal ultrasound can rule out some conditions and provide useful reassurance, but it cannot exclude every form of endometriosis.
You know when something does not feel right in your body.
If pain is regularly interfering with your periods, sex, work, exercise, bowel or bladder function, fertility or everyday life, speak with your GP or gynaecologist about the next step.
There are options for further assessment and treatment, and you do not need an abnormal ultrasound result before starting that conversation.
What Happens If Endometriosis That Needs Treatment Goes Untreated?
Here’s the thing: untreated endometriosis doesn’t just sit quietly. It can cause a ripple effect in your body that impacts your health, fertility, and quality of life. I thought I’d talk you through a few of the most common complications.
Chronic Pain
Endometriosis is one of the leading causes of pelvic pain. As the endometrial-like tissue grows and spreads, it can irritate nearby organs and cause chronic inflammation. This pain can go from occasional to constant, interfering with everything from work to relationships to exercise.
Adhesions and Scar Tissue
When inflammation becomes a regular visitor, your body tries to protect itself by forming scar tissue or adhesions. Think of adhesions like sticky bands that glue your organs together. They can change the normal anatomy of your pelvis, making movement painful and even affecting the function of your bowels or bladder.
Ovarian Cysts (Endometriomas)
These are cysts that form when endometriosis invades the ovaries. Known as “chocolate cysts” because of their dark, blood-filled appearance, they cause pain AND they can also damage the ovaries and reduce your fertility.
Fertility Problems
Endometriosis is a major cause of infertility, affecting up to 50% of women who struggle to conceive. Scar tissue and adhesions can block the fallopian tubes, preventing eggs from meeting sperm. The inflammation it causes can also affect the quality of your eggs and the environment in your pelvis, making conception harder.
Bowel and Bladder Issues
If endometriosis spreads to your bowel or bladder, it can cause symptoms like painful bowel movements, diarrhea, constipation, or urinary urgency (feeling like you need to go all the time). Severe cases may even lead to partial bowel obstruction, which is a medical emergency.
Increased Risk of Ovarian Cancer
Now, this part sounds scarier than it is. The overall risk of developing ovarian cancer from endometriosis is still low, but studies show that women with endometriosis have a slightly higher chance compared to those without it. Regular monitoring is key.
When Should You Seek Treatment?
If your endometriosis is causing symptoms that interfere with your life or your ability to have children, it’s time to explore treatment options. These may include:
Medications to manage pain and inflammation.
Hormonal therapies to slow the growth of endometriosis.
Surgical options to remove excess tissue, cysts, or adhesions. Laparoscopic excision of endo is classed as the “gold standard”.
Treatment isn’t one-size-fits-all, and the best approach depends on your symptoms, age, and future fertility plans. A conversation with a specialist can help you decide the best path forward. Our OBGYNs here at SHE Medical ALL specialise in endometriosis and we have half a century of experience between us.
Final Thoughts
Endometriosis isn’t just a bad period. It can impact your whole life. And while not every case needs treatment, ignoring the symptoms or delaying care can lead to more serious complications.
If you suspect you have endometriosis or you’ve been diagnosed but are unsure about your next steps, it’s worth having an open and honest conversation with a specialist gyno, like one of us. You deserve to live without pain, and without the worry of what might happen if you don’t seek care.
At SHE Medical, we’re here to guide you through every step of your health journey with compassion, expertise, and the answers you need.
One of the most common issues we come across at our clinic is endometriosis. If you’re here reading about it, chances are you might already suspect endo could be affecting you or a loved one. As specialists in women’s health, we want to shed some light on this disease – what it is, how it presents, and why early treatment is so crucial. The sooner you address endometriosis, the less pain you may endure and the better your overall outcome is likely to be.
So, let’s get into it: What is endometriosis, and why is it so important to know the signs?
What is Endometriosis?
Endometriosis is a chronic condition where tissue similar to the lining of the uterus begins to grow outside of it, most commonly on the ovaries, fallopian tubes, and surrounding pelvic tissues. For those affected, it can be life-altering, causing symptoms ranging from painful periods and chronic pelvic pain to digestive issues and, in some cases, fertility challenges.
The challenge with endometriosis is that it’s often misunderstood, underdiagnosed, and misdiagnosed. Many women endure years of discomfort, sometimes thinking these symptoms are “normal.” That’s where our team at SHE Medical steps in.
Meet Our Specialists in Endometriosis Care
At SHE Medical, we are proud to have three highly skilled OBGYNs specialising in endometriosis treatment and management. Dr. Gary Swift, Dr. Sean Holland, and Dr. Abigail Evans each bring extensive experience and dedication to helping women navigate this complex disease. All three doctors specialise in laparoscopic excision of endometriosis, a surgical method that provides a thorough and lasting solution for many patients.
Why Laparoscopic Excision?
Laparoscopic excision is considered the “gold standard” in endometriosis treatment. Unlike ablation, where lesions are superficially burned away, excision involves cutting out endometriosis tissue at its root, reducing the likelihood of recurrence. Excision also helps preserve healthy tissue, making it a particularly effective option for women concerned about fertility. Our specialists use advanced laparoscopic techniques to remove lesions with precision, ultimately aiming to relieve pain, improve function, and support better long-term outcomes.
Recognising the Symptoms of Endometriosis
If any of the following symptoms sound familiar, it may be worth consulting one of our specialists:
Painful Periods (Dysmenorrhea): Intense cramping, lower back pain, and pelvic pain that begins before and continues throughout your period.
Painful Intercourse: Deep pain during or after sex is a common sign that endometriosis might be present.
Chronic Pelvic Pain: Not just related to your menstrual cycle, this pain can persist throughout the month.
Digestive Symptoms: Bloating, constipation, or diarrhea, especially during your period, can sometimes indicate endometriosis.
Infertility: Endometriosis is found in a significant number of women facing fertility challenges.
Why Early Diagnosis Matters
Endometriosis can progress over time, leading to more significant pain, more extensive lesions, and, in some cases, increased difficulty with fertility. By seeking diagnosis and treatment sooner rather than later, you’re taking control of the disease before it has the chance to impact your health more seriously. Early intervention can often mean reduced pain, less time lost to symptoms, and a stronger chance of preserving fertility.
At SHE Medical, we believe in empowering women with knowledge and options, which is why our team works together to provide holistic, individualised care. We recognise that each patient’s journey with endometriosis is unique. By taking the time to understand your specific symptoms and concerns, our doctors can recommend a tailored approach to help you achieve the best possible outcome.
Your Path Forward
The journey with endometriosis can be challenging, but it’s one you don’t have to face alone. Whether you’re newly experiencing symptoms, have been struggling for years without answers, or are seeking an expert in advanced laparoscopic excision, we’re here to help. Our team at SHE Medical is committed to providing the highest standard of care, supporting our patients every step of the way.
If you’re ready to talk with a specialist or simply want to learn more, please reach out. Drs Gary, Sean and Abby are here to offer their expertise, compassionate care, and commitment to helping you find relief.
You can call our clinic for an appointment on 07 55 649 683. Don’t forget to see your GP for a referral so you can claim part of the consultation fee through Medicare.
