Ultrasound in Endometriosis: Beyond the Surface

Endometriosis is a complex condition where tissue similar to the uterine lining (endometrial glands and stroma) grows outside the uterus. This tissue undergoes cyclical bleeding during menses, leading to inflammation, severe pain, and often, fertility challenges. Detecting this condition accurately is the first step toward effective management.

Common Sites of Endometriosis

Endometriosis can manifest across various pelvic regions, including:

• Ovaries: The most common site, often involving bilateral lesions.
• Pelvic Surfaces: Fallopian tubes, uterine walls, and the Pouch of Douglas.
• Deep Infiltration: Lesions penetrating >5mm into tissues like the bladder, cervix, intestines, or even old surgical/caesarean scars.

Ovarian Endometriosis: The “Chocolate Cyst”

When endometriosis involves the ovaries, it often forms cysts filled with old blood, popularly known as Chocolate Cysts. On a Transvaginal Ultrasound (TVS), these have a very specific “classic” appearance:

Depth of Penetration

Ultrasound helps us classify the severity based on depth:

• Superficial: <5mm depth of penetration from the surface.
• Deep (DIE): >5mm depth, often accompanied by fibrosis and muscular hyperplasia, causing significant pelvic adhesions.

Impact on Fertility

Endometriosis can affect fertility by distorting pelvic anatomy, causing tubal blockages, or reducing egg quality. At Talwar Fertility & Child Health Centre, we specialize in “Endometriosis-safe” IVF protocols and surgical interventions to help patients conceive despite these challenges.