Purpose of Review <p>Endometriosis is a chronic gynecological condition that affects millions of individuals assigned female at birth worldwide, often leading to severe pelvic pain and infertility. This review focuses on the current techniques, challenges and clinical applications of transvaginal ultrasound (TVS) in endometriosis diagnosis, highlighting its role in enhancing early detection and precision imaging.</p> Recent Findings <p>Advances in TVS, including real-time dynamic imaging, sonoPODgraphy and Doppler assessment, has emerged as a non-invasive, accessible, and highly effective tool for diagnosing endometriosis. Evolving sonographic techniques allow better visualization of superficial endometriosis, which were previously difficult to detect.</p> Summary <p>This review summarizes the current TVS techniques and specialized protocols for detecting endometriosis, offering clinicians valuable insights into optimizing diagnostic strategies and enhancing patient care. With ongoing advancements in ultrasound, it has the potential to revolutionize the standard diagnostic approach, minimizing delays and significantly improving patient outcomes.</p>