Question 1

How rare is endosalpingiosis?

Accepted Answer

Endosalpingiosis is generally considered uncommon, but “how rare” it is depends heavily on who’s being studied and how it’s found. Many cases are discovered incidentally on pathology—meaning tissue is identified under the microscope after surgery done for other reasons—so it’s likely underrecognized in the general population. In other settings (like surgical cohorts), it may appear more often simply because more tissue is being sampled and examined carefully.

What matters most for patients is that endosalpingiosis can be confused with endometriosis on imaging or even at surgery, yet it doesn’t always behave the same way clinically. If you’ve been told you have endosalpingiosis and you also have pelvic pain, bowel/bladder symptoms, or fertility concerns, our team can help interpret what that finding means in the context of your symptoms and operative/pathology reports. You’re welcome to explore our educational content on related endometriosis and uterine conditions, and reach out to schedule a consultation if you want a personalized plan.

Question 2

What is the AAGL endometriosis classification system?

Accepted Answer

The AAGL endometriosis classification system is a standardized way surgeons describe what they found at surgery—where endometriosis is located, how extensive it is, and how complex the disease appears. Its goal is to create a more consistent “shared language” than older staging alone, especially for cases where symptoms and imaging don’t tell the full story.

Unlike simple stage labels, AAGL-style classification is meant to better capture real-world surgical complexity, including deeper disease that can involve structures like the uterosacral ligaments, rectovaginal space, bowel, bladder, or ureters. This matters because location and depth (for example, deep infiltrating disease) can drive very different symptoms and may change imaging choices and surgical planning. If you’re reading an operative report or trying to make sense of what a surgeon told you, our team can help translate the classification into what it likely means for your body, your symptoms, and the treatment path you’re considering.

Question 3

What is pelvic dissection in endometriosis surgery?

Accepted Answer

Pelvic dissection in endometriosis surgery means carefully separating and opening tissue planes in the pelvis so we can clearly see normal anatomy and remove disease safely. Endometriosis can cause inflammation and scarring that “glues” organs together (sometimes called a frozen pelvis), so dissection is often the step where we free adhesions and restore normal relationships between the uterus, ovaries, bowel, bladder, and pelvic sidewalls.

In practical terms, pelvic dissection may include identifying and protecting critical structures like the ureters, bladder, bowel, blood vessels, and pelvic nerves before excising endometriosis at its roots. This is where surgical precision matters: the goal is to fully address disease while minimizing injury to healthy tissue, especially in complex or re-operative cases. If you’re seeing this term on an op note or surgical plan, it usually reflects the complexity of the anatomy and the deliberate work needed to make excision both complete and safe—our team can walk you through exactly what was dissected and why in your specific case.

Question 4

Should I trust normal imaging if symptoms persist?

Accepted Answer

A “normal” ultrasound or MRI can be reassuring that certain problems weren’t seen, but it doesn’t automatically explain away ongoing symptoms. Endometriosis (and sometimes adenomyosis) can still be present even when imaging looks normal, because scans are better at detecting some patterns and locations than others—and accuracy can depend heavily on the protocol and the experience of the reader. Imaging is often more useful for estimating likelihood and mapping suspected disease than acting as a simple yes/no test.

When symptoms persist, we treat your story as the primary data: your flare timing, pain triggers, bleeding patterns, bowel/bladder symptoms, and how your symptoms evolve over time. We also look deliberately for conditions that can mimic or amplify endometriosis pain—like pelvic floor dysfunction, pelvic venous congestion, hernias, thyroid/PCOS overlap, gut dysbiosis, or nervous system sensitization—so the plan is based on what’s truly driving your symptoms. If you’re stuck with “everything is normal” but you don’t feel normal, reach out to schedule a consultation so our team can review your history, interpret your imaging in context, and map a clear next step.

Question 5

What does endometriosis show on a pathology report?

Accepted Answer

On a pathology report, endometriosis is typically described as endometrial-type glands and stroma found outside the uterus. Pathologists may also note supportive findings such as old or recent bleeding and iron-laden (hemosiderin) macrophages, which are signs the tissue has been hormonally active and bleeding over time. The report often lists the site the tissue came from (for example, pelvic peritoneum, ovary, bowel surface, bladder peritoneum) and may comment on the pattern, such as superficial implants, deeper fibrotic/nodular disease, or an ovarian endometrioma.

