Can endometriosis be present with normal ultrasound and MRI?

Yes. It’s very possible to have endometriosis even when an ultrasound and MRI are read as “normal,” because imaging is not a simple yes/no detector for all lesion types or locations. Scans are best at spotting certain patterns—like ovarian endometriomas or some deep disease—but superficial implants, small lesions, or disease hidden in less-visible areas can be missed. That’s why a normal scan should never automatically cancel out symptoms like cyclical pelvic pain, painful sex, bowel/bladder symptoms, or infertility.

In our evaluation process, we use imaging as one piece of the puzzle—often more for mapping suspected disease and planning safe surgery than for ruling endometriosis in or out. We put major weight on your full symptom story, flare patterns, and a careful exam, and we also look for conditions that can mimic or coexist with endometriosis (including adenomyosis, pelvic floor dysfunction, vascular causes of pelvic pain, and other drivers of inflammation). If your symptoms persist despite “normal” imaging, reach out to our team—our job is to connect the dots and build a clear, actionable plan toward diagnosis and lasting relief.