Pelvic ultrasound in gynaecology
Welcome to Women’s Ultrasound Melbourne at the Epworth Freemasons and at Tooronga Village.
We are a group of specialist Obstetricians and Gynaecologists with additional qualifications and experience in women’s ultrasound. We are committed to personalized scanning by medical practitioners in a welcoming environment that is comfortable and respectful of women. The doctor who sees you will perform the whole ultrasound examination, issue the report, and explain and discuss results directly with you. You will know the results of your scan before you leave our practice.
You are welcome to ask questions at any time during the scan, although a complete answer may not be possible until the end of the scan.
What is Ultrasound?
Ultrasound examinations use sound waves that are of a higher frequency than human hearing. The sound waves are reflected from tissue that they pass through, and are changed into an image on a TV screen by a sophisticated computer. The examination, which may sometimes be called a “scan”, allows the doctor performing the scan to examine many tissues and organs of the body, and to see normal and abnormal anatomy. If is particularly suitable for the examination of the female pelvis.
How is the examination performed?
Ultrasound waves are sent out from the small metallic crystals within a plastic case: the ultrasound prove. Gel is first spread on the skin or the probe to allow the ultrasound waves to pass from the probe into the body. The probe is then moved over the skin. There is no pain or other sensation from the ultrasound waves.
Abdominal and Vaginal Ultrasound.
For most women, both techniques will be used but a vaginal scan will almost always allow clearer views as the probe is close to the pelvic structures.
A full bladder is only required when a vaginal scan cannot be performed. If this applies to you, then please attend with a full bladder. Ultrasound waves travel easily through fluid and a large bladder will create a window into the pelvis allowing the ultrasound to reach the pelvic organs to create a diagnostic image. Without a full bladder the ultrasound waves are scattered by bowel gas. A full bladder will make the images obtained from abdominal scanning as clear as possible. For a vaginal scan an empty bladder is required.
Vaginal Scanning
To perform a vaginal san, a thin probe is placed gently into the vagina and moved close to the cervix, where the views of the uterus are best. The probe is moved gently within the vagina to view all the pelvic organs. This is associated with minimal discomfort and is usually short, lasting only a few minutes. The scan is very similar to a vaginal examination and generally more comfortable than a smear test.
Vaginal scanning has revolutionized the non-invasive assessment of gynaecological disorders. Using this technique, the uterus and ovaries can be assessed from the close proximity of the vagina. This allows much clearer views and more detail of the delicate structures within the female pelvis.
When is the best time to have the scan?
A vaginal scan be done at any time during the menstrual cycle, even when you are bleeding. It is not necessary to change your appointment if this happens. However, our preference is to perform a scan shortly after the period has finished. This is the best time to assess the pelvis for polyps or cysts, though any time of the cycle will allow good views of the uterus and ovaries.
Why are scans used in Gynaecology?
The value of Ultrasound in gynaecology varies with the age, and the reason for the scan.
1. Young girls and adolescents.
Scans are not commonly ordered in this age group, but when they are it can be worrying for them. In this age group only abdominal scans are performed and a very full bladder is needed. If the bladder is not full enough we will provide further drinks until the bladder fills.
A very common reason for scans in young girls is pelvic pain associated with the start of their periods. Absence of periods may also be a reason for a scan. Young girls are always scanned with their mothers present though many adolescents prefer to be seen with a friend rather than a parent. The doctor will always explain the findings to both the girl and a her mother, or the adolescent and their accompanying person.
2. The fertile years.
This is the age group in which most scans are performed. During these years ultrasound is very good at assessing the menstrual cycle in all phases. Ultrasound can distinguish abnormal findings from the normal changes that occur during the menstrual cycle.
The major reasons for scans are listed:
- Bleeding between periods
- Heavy periods
- Period or pelvic pain
- Absence of, or irregular periods
- Excess hair growth
- Possible fibroids
- Suspected pelvic mass
- Difficulty conceiving
The ultrasound examination may detect fibroids and polyps of the uterus, which can be the cause of abnormal bleeding. Cysts of the ovaries are a very common cause of pain and these are usually easily seen with ultrasound. Other problems that might be detected include evidence of pelvic infection (fluid in the tube) and occasionally bowel problems.
