An ultrasound of the uterus is a non-invasive imaging technique that uses sound waves to visualize the female reproductive organs, including the uterus, ovaries, and fallopian tubes. It helps assess their health and structure, identifying deviations from typical appearance.
Visualizing a Healthy Uterus
A healthy uterus typically presents as a pear-shaped organ with smooth contours. Its size varies depending on factors like age and reproductive history, but it generally measures around 7-8 cm in length, 5 cm in width, and 3 cm in thickness in non-pregnant adults. The uterus is composed of two main layers visible on ultrasound: the myometrium, which is the muscular wall, and the endometrium, the inner lining.
The myometrium of a healthy uterus appears homogenous, meaning it has a uniform texture. The endometrium, which thickens and sheds during the menstrual cycle, shows a distinct “triple stripe” pattern during the proliferative phase. Ovaries are typically oval-shaped with small, fluid-filled sacs (follicles) visible within them, indicating normal function.
Identifying Specific Abnormalities
An abnormal uterus ultrasound can reveal various conditions. Uterine fibroids, also known as leiomyomas, appear as well-defined, solid masses within the myometrium, often darker (hypoechoic) than the surrounding muscle, and may cast shadows. These growths vary in size and location, appearing under the surface lining (submucosal), within the muscle wall (intramural), or on the outer surface (subserosal).
Endometrial polyps manifest as focal thickenings of the endometrial lining, typically appearing brighter (hyperechoic) and often with a distinct blood vessel supplying them, sometimes described as a “feeder vessel.” Adenomyosis involves the growth of endometrial tissue into the myometrium, leading to a diffusely thickened and heterogeneous myometrium with a mixed texture. Ultrasound findings for adenomyosis can include small fluid-filled cysts, linear striations, and a poorly defined junction between the endometrium and myometrium, sometimes presenting as a “Venetian blind” pattern.
Congenital uterine anomalies are structural variations present from birth, such as a septate uterus (a wall dividing the uterus), bicornuate uterus (heart-shaped uterus with two horns), or unicornuate uterus (a single-horned uterus). These variations alter the typical pear shape and internal cavity structure. Endometrial hyperplasia, an overgrowth of the uterine lining, appears as endometrial thickening beyond normal limits for the menstrual cycle or menopausal status. Endometrial cancer can also present as endometrial thickening, often with an irregular or heterogeneous appearance, and may show disruption of the subendometrial halo.
Ovarian cysts and masses, though not uterine abnormalities, are often observed during a pelvic ultrasound. Simple ovarian cysts are typically anechoic (fluid-filled and black on ultrasound) with thin, smooth walls and posterior acoustic enhancement. Complex cysts might contain internal echoes, septations (dividing walls), or solid components. Solid masses on the ovary may indicate a different type of growth.
Recognizing Associated Symptoms
Abnormal ultrasound findings often correspond with various symptoms. Uterine fibroids can cause heavy or prolonged menstrual bleeding, bleeding between periods, pelvic pain or pressure, frequent urination, and lower back pain. Endometrial polyps commonly lead to irregular menstrual bleeding, including spotting, heavy menstrual flow, or bleeding after menopause.
Adenomyosis frequently presents with severe and painful menstrual cramps, heavy or prolonged menstrual bleeding, chronic pelvic pain, and discomfort during sexual intercourse. Congenital uterine anomalies may be associated with recurrent miscarriages or difficulties achieving pregnancy. Endometrial hyperplasia typically causes abnormal vaginal bleeding, such as heavier or longer periods, bleeding between cycles, or postmenopausal bleeding. Endometrial cancer also commonly manifests as abnormal vaginal bleeding, particularly after menopause, or changes in menstrual patterns for those still menstruating.
Ovarian cysts can cause pelvic pain, which may be dull or sharp and intermittent, a feeling of fullness or pressure in the lower abdomen, and bloating. If a cyst ruptures or causes the ovary to twist (torsion), it can lead to sudden, severe pain, often accompanied by nausea and vomiting.
Understanding Your Next Steps
Upon receiving an abnormal uterus ultrasound report, the next step is a consultation with a healthcare provider. The provider will discuss the findings, explaining what the abnormalities might signify in the context of your symptoms and medical history. This clarifies potential diagnoses and health implications.
Further diagnostic tests are often necessary to confirm initial ultrasound findings and establish a definitive diagnosis. These may include a hysteroscopy, where a thin, lighted telescope is inserted into the uterus to visualize the lining, or an endometrial biopsy, which involves taking a tissue sample for microscopic examination. In some cases, a Magnetic Resonance Imaging (MRI) scan might be recommended for more detailed imaging.
Based on the confirmed diagnosis, various treatment options may be considered. These options vary depending on the specific condition, its severity, and individual desires, such as fertility preservation. Treatment could involve medication, watchful waiting with repeat imaging, or surgical intervention.