Endometriosis Imaging: Why Your "Normal" Results Don't Rule Out Endometriosis

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Most women with endometriosis are told their imaging is "normal" — sometimes for years, sometimes for decades — while the disease silently progresses through their body. When Bryan Johnson posted a viral photo of his girlfriend Kate Tollo undergoing a transvaginal ultrasound, it exposed more than just one couple's private medical moment. It exposed how little most people — including those with enormous platforms — understand about what proper endometriosis imaging and diagnosis actually require.
In this episode, I respond to that viral post and use it as a teaching moment. I walk through why normal imaging can never rule out endometriosis, how most radiologists miss the disease entirely, and what the right diagnostic pathway actually looks like. I also share my own story of being dismissed as "attention-seeking" by a radiologist — only to be diagnosed with stage four endometriosis.
You'll learn:
- Why a "normal" ultrasound or MRI does not rule out endometriosis — and what gets missed when general radiologists read your scans
- What an ENZIAN score is, why it matters more than the I–IV staging system for surgical planning, and how to request one
- The three types of endometriosis (endometriomas, deep infiltrating, and superficial/peritoneal) — and which ones imaging can and cannot detect
- Why endometriosis is a full-body inflammatory disease linked to a 20–60% increased risk of cardiovascular disease, stroke, and blood clots
- The embryological rest theory: why endometriosis can occur without a uterus, and why you don't need to have a period to have this disease
- The mast cell, histamine, and estrogen feedback loop that drives lesion growth and systemic inflammation
- How to vet your radiologist, why an "endometriosis protocol" at an imaging center isn't a guarantee, and what questions to ask before surgery
- Why the birth control pill and Lupron are symptom management tools, not treatment — and what true treatment actually requires
- What proper pre-surgical imaging looks like — from transvaginal ultrasound at a center of excellence to ENZIAN-scored expert reads — and why it's the difference between a planned surgery and waking up to surprises
This episode will change how you think about endometriosis diagnosis — and what you demand from your next scan.
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