It’s also common for pathology to come back as “no endometriosis identified” even when symptoms are very real—or even when lesions looked suspicious in surgery—because confirmation depends on getting the right tissue from the right spot. Endometriosis can be subtle, patchy, or sit beneath a normal-looking surface, so sampling technique and lesion location matter. If you have a report you’re trying to decode, our team can help you understand what the wording means in the context of what was seen during surgery and what it suggests about next steps.

Question 6

Can pathology be negative even if I have endometriosis?

Accepted Answer

Yes. A pathology report can come back “negative” even when endometriosis is present, and the most common reason is sampling—endometriosis lesions can be tiny, patchy, or hidden beneath a normal-looking surface, so a biopsy may miss the true focus of disease. Lesions also vary in appearance and depth (including disease that sits under the peritoneum or within organs), which can make what the surgeon sees and what the pathologist receives two different stories.

A negative pathology result doesn’t automatically mean your symptoms aren’t real or that endometriosis has been ruled out; it often means we need to interpret the result in context of your history, exam, imaging, and what was actually removed. Our team focuses on careful identification and complete excision of suspicious tissue when surgery is the right step, and we also evaluate for look-alike or coexisting conditions that can drive pelvic pain and inflammation.

If you’ve been told “it wasn’t endometriosis” based only on a negative biopsy, we can help you review the operative findings and pathology details and build a clearer diagnostic plan. Many patients get answers when the full picture is put together thoughtfully—before and after surgery—rather than relying on a single datapoint.

Question 7

Do bowel endometriosis symptoms require a colonoscopy?

Accepted Answer

Not usually. Most bowel endometriosis lives on the outside of the bowel or within the bowel wall (most often the rectum and sigmoid), so a colonoscopy can look completely normal even when symptoms are significant. Colonoscopy is better at evaluating problems on the inside lining of the colon, which is why it’s not a reliable test to confirm—or rule out—bowel endometriosis.

That said, a colonoscopy can be part of the workup when your symptoms raise concern for a different or coexisting condition (for example inflammatory bowel disease), or when there are “red-flag” bowel symptoms that need a direct look at the colon. In our evaluation process, we start with your full symptom story and cycle pattern, then use targeted imaging (often expertly interpreted ultrasound and/or MRI) to map suspected deep disease and plan next steps. If you’re trying to figure out whether your symptoms fit bowel endometriosis, a look-alike GI condition, or both, our team can help you build a clear diagnostic plan and discuss what testing actually moves the needle.

Question 8

Will endometriosis show up on MRI?

Accepted Answer

Sometimes—but a normal MRI does not rule out endometriosis. MRI is best at picking up certain patterns, such as ovarian endometriomas (“chocolate cysts”), deep infiltrating disease (for example involving the bowel, bladder, or uterosacral ligaments), and related conditions like adenomyosis or pelvic masses. Superficial peritoneal endometriosis and small implants often don’t show up, even when symptoms are significant.

When we use MRI, we think of it as a tool for mapping and surgical planning, not a yes/no test. The most accurate diagnosis still comes from minimally invasive surgery with direct visualization and biopsy, but imaging—when expertly interpreted—can help identify suspected disease and clarify what else might be contributing to your symptoms. If you’re trying to make sense of an MRI report (or a “normal” result despite classic symptoms), our team can review your history and imaging together and outline a clear next-step plan.

Question 9

Can adenomyosis raise CA-125?

Accepted Answer

Yes—adenomyosis can be associated with a raised CA-125. CA-125 is a nonspecific marker that can rise with inflammation and irritation in the pelvis, and adenomyosis involves endometrial-like tissue within the uterine muscle that can drive chronic inflammation, heavy bleeding, and pain.

That said, an elevated CA-125 does not diagnose adenomyosis on its own, and it also doesn’t tell you how severe adenomyosis is. CA-125 can be elevated for a range of gynecologic and non-gynecologic reasons, and it may also be higher when adenomyosis overlaps with endometriosis (which is common).

If you’ve had a high CA-125 and symptoms like heavy periods, severe cramps, or ongoing pelvic pressure, our team can help you put that result in context and focus on the right next step—typically a symptom-driven evaluation with high-quality imaging (ultrasound and/or MRI) and a plan tailored to your goals, including fertility and long-term relief.

Question 10

How is adenomyosis described on ultrasound reports?

