A pelvic ultrasound may detect a variety of diseases of the female reproductive system tract, some of which require treatment. The examination assesses the structure of the vagina, cervix, uterus, fallopian tubes, ovaries and other pelvic structures.
This appointment will take approximately 30 to 45 minutes. We do our best to run on time, however situations outside of our control can result in delays in the scheduling.
This procedure is normally performed transvaginally with an empty bladder. However, if you have never had sexual intercourse, you may prefer the examination to be performed transabdominally, although transvaginal ultrasound does allow us to obtain much clearer images.
Normal Uterus Normal Uterus and Endometrium
A fibroid is a benign growth of muscle which develops in the wall of the uterus. Fibroids range in size from 5mm to 150mm. They are very common, occurring in up to 30% of women. They generally do not cause any problems and many patients go through life with their fibroids unnoticed. Also, the majority of fibroids shrink significantly in size after menopause.
Some patients do however run into problems which may include heavy or irregular periods, infertility and pain.
Infertility may occur as a result of blockage of the fallopian tubes. Such a blockage may prevent the sperm from meeting the egg just before conception or prevent the embryo’s passage toward the uterus. Fertility may also be reduced if the fibroids significantly disrupt the cavity of the uterus.
Irregular bleeding with fibroids is usually the result of enlargement or distortion of the uterine cavity. Sometimes a small fibroid within the cavity may also cause heavy and irregular bleeding.
If fibroids enlarge and outgrow their blood supply, degeneration of the muscle may occur causing pain. Degeneration generally only occurs during pregnancy. Such a complication is rare.
Problematic fibroids may be treated with a variety of hormones to decrease their size. It may however, take several months before a reduction in size is noted. Other fibroids may be dealt with by surgery. If the fibroid is small and positioned within the cavity it may be possible to introduce a narrow telescope into the uterine cavity and remove the fibroid. Larger fibroids are usually approached either through keyhole or open surgery.
Vaginal bleeding after the menopause should always be investigated. About 1 in 10 women will develop vaginal bleeding after menopause, the blood loss is usually slight and often amounts to no more than a little spotting on the underwear. In the vast majority of patients who develop such bleeding, no serious cause is found. Most episodes are explained by hormonal imbalance that occurs around the time of menapause, problems related to hormone replacement therapy (HRT) or excessive dryness of the vagina.
In a small number of patients the bleeding may be due to cancer of the lining of the uterus (the endometrium). It is therefore important to assess the endometrium to exclude cancer.
A transvaginal ultrasound examination of the uterus provides detailed views of the uterus and its lining. A thin lining virtually excludes cancer of the endometrium; however should another episode of bleeding occur after the scan it is still important that you let your doctor know.
In some patients the endometrium is thickened. This is usually explained by either problems with HRT or by overgrowth of the cells lining the cavity (hyperplasia). Hyperplasia may lead to the formation of a polyp. A polyp is a grape-like structure that is attached by a narrow stalk to the endometrium. In a small number of patients however the appearances of a cancer may be seen. In these circumstances an endometrial biopsy is required.
Polycystic Ovaries (PCO)
In a normal menstrual cycle there are usually 5-14 follicles at the beginning of the cycle. At around day 14 of the cycle one follicle (leading egg) gets bigger and shortly thereafter ovulation takes place when the egg is released. The remaining eggs regress and disappear before the next cycle. At the end of this cycle there is a menstrual bleed. This cycle is repeated roughly every 4 weeks.
In a patient who has PCO this cycle does not take place – instead no leading egg develops and there is a build up of small immature follicles with successive cycles. PCO is very common, with one in three women estimated to have PCO. Most of these women remain undiagnosed and require no treatment.
Some women with PCO may suffer symptoms including infertility, acne, increased facial hair (hirsutism) and infrequent or irregular periods.
There is a wide range of treatment options and most have good success rates treating menstrual problems and infertility. Dr Carmody and your obstetrician will discuss your options with you after diagnosis.