Precision diagnosis in endometriosis and adenomyosis: the power of ultrasound

The management of endometriosis and adenomyosis is critically dependent on timely and accurate diagnosis. The non-specific symptomatology of these conditions has led to significant diagnostic delays, often resulting in unnecessary morbidity for patients. Recent advances challenge the traditional need for invasive procedures to diagnose endometriosis, emphasizing non-invasive imaging instead. Ultrasound, often now considered the first-line tool, shows high accuracy, especially for deep endometriosis (DE), and can be enhanced by MRI.

A structured approach to sonographic diagnosis

In this important new addition to the Ultrasound in Gynecology volume of GLOWM's Continuous Textbook of Women's Medicine, Endometriosis and Adenomyosis: Ultrasound Features and Diagnosis, experts from Belgium and Poland provide an invaluable guide to ultrasound diagnosis of this challenging condition.

This newly published chapter, by Drs Stefan Timmerman and Agnieszka Kotlarz, is a definitive resource, offering a structured, detailed approach to utilizing transvaginal ultrasound (TVS) as the primary, non-invasive diagnostic modality. Aimed at specialist gynecologists, radiologists and advanced trainees, the chapter emphasizes adherence to standardized international terminology and mapping systems, including the IDEA and MUSA consensuses.

It provides granular detail on identifying subtle and complex sonographic markers, including the characteristic ‘hard-to-see’ signs of DE in the bowel, bladder and uterosacral ligaments, as well as the established features of ovarian endometriomas.

The distinguishing myometrial features of adenomyosis, essential for differential diagnosis in patients presenting with chronic pelvic pain or abnormal uterine bleeding are also explained.

By providing a clear framework for comprehensive pelvic scanning, this resource aims to standardize technique and enhance diagnostic specificity, effectively shortening the path from symptom onset to definitive treatment.

Five pillars for diagnosing endometriosis

In a newly updated chapter in the Endometriosis volume of the Continuous Textbook of Women's Medicine Diagnosing Endometriosis, Dr Kevin Kuan and A/Prof. Mathew Leonardi provide essential academic and clinical context by introducing the ‘five pillars’ for diagnosing endometriosis, namely, clinical findings, imaging, biomarkers, surgery and histopathology. These pillars establish a comprehensive framework for overcoming the diagnostic challenge: beginning with patient history and TVS for risk assessment, using biomarkers for future non-invasive screening, and reserving surgery (laparoscopy) and tissue biopsy for definitive confirmation and staging. The chapter contextualizes TVS within the broader clinical workflow, emphasizing the integration of symptom assessment, physical examination findings and imaging results to formulate a robust preoperative management plan.

The five pillars for diagnosing endometriosis:

For further chapters on endometriosis in GLOWM's Continuous Textbook of Women's Medicine, access here the volume dedicated to this subject.

The patient’s perspective

The critical case for diagnostic speed is compellingly made in a powerful lecture, The Power of Ultrasound – Diagnosis is Therapy – ISUOG 2025, delivered by A/Prof. Leonardi at the 35^th World Congress on Ultrasound in Obstetrics and Gynecology in Cancun last month. Drawing on patient testimonies, the lecture highlights the profound psychological and clinical impact of delay in diagnosis of endometriosis. A/Prof. Leonardi argues that the visibility afforded by a definitive ultrasound image is not merely a technical finding but a therapeutic intervention in itself. Furthermore, early diagnosis, particularly in adolescent populations, is crucial for intercepting the disease's progression and preventing the cumulative, long-term impact on fertility, career and quality of life.

GLOWM is dedicated to equipping the academic and clinical community with high-quality, evidence-based resources. We urge clinicians and researchers to utilize these resources to refine their diagnostic skills, reduce the diagnostic interval, and improve the clinical and psychological outcomes for the millions affected by endometriosis and adenomyosis worldwide.