Long read but bear with me, just via a quick Google search about "how can endometriosis be detected via ultrasound?" And this is the results:

"Endometriosis is detected via ultrasound by identifying characteristic appearances like hypoechoic lesions (dark spots), which can represent deep infiltrating endometriosis, and ovarian cysts (endometriomas). An expert sonographer will also check for adhesions between organs by looking for a lack of "sliding" when pressure is applied, and assess for adenomyosis in the uterus. These findings are often seen in more advanced cases, while superficial endometriosis is typically not visible via ultrasound and is better diagnosed during a laparoscopy. 

What a sonographer looks for

Endometriomas: Cysts on the ovaries filled with dark, blood-like fluid, often called "chocolate cysts". 

Deep infiltrating endometriosis (DIE): Lesions of endometriosis that grow into other organs. These can appear as dark spots on the bladder, bowel, or ligaments. 

Adenomyosis: A condition where the uterine lining grows into the muscular wall of the uterus. It may appear as a bulky uterus with small cysts or an indistinct junction, notes OMNI Ultrasound & Gynaecological Care. 

Adhesions: Bands of scar tissue that can bind organs together. A key indicator is a "negative sliding sign," where the uterus and bowel do not slide past each other when the probe applies pressure, a sign of a "frozen pelvis."

Important considerations

Expertise is key: Detecting deep infiltrating endometriosis requires specialized training to identify the subtle signs and perform specific maneuvers. 

Ultrasound limitations: Basic pelvic ultrasounds may only pick up large endometriomas or adenomyosis. Superficial endometriosis is often too thin to be seen on an ultrasound and may only be visible during a surgical procedure. 

Different ultrasound types: A standard transvaginal ultrasound is common for a pelvic exam. However, a transrectal ultrasound may be used to get a clearer view of the bowel and rectum where endometriosis can hide.

So, tldr, endo isn't always detected via normal ultrasound or pelvic ultrasound. WHY the heck do we have to go through such invasive tests to prove endo? Why do we not have the choice to say we want a hysterectomy??? "Your body, your choice" means nothing in the health industry.

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Thank you all so so much!