Accepted Answer

On ultrasound, adenomyosis is usually described as features suggestive of adenomyosis rather than a single “yes/no” finding, because the condition represents endometrial-like tissue growing into the uterine muscle (myometrium). Reports may note an enlarged or tender-appearing uterus and a heterogeneous (patchy or uneven) texture of the myometrium, which reflects diffuse changes within the uterine wall.

More specific ultrasound language can include findings such as myometrial cysts, subendometrial lines or buds, and irregularity where the inner uterine lining meets the muscle. If the disease is localized, it may be described as focal adenomyosis or an adenomyoma—a mass-like area that can resemble a fibroid on imaging.

If your report feels vague or uses terms like “possible” or “borderline,” that often reflects real limits of ultrasound and differences in imaging technique and reader experience—not the severity of your symptoms. Our team can help interpret the exact wording of your ultrasound in context (including whether the pattern sounds focal, diffuse, or mixed) and decide whether additional imaging like MRI would meaningfully clarify the diagnosis and next steps.

Question 11

What do endometriosis stages I–IV actually measure?

Accepted Answer

Endometriosis stages I–IV mainly describe the visible amount and distribution of disease and scar tissue (adhesions), based on what’s seen and scored at surgery—most often during laparoscopy. In other words, staging is an anatomic scoring system, not a direct measure of how much pain someone has or how much their symptoms affect daily life.

Because staging doesn’t reliably capture nerve involvement, deep organ infiltration, or how inflammatory a lesion is, someone can have “low-stage” disease and still have severe symptoms. For deeper disease patterns, additional mapping systems (such as ENZIAN) and high-quality, endometriosis-focused imaging can provide a more meaningful picture. If you’re feeling dismissed because your stage doesn’t match your pain, our team can help interpret your findings in context and discuss what evaluation and treatment options make sense for your specific goals.

Question 12

What happens to excised tissue, and does pathology matter?

Accepted Answer

During surgery, the tissue we remove is typically sent to a pathology lab. Pathology can confirm whether the sample contains endometriosis and can describe what’s present—such as an endometrioma, scarring/fibrosis, or other tissue changes. It also helps us rule out rare but important concerns, especially when removing ovarian cysts or complex-appearing tissue.

Pathology is helpful, but it isn’t the whole story: a pathology report only reflects the specific samples submitted, and endometriosis can be missed if disease is microscopic or located in areas that weren’t sampled. Symptom improvement depends most on complete, careful removal of visible disease and addressing contributing factors as part of a coordinated plan. If you have questions about your pathology results or what they mean for next steps, our team can review the report with you and tailor follow-up to your goals.

Question 13

Can genetic testing diagnose endometriosis?

Accepted Answer

No—at this time, there isn’t a validated clinical genetic test or polygenic risk score that can diagnose endometriosis or replace a proper medical evaluation. Genetics may help researchers understand risk over time, but it doesn’t reliably confirm or rule out disease in an individual patient today.

In practice, we diagnose and plan care by putting your symptom history together with a focused pelvic exam and targeted imaging when appropriate. High-quality ultrasound and MRI can be especially useful for mapping suspected disease and guiding next steps, and our team can help you understand what testing is most likely to be informative for your specific symptoms and goals.

