Is pelvic ultrasound still important in menopause and postmenopause? Yes, without a doubt. Let's explore its purpose, its utility, and the significance of undergoing this procedure during menopause.

What is pelvic ultrasound?

Ultrasound is also known as an echosonogram or sonogram. This is a non-invasive diagnostic procedure that uses high-frequency sound waves to create real-time images of organs and structures in the body. In this case, it makes images of the organs located in the female pelvis such as the uterus, ovaries and fallopian tubes. However, ultrasound can also be performed on other body parts, including the breasts, neck, abdomen, among others ^(1,2).

This test is conducted using a transducer, which is a device that sends sound waves into the body. In the context of a pelvic ultrasound, the transducer can be placed on the skin of the pelvic region or inserted through the vagina ⁽¹⁾.

Pelvic ultrasound is a simple, non-invasive test that does not generate radiation. It is usually very quick, lasting only 15 – 30 minutes. Transvaginal ultrasound, on the other hand, can be a little uncomfortable, but never painful. It usually doesn’t require any prior preparation. However, depending on the organs to be evaluated, the specialist may ask you to drink plenty of water or urinate before the test ^(2,3).

For this procedure, you will be asked to expose the skin of your lower abdomen. If a transvaginal echo is needed, you may also be requested to remove your underwear. Next, a small amount of gel will be applied to help the transducer move more easily. The doctor will evaluate the images in real time and then the study will end ^(2,3).

Usefulness of ultrasound of the pelvis

The primary purpose of pelvic ultrasound is to assess part of the female reproductive system. Also, to diagnose diseases related to the organs and structures located in the pelvis. Some of the key applications of this study are ⁽¹⁾:

• Detect and monitor pregnancy.
• Assess the baby in the uterus.
• Diagnose masses or cysts on the ovaries.
• Evaluate the uterus and the tissue inside the uterus for masses, lesions, or bleeding.
• Detect and monitor ovarian or endometrial cancer.
• Investigate possible causes of pelvic pain.
• Evaluate the causes of menstrual disorders.

However, although pelvic ultrasound is a valuable tool, it also has some limitations. For example, the quality of the images may be affected in people with obesity. In addition, it may not be sufficient to diagnose some diseases. Vaginismus, vaginitis and vaginal infections cannot be diagnosed with this test. Diseases such as endometrial or ovarian cancer require further confirmatory studies ⁽¹⁾.

Pelvic ultrasound in menopause

This procedure is highly beneficial during menopause and postmenomause. It allows a more detailed evaluation of the uterus and ovaries. Thus, it is possible to diagnose the following diseases in menopause ⁽⁴⁾:

• Uterine fibroids.
• Thickening of the inner layer of the uterus.
• Endometrial cancer. 
• Ovarian cysts
• Ovarian cancer.

Because many pelvic organs undergo changes during menopause, it is difficult to assess them by placing the transducer over the abdomen. Therefore, a transvaginal ultrasound is best used. A saline infusion ultrasound can also be used, which consists of filling the uterus with sterile saline to more easily assess the innermost layer of the uterus. In addition, a Doppler sonogram can help differentiate between a harmless mass and a possibly malignant one ⁽⁴⁾.

This test is generally suggested when there is irregular bleeding, pain or heaviness in the pelvis, and pain or swelling in the abdomen. If the test is abnormal, the doctor may recommend repeating the test every year or more frequently. This is to monitor the progression of the disease ⁽⁴⁾.

Pelvic ultrasound is a valuable medical tool to diagnose and evaluate a variety of pelvic organ conditions. During menopause, it can be used to rule out endometrial and ovarian cancer, among other things. It is therefore important that you go for your ultrasound examination according to your doctor's instructions.

Bibliographical references

1. Johns Hopkins Medicine.

2. NHS. Ultrasound scan.

3. Cambridge University Hospitals. Ultrasound scan of the pelvis (gynaecological).

4. Buckley, I. & Kondagari, L.Sonography post-menopausal assessment protocols, and interpretation.Statpearls.