Subspecialist pelvic MRI and ultrasound for endometriosis, adenomyosis, fibroids and mesh complications — led by fellowship-trained consultants.
Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus — on the ovaries, fallopian tubes, bowel, bladder, peritoneum and, in rare cases, more distant sites.
It affects an estimated 1 in 10 women of reproductive age in the UK. Despite its prevalence, the average time from symptom onset to diagnosis is still over seven years — largely because symptoms are often dismissed, and because the condition can only be definitively diagnosed by laparoscopy or by specialist imaging interpreted by an experienced radiologist.
Endometriosis causes a spectrum of symptoms including severe pelvic pain (especially during menstruation), deep pain during intercourse, painful bowel or bladder symptoms, and infertility. The severity of symptoms does not always correlate with the extent of disease visible on imaging.
Why imaging matters: A negative ultrasound does not exclude endometriosis. Deep infiltrating endometriosis (DIE) is the most clinically significant form. Our consultants have specialist experience in the diagnostic imaging of endometriosis.
| Prevalence | ~10% of women of reproductive age |
| Average time to diagnosis | 7–8 years in the UK |
| Best imaging test | Pelvic MRI (for DIE) + transvaginal ultrasound |
| Related conditions | Adenomyosis, fibroids, ovarian cysts |
MRI is the gold standard for staging deep infiltrating endometriosis (DIE). It accurately maps the location, extent and depth of endometriotic deposits across the pelvis — including involvement of the bowel, bladder, ureters and pelvic sidewall. This information is crucial for surgical planning.
A dedicated endometriosis MRI uses specific protocols (including rectal enema preparation in some centres to improve visualisation of posterior compartment disease) to maximise diagnostic yield.
Transvaginal ultrasound, performed by an experienced operator, can identify ovarian endometriomas (chocolate cysts), posterior compartment adhesions and some DIE deposits. It is less reliable than MRI for deeply infiltrating disease, particularly in the posterior compartment.
At Bristol Medical Imaging, TVUS is performed by Consultant Radiologists — not radiographers or sonographers — ensuring the highest level of operator expertise.
Adenomyosis — endometrial tissue embedded within the uterine muscle (myometrium). MRI is highly accurate for diagnosis and can assess disease extent before treatment decisions.
Fibroids (uterine leiomyomata) — MRI is the most complete assessment tool, mapping fibroid number, size, position and relationship to the endometrial cavity before surgery or interventional treatment.
Pelvic mesh — used in surgical procedures for stress urinary incontinence and pelvic organ prolapse — can cause significant long-term complications in some patients. Both MRI and Ultrasound are often used for assessing mesh position, integrity and relationship to surrounding pelvic structures.
Transvaginal mesh (TVM) and midurethral sling procedures were widely performed in the UK until restrictions were introduced following recognition of serious complications. Many patients now present with chronic pelvic pain, urinary symptoms, dyspareunia or suspected mesh erosion, and require specialist imaging to guide management.
MRI and ultrasound allows detailed assessment of the mesh itself as well as any associated fibrosis, folding, contraction or erosion into adjacent structures such as the bladder, urethra, vagina or rectum. This information is essential for surgical planning before any revision or removal procedure.
Why specialist reporting matters: Mesh assessment requires an experienced radiologist familiar with normal and abnormal mesh appearances. Our consultants report pelvic mesh MRI and carry out translabial ultrasound as part of our dedicated gynaecological imaging service.
| Best imaging test | Ultrasound and MRI |
| Common complications | Erosion, contraction, fibrosis, pain |
| Structures assessed | Bladder, urethra, vagina, rectum |
| Referral pathway | GP or specialist in gynaecology |
For a dedicated endometriosis MRI, you will be asked to avoid eating for at least 4 hours beforehand to reduce bowel movement artefact. You will also be asked to have a moderately full bladder — we will give you specific instructions. Some protocols use a rectal preparation to improve bowel visualisation; we will advise if this is needed.
You will change into a gown and lie on the MRI table. An intravenous antiperistaltic agent (Buscopan) and/or gadolinium contrast may be used to improve image quality — you will be asked about any relevant allergies or medical conditions. The scan typically takes 40–60 minutes.
If a TVUS is also requested, this is performed by the Consultant Radiologist using a small internal probe. It is performed gently and with respect for your comfort. Please let us know if you have any concerns about this part of the examination.
Your MRI is personally reviewed by a Consultant Radiologist with specific expertise in pelvic imaging. The report will clearly describe the presence, location and extent of any endometriosis, adenomyosis or other pelvic pathology — providing the detail your surgeon or gynaecologist needs to plan treatment.
For surgical planning: Our endometriosis MRI reports are written to include the specific anatomical detail required by laparoscopic and robotic surgeons — compartment-by-compartment description, depth of invasion, and bowel involvement. Please indicate in your referral if the patient is being considered for surgical intervention.