Term	Definition	Phonetic Spelling (Pronunciation)
Abdominal Cavity	The space within the abdomen that houses the intestines, liver, and other organs.	/ab·doh·mi·nuhl kav·i·tee/
Ablation	The removal or destruction of tissue using heat, laser, or other methods.	/uh·blay·shun/
Adhesions	Bands of scar tissue that bind organs together.	/ad·hee·zhuhnz/
Adenomyosis	A condition in which endometrial-like tissue exists within and grows into the uterine muscle wall.	/ad·uh·noh·my·oh·sis/
Amenorrhea	The absence of menstruation.	/ay·men·uh·ree·uh/
Analgesic	A medication that reduces or eliminates pain.	/an·uhl·jee·zik/
Anovulation	The absence of ovulation.	/an·ov·yuh·lay·shun/
Aromatase Inhibitors	Drugs that inhibit the enzyme aromatase, reducing estrogen levels.	/uh·roh·muh·tayz in·hib·i·terz/
Biopsy	A medical test involving the extraction of sample cells or tissues for examination.	/bye·op·see/
Bilateral Oophorectomy	Surgical removal of both ovaries.	/bye·lat·uh·ruhl oh·uh·fuh·rek·tuh·mee/
Catamenial Pneumothorax	A rare condition where air leaks into the space between the lungs and chest wall during menstruation.	/kat·uh·mee·nee·uhl noo·moh·thor·aks/
Cervix	The lower part of the uterus that opens into the vagina.	/sur·viks/
Chocolate Cyst	Ovarian cysts filled with old blood, also known as endometriomas.	/chaw·klit sist/
CO2 Laser	A laser used in surgical procedures to cut or vaporize tissue.	/see·oh·too lay·zer/
Cul-de-sac	The area between the uterus and the rectum where endometriosis commonly occurs.	/kull·duh·sak/
Deep Infiltrating Endometriosis (DIE)	Severe form of endometriosis that invades deeper tissues.	/deep in·fil·tray·ting en·doh·mee·tree·oh·sis/
Dyschezia	Painful bowel movements, often associated with endometriosis.	/dis·kee·zee·uh/
Dysmenorrhea	Painful menstruation.	/dis·men·uh·ree·uh/
Dyspareunia	Painful intercourse.	/dis·puh·roo·nee·uh/
Endocrinologist	A doctor who specializes in the endocrine system, which regulates hormones.	/en·doh·kri·nah·luh·jist/
Endometrioma	A type of cyst formed when endometrial-like tissue grows in the ovaries.	/en·do·me·tree·oh·muh/
Endometriotic Lesions	Areas of endometrial-like tissue growth outside the uterus.	/en·doh·mee·tree·ot·ik lee·zhunz/
Endometrium	The inner lining of the uterus that thickens and sheds during the menstrual cycle.	/en·do·mee·tree·um/
Endometriosis	A condition where tissue similar to the lining inside the uterus grows outside it.	/en·do·mee·tree·oh·sis/
Endovaginal Ultrasound	An ultrasound test performed via the vagina to get a closer look at the reproductive organs.	/en·doh·vaj·in·uhl ul·truh·sownd/
Estrogen	A hormone that plays a key role in the development of female reproductive tissues and secondary sexual characteristics.	/es·truh·jen/
Excision Surgery	A surgical procedure to cut out endometriosis tissue.	/ek·si·zhun sur·juh·ree/
Fallopian Tubes	Tubes that carry eggs from the ovaries to the uterus.	/fuh·loh·pee·uhn toobs/
Follicle-Stimulating Hormone (FSH)	A hormone involved in the development of eggs in women and sperm in men.	/fol·i·kul stim·yuh·lay·ting hor·mohn/
Gonadotropin	Hormones that stimulate the activity of the gonads (ovaries and testes).	/goh·nad·oh·troh·pin/
Gonadotropin-releasing Hormone (GnRH) Agonists/Antagonists	Drugs that reduce estrogen production by affecting the pituitary gland.	/goh·nad·oh·troh·pin ree·lees·ing hor·mohn ag·oh·nist/
Hormone Replacement Therapy (HRT)	A treatment used to relieve symptoms of menopause by replenishing estrogen and progesterone.	/hor·mohn ree·plays·muhnt thair·uh·pee/
Hysterectomy	Surgical removal of the uterus.	/his·tuh·rek·tuh·mee/
Hysterosalpingography	An X-ray procedure to examine the inside of the uterus and fallopian tubes.	/his·ter·oh·sal·pin·goh·grah·fee/
Implantation	The process by which a fertilized egg attaches to the lining of the uterus.	/im·plan·tay·shun/
In Vitro Fertilization (IVF)	A procedure in which eggs are fertilized by sperm outside the body and then implanted in the uterus.	/in vee·troh fur·tuh·luh·zay·shun/
Infertility	The inability to conceive after one year of unprotected intercourse.	/in·fur·til·i·tee/
Interstitial Cystitis	A chronic bladder condition causing bladder pain and frequent, urgent urination.	/in·ter·stish·uhl si·sty·tis/
