Endometriosis Part 2- Deep Endometriosis Ultrasound

Last week I said that my next post would be about diagnosing endometriosis on ultrasound.

I would firstly like to point out that a laparoscopy (key hole surgery) with a biopsy is still the gold standard of diagnosing endometriosis. Ultrasound techniques can be used to assess the severity of endometriosis and to help plan surgery if it is necessary.

This ultrasound is known as “sonovaginography” or a “deep endometriosis (DE) ultrasound”. It is an ultrasound performed vaginally usually by a gynaecologist with specialised training to perform the scan. The scan relies on being performed in real time. It is the real time aspect as opposed to just pictures that gives an idea of the significance of disease.

So what do they look for?

In my previous post I talked about how endometriosis can make organs stick together and cause bowel nodules. Well that’s what it looks at. It can see:

1. The Pouch of Douglas- the space at the back of the uterus to see if the bowel sticks. The bowel and uterus should normally slide over each other (the sliding sign).

2. Any endometriosis nodules in the bowel, an area called the rectovaginal septum- between the vagina and the bowel.

3. Vaginal endometriosis

4. Whether the ovaries have a cyst related to endometriosis called an endometrioma.

5. If the ovaries are mobile and move separately to the uterus or of they are stuck as a possible sign of endometriosis.

6. Some scanners can also see if there is any endometriosis on the ligaments supporting the uterus at the back called the uterosacral ligaments.

7. They can also see if endometriosis is affecting the ureters (the tube connecting the kidneys to the bladder).

If the scan is normal, this does not necessarily rule out endometriosis, it just means that if you do have it, it is likely to be superficial and not be affecting any organs. Remember, the amount of disease you have is not linked to how bad the disease is.

The great thing about the scan is that if you do have severe disease, a scan like this can avoid one of potentially two surgeries. Previously, someone who had severe disease had one laparoscopy to diagnose,assess and plan the next surgery and the second would be to complete the procedure.

Next week I’ll discuss the reasons why we treat women with endometriosis.