The transvaginal ultrasound is quickly becoming the standard of all gynecologic exams. The standard pelvic examination performed 10 or 20 years ago as part of your annual exam is not very helpful in assessing a woman with abnormal uterine bleeding. A ‘growth’ no larger than a grape can cause very heavy menstrual bleeding yet is almost impossible to detect by a digital examination. The ultrasound exam offers several advantages, among which are that it is less uncomfortable and provides far greater information along with an image of your uterus and ovaries which can be printed and kept on file for future reference.
Consider the ultrasound on the left of an anatomically normal uterus versus the one on the right that shows a small fibroid in the center of the uterine cavity. On bimanual (“pelvic”) examination both of these uteri will feel virtually identical to the examiner. Yet the quarter-sized fibroid seen on the right is enough to wreak havoc on your periods!
For about 3/4 of the women we see with menstrual abnormalities the medical history, menstrual history and the ultrasound examination provides us with enough information to develop a treatment plan.
If your ultrasound is completely normal—which is true 75% of the time—you may still require various blood tests or an endometrial biopsy (a biopsy of the uterine lining). If your ultrasound is abnormal, you may require a test called a sonohysterogram or a diagnostic hysteroscopy. In general, we try to keep testing to a minimum and we avoid testing that will not affect your treatment.