Laparoscopy	A surgical procedure involving small incisions and the use of a camera to diagnose or treat conditions.	/lap·uh·ros·kuh·pee/
Laparotomy	A surgical procedure involving a large incision through the abdominal wall to gain access to the abdominal cavity.	/lap·uh·rot·uh·mee/
Laparoscopic Excision	A minimally invasive surgical technique used to remove endometriosis lesions.	/lap·uh·roh·skop·ik ek·si·zhun/
Lupron	A medication used to treat endometriosis by suppressing estrogen production.	/loo·pron/
Menarche	The first occurrence of menstruation.	/men·ahr·kee/
Menopause	The time in a woman’s life when menstrual periods permanently stop.	/men·uh·pawz/
Menorrhagia	Heavy menstrual bleeding.	/men·uh·ray·jee·uh/
Myometrium	The muscular layer of the uterine wall.	/my·oh·mee·tree·um/
Neurectomy	Surgical removal of a nerve or part of a nerve.	/noo·rek·tuh·mee/
Oophorectomy	Surgical removal of one or both ovaries.	/oh·uh·fuh·rek·tuh·mee/
Oral Contraceptives	Birth control pills that contain hormones to prevent pregnancy.	/awr·uhl kon·truh·sep·tivz/
Ovarian Cyst	A fluid-filled sac within the ovary.	/oh·vair·ee·uhn sist/
Ovary	The female reproductive organ that produces eggs and hormones.	/oh·vuh·ree/
Pelvic Floor Dysfunction	A condition where the muscles and tissues supporting the pelvic organs are weakened.	/pel·vik flawr dis·funk·shun/
Pelvic Inflammatory Disease (PID)	Infection of the female reproductive organs.	/pel·vik in·flam·uh·tor·ee dih·zeez/
Peritoneum	The membrane lining the abdominal cavity and covering the abdominal and pelvic organs.	/per·i·toh·nee·um/
Progesterone	A hormone involved in the menstrual cycle, pregnancy, and embryogenesis.	/proh·jes·tuh·rohn/
Progestins	Synthetic hormones similar to progesterone.	/proh·jes·tinz/
Rectovaginal Septum	The tissue between the rectum and the vagina.	/rek·toh·vaj·in·uhl sep·tuhm/
Reproductive Endocrinologist	A doctor who specializes in reproductive hormones and fertility issues.	/ree·proh·duk·tiv en·doh·kri·nah·luh·jist/
Resection	Surgical removal of part of an organ or structure.	/ri·sek·shun/
Retrograde Menstruation	The backward flow of menstrual blood into the pelvic cavity.	/re·troh·grayd men·stroo·ay·shun/
Retroverted Uterus	A uterus that tilts backward instead of forward.	/reh·troh·vur·tid yoo·tuh·rus/
Robotic Surgery	Minimally invasive laparoscopic surgery enhanced by robotic technology.	/roh·bot·ik sur·juh·ree/
Salpingectomy	Surgical removal of one or both fallopian tubes.	/sal·pin·jek·tuh·mee/
Sonohysterography	An ultrasound procedure to examine the inside of the uterus.	/soh·noh·his·ter·oh·grah·fee/
Subfertility	Reduced level of fertility characterized by an unusually long time to conceive.	/sub·fur·til·i·tee/
Transabdominal Ultrasound	An ultrasound test performed through the abdomen.	/tranz·ab·doh·mi·nuhl ul·truh·sownd/
Transcervical	Through the cervix.	/tranz·sur·vik·uhl/
Transvaginal Ultrasound	An imaging test using sound waves to look at the reproductive organs.	/tranz·vuh·jy·nuhl ul·truh·sownd/
Ultrasound	An imaging method that uses high-frequency sound waves to capture live images from inside the body.	/uhl·truh·sownd/
Uterine Fibroids	Noncancerous growths in the uterus.	/yoo·ter·in fye·broidz/
Uterus	The organ in the female reproductive system where a fetus develops.	/yoo·tuh·rus/
Vaginal Atrophy	Thinning, drying, and inflammation of the vaginal walls due to decreased estrogen.	/vaj·in·uhl at·ruh·fee/
Vaginismus	Involuntary muscle spasms in the pelvic floor muscles.	/vaj·in·iz·muhs/
Vulvodynia	Chronic pain or discomfort around the opening of the vagina.	/vuhl·voh·din·ee·uh/

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Endometriosis Glossary

A clear, comprehensive reference for patients, caregivers, and clinicians.

Common Terms & Defintions

Common Questions

How rare is endosalpingiosis?

What is the AAGL endometriosis classification system?

What is pelvic dissection in endometriosis surgery?

Should I trust normal imaging if symptoms persist?

What does endometriosis show on a pathology report?

Can pathology be negative even if I have endometriosis?

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