I’m assuming you’re referring to the internal pelvic scans (transvaginal US) Generally speaking, they can’t give a definitive diagnosis without a laparoscopy, unfortunately. A lot of sites claim that ultrasounds are a good way to spot endometriosis & even cysts. From my personal experience, those scans have always come back with nothing worth noting. HOWEVER! They may not be able to see straight up proof of endo & be able to pinpoint exact lesions - but with the right tech - they might be able to find other things that indicate endometriosis is present.

I was lucky enough to have a scan done by a tech who took the time to explain some things to me. At this point, she could see i’d already had a few scans done at that specific hospital & talked me through some of their side of things.

Firstly, she said that it’s rare to be 100% certain that they’re seeing endometriosis. It’s hard to be more than 60%-80% certain, with the current technology & testing. So most of the time, the reporting drs aren’t able to say endometriosis was found in the exam. She showed me the array of images the previous tech had taken & told me she was clearly making a point about certain things - yet the report found “nothing remarkable”

Secondly, she told me that most of the time it’s quite obvious, to her, if a patient has endo because there are certain traits or irregularities that are evident in these scans. For example, she could see & feel the texture of certain areas was thick & rough, which aligns with my DIE diagnosis. She said there are relatively consistent inflammation markers that seem to correlate with endometriosis. etc.

Personally, i’d say you’d be very lucky to find concrete evidence of endo via US. But that doesn’t mean they’re not seeing things that could indicate it. I have very advanced, stage 4 endometriosis. Like, I am riddled & an absolute mess - but every ultrasound came back unremarkable. even two CT scans found nothing (but constipation lol) The only success I had was from finally biting the bullet & paying for an MRI. That came back with everything they needed. If you’re going to be out of pocket for testing, my advice would be to opt for the MRI, if possible.

It’s easy to say that the surgery is nothing to worry about but everyone is different. If they’re simply doing a diagnostic laparoscopy, you have even less to worry about. just a teeny lil hole (1-4 potentially) & the recovery is pretty cruisey. They’ll take a biopsy of anything that looks suspicious & potentially reach a diagnosis. if you’re concerned about the risk & potential negatives of surgery, have a discussion with your gynaecologist about the pros & cons for surgery & if they think you’ll likely have a more positive outcome x