04/24/2026
Our letter to the editor responding to ACOG’s new guideline on endometriosis diagnosis was not accepted, but the message remains important.
Endometriosis diagnosis cannot be reduced to a simple “yes or no.”
The guideline acknowledges that ultrasound has a role, and that accuracy depends on the training and expertise of the person performing and interpreting the scan. That point deserves emphasis.
A routine pelvic ultrasound is not the same as an advanced endometriosis mapping ultrasound.
Modern imaging should evaluate more than the uterus and ovaries. It should assess for endometriomas, adenomyosis, deep disease, pelvic mobility, sliding sign, bowel involvement, bladder disease, uterosacral disease, rectovaginal disease, and other findings that may change treatment planning.
But even excellent imaging is only one part of the picture.
Chronic pelvic pain is often driven by multiple overlapping contributors, including adenomyosis, pelvic floor dysfunction, bladder pain, bowel disorders, neuropathic pain, nociplastic pain, and central sensitization.
So the question should not only be, “Can we see endometriosis?”
It should be: What else is contributing to this person’s pain? What needs to be mapped? What needs to be treated? And what does the care team need to know before any intervention?
The future of endometriosis care is not ultrasound versus laparoscopy.
It is clinical phenotyping, advanced imaging, standardized reporting, and multidisciplinary planning.
Proud to have written this letter with Jorge Carrillo and Juan Diego Villegas. The letter was not accepted, but the conversation still needs to happen.