3. Postmenopausal years.
We perform many scans in this age group for unexpected problems. The common reasons are listed:-
2. Screening for Ovarian Cancer: It is in this age group that many scans are performed to screen for ovarian cancer, particularly in those women with a family history of breast or ovarian cancer. The ovaries will be assessed regardless of the reason for the scan. In older women the ovaries should be very small. Occasionally a cyst may be present, and the great majority of these are simple or benign cysts. Some cysts may cause concern, and to make sure there are no features of cancer, a repeat scan in a few weeks or months may be suggested.
3. Tamoxifen screening: This is a drug used to reduce the rate of breast cancer recurrence. It is associated with an increased risk of polyps, and occasionally cancer of the endometrium (lining of the uterus). These complications are very rare but many women will have regular scans to check for changes that might suggest problems. Some women will need a Saline Infusion Sonohysterography (see Other Procedures).
Common Findings
Endometrial Polyps: Polyps occur in the lining of the uterus or endometrium. They are fleshy overgrowths of tissue that can cause spotting between periods or heavy bleeding with the period. They are common in the premenopausal years, and are almost always benign and are easily treated.
Ovarian Cysts: The ovaries are active organs, which naturally develop cysts during each menstrual cycle. Small ovarian cysts (follicles) are normal especially in the lead up to ovulation (egg production) at mid-cycle. The follicle changes in appearance after ovulation and can be seen up until the next period. The doctor scanning you will assess any cyst to determine whether it is a natural cyst (which will resolve by itself), or a pathological cyst, which might need removal. Luckily most cysts do not need surgery.
Endometriosis: is a condition where there is bleeding into a cyst each month. The same tissue (endometrium) that lines the uterus and sheds each month is found in these cysts outside the uterus. It is commonly found in the ovaries and is almost always associated with pain. Endometriosis cysts do not resolve spontaneously. Unfortunately, ultrasound cannot detect all cases of endometriosis, and further investigations by your gynecologist may be necessary to make this diagnosis.
Polycystic Ovaries: are an ovarian condition that is commonly diagnosed in women who have irregular periods, and sometimes also excess hair growth and acne. The ultrasound findings are usually confirmed with hormone blood tests, which are organized by the referring doctor.
Fibroids: are masses that occur commonly in the uterus. They are made of uterine muscle, and grow into a ball shape within the normal muscle layers of the uterus. They undergo fibrosis with time; hence their name “fibroid” i.e. like fibrous tissue. They vary in size from very tiny to large masses, and are almost always benign. Most cause no problems, and do not need to be removed or scanned again.
Other procedures.
1. Saline Infusion Sonohysterography: This procedure is used occasionally to diagnose polyps in the lining of the womb (endometrial cavity). A very fine plastic catheter (tube) is passed through the cervix and into the womb – this feels very much like a smear test, and causes minimal discomfort. The doctor then performs a vaginal scan while inserting a small amount of saline (salt water) into the womb. The saline outlines any growths within the cavity. This procedure is only suggested when the normal views from vaginal scanning cannot distinguish normal from abnormal findings. If the doctor suggests this procedure he/she will explain in detail how it is performed.
2. Tubal Assessment with Levovist: Levovist is an ultrasound contrast medium that can be used to demonstrate the Fallopian tubes. It may be recommended in some women who are having difficulty conceiving. The procedure is very similar to saline infusion, though the catheter used has a small balloon that can be inflated to keep the catheter in place. This procedure sometimes makes women feel faint or have period pain, so you should allow extra time to rest after the test. Period pain medications such as Nurofen taken half an hour before the procedure may be helpful.
3. Cyst Aspiration: It is possible to pass a needle into a cyst under ultrasound guidance and then to aspirate the fluid from the cyst. This procedure is only performed when there is a persistent cyst that has no features of cancer. If the doctor thinks this is a possible option for treatment he/she will discuss this with you and the referring doctor.