Endometriosis evaluations involve multiple methods that examine the biological and anatomical features of the disease. Structural assessment detects visible or palpable changes in the pelvic organs, while imaging reveals bigger anatomical changes and the spread of lesions. Other types of testing examine inflammatory markers in the uterine lining that can be missed in structural tests. Here are a few common endometriosis tests:
Pelvic Exams
This endometriosis test involves a pelvic examination that assesses the uterus, ovaries, cervix, and surrounding pelvic structures. It identifies physical signs associated with endometriosis and other conditions. During the exam, the clinician evaluates tenderness, tissue irregularities, and structural abnormalities. Endometriosis often presents with firm or nodular areas, particularly in deeper pelvic tissues, where inflammation and scar formation alter normal tissue texture. Adhesions may restrict the movement of the uterus and adjacent organs, resulting in reduced mobility during manual assessment.
Ultrasound Scans
Ultrasound uses sound waves to produce images of the pelvic organs. This test evaluates structural anatomy and visualizes physical pelvic structures rather than functional or molecular activity. Transvaginal ultrasound uses a probe placed in the vagina, positioning it closer to the uterus and ovaries to improve image resolution and detail of the reproductive organs.
Endometriomas appear as ovarian cysts with internal echo patterns that differ from simple fluid-filled cysts. Ovarian mobility during scanning often decreases when adhesions involve surrounding pelvic tissues. Small superficial lesions and early tissue changes are not consistently visible on ultrasound, particularly when the disease is limited to surface-level implants. Treatment options are available that reduce pain, control lesion growth, and improve daily function across different stages of the condition.
Magnetic Resonance Imaging Scans
Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to generate detailed images of soft tissues, and clinicians use it to evaluate pelvic endometriosis. This test provides high-resolution views of structures such as the bowel, bladder, uterosacral ligaments, and pelvic sidewalls. These areas are often involved in deeper disease.
It also maps lesion location and extent before treatment planning or surgery, and it provides more anatomical detail than ultrasound in cases of deep-infiltrating issues. An MRI identifies ovarian endometriomas associated with endometriosis. It also detects deeper involvement of structures such as the bowel, uterosacral ligaments, and rectovaginal septum.
MRIs show indirect signs, including tissue thickening, distortion of normal pelvic anatomy, and loss of normal separation between adjacent structures due to adhesions. These findings support the assessment of disease distribution, although small superficial implants are not consistently visible on MRIs. Treatment approaches include medical therapy and surgical options that reduce symptoms, address lesion burden, and support long-term symptom management.
Endometrial Biopsies
An endometrial biopsy removes a small sample of the uterine lining for laboratory analysis. Pathology teams examine cellular structure and molecular markers within the endometrium. The procedure focuses on uterine lining biology rather than pelvic anatomy. BCL6 appears as a molecular marker associated with inflammatory signaling patterns and progesterone resistance in endometrial tissue. These findings describe endometrial behavior at a cellular level rather than structural changes in surrounding organs.
Clinicians obtain the sample from the uterine cavity lining, without direct assessment of ovarian or peritoneal structures. The method evaluates endometrial biology and does not include surgical visualization of pelvic lesions. Pathology analysis assesses cellular organization and marker expression, and variations in these patterns reflect differences in endometrial function at a microscopic level.
You can also read about Understanding Treatments for Unexplained Infertility.
Laparoscopic Surgeries
Laparoscopy is a surgical procedure used to diagnose endometriosis through direct visualization of the pelvic and abdominal cavity. The surgeon makes a small incision in the abdomen and inserts a camera to view the outer surfaces of the uterus, fallopian tubes, ovaries, and surrounding pelvic structures. Endometriosis appears as lesions or ovarian endometriomas on these surfaces. When abnormal tissue is identified, the surgeon removes a sample for biopsy. A pathologist examines the tissue under a microscope to identify histological features consistent with endometriosis. This combination of visual inspection and microscopic analysis supports definitive diagnosis.
Schedule an Endometriosis Test
Endometriosis testing evaluates pelvic anatomy, imaging results, and tissue characteristics to identify signs of disease and determine its extent. Clinicians interpret these results together, since no single test provides a complete assessment on its own. Contact a fertility specialist today to determine the appropriate endometriosis testing approach based on your symptoms and clinical findings.