After one week of DIE-TVUS training, competency can be achieved within forty procedures, allowing diagnosis of DIE with similar diagnostic accuracy as reported by centres of excellence.

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Introduction: This study aims to evaluate the use of transvaginal ultrasound in predicting superficial endometriosis near the uterosacral ligaments, in women with symptoms of endometriosis. Methods: This was a prospective observational pilot study in which women with symptoms of endometriosis underwent detailed pre-operative transvaginal ultrasound to assess the uterosacral ligament area for thickening ('white line sign'), tenderness and small hypoechoic nodules. Women with deep infiltrating endometriosis were excluded. The test characteristics of transvaginal ultrasound were reported using histologically or visually proven endometriosis near the ipsilateral uterosacral ligament as a reference standard. Results: In 81 patients who underwent pre-operative transvaginal ultrasound and laparoscopy, no marker had appropriate test characteristics for a diagnostic or screening test for endometriosis near the ipsilateral uterosacral ligament when used alone. The presence of a small hypoechoic nodule on the white line had the highest specificity of the three markers, at 82% (95% confidence interval 66%-92%). Quantitative measurement of the white line also achieved a high specificity of ≥96% using a cutoff of 5.8 and 6.1 mm, on the left and right sides, respectively. Conclusion: Transvaginal ultrasound of the uterosacral ligament area using the three proposed markers is not a clinically useful screening test for superficial endometriosis near the uterosacral ligaments. A grossly thickened white line (≥5.8 mm) and/or the presence of small hypoechoic nodules are highly specific findings for superficial endometriosis near the uterosacral ligaments and may prompt surgical management.

Metformin appears to inhibit tamoxifen-induced endometrial changes and has favourable metabolic effects. Further research into the adjuvant use of metformin after breast cancer and to prevent EH and cancer is warranted.

Ultrasound is a reliable first line method for localising non-palpable Implanon. When the Implanon is localised on ultrasound, it is very likely present. When the Implanon is not seen on ultrasound, etonogestrel determination should be carried out to confirm its absence.