Gynecologic Ultrasound

What Is Gynecologic Ultrasound?

Gynecologic ultrasound is a safe, radiation-free diagnostic method that enables imaging of the female reproductive organs by means of high-frequency sound waves. It is regarded as the first-line diagnostic tool in the evaluation of the uterus, ovaries, fallopian tubes, and pelvic region. At the clinic of Prof. Dr. Melahat Atasever, ultrasound is used as a reliable and indispensable tool in many areas, from the diagnosis of gynecological diseases to pregnancy follow-up.

Ultrasonography is an imaging method in which a probe containing piezoelectric crystals sends high-frequency sound waves, and the images formed by the reflection of these waves from tissues are displayed on a screen. Since it contains no radiation, it can be safely repeated in both pregnant and non-pregnant women. Because the results are evaluated in real time, it is also indispensable in emergency situations.

Gynecologic ultrasound is applied in two basic ways: transabdominal (through the abdomen) and transvaginal (through the vagina). Transabdominal ultrasound requires a full bladder and provides a broad overview of the pelvis. Transvaginal ultrasound, on the other hand, is performed by placing a long, thin probe into the vagina; it provides much closer and more detailed images of the organs. The two are sometimes used together to obtain complementary information.

Modern ultrasound devices offer 2D, 3D, and 4D imaging options. 3D ultrasound provides a notable advantage over standard 2D in the evaluation of uterine anomalies and congenital malformations. The color Doppler mode, in turn, plays a critical role in assessing the malignancy risk of ovarian cysts by examining blood flow.

The Difference Between Transabdominal and Transvaginal Ultrasound

Transabdominal ultrasound is performed from the surface of the abdomen; the full bladder acts as a conductor for the sound waves. The uterus, both ovaries, and the general pelvic structure can be imaged from a wide angle. However, in obese patients or when the bladder is not sufficiently full, image quality may decline. It is frequently preferred especially in the second and third trimesters of pregnancy and in the evaluation of large pelvic masses.

Transvaginal ultrasound, on the other hand, images the organs from a much closer distance by placing the probe into the vagina. It is the standard approach for small ovarian cysts, subtle endometrial lesions, early pregnancy findings, and cervical evaluation. An empty bladder is preferred. It is also regarded as the reference method for follicle monitoring during the infertility process. It can be performed comfortably in sexually active women.

The Importance of Ultrasound in Pregnancy Follow-Up

Ultrasound provides critical information at every stage of pregnancy:

• Early pregnancy: confirming the presence of the pregnancy, determining its location (ruling out ectopic pregnancy), and establishing the estimated due date.
• Fetal development: weekly monitoring of the baby’s size, weight, and organ development.
• Structural screenings: nuchal translucency measurement at weeks 11-14 and examination of all the baby’s organs with the detailed anomaly scan at weeks 18-22.
• Placenta and amniotic fluid: regular monitoring of the condition of the placenta and the amount of fluid surrounding the baby.

In Which Situations Is Gynecologic Ultrasound Performed?

It is the first diagnostic tool used for complaints such as pelvic pain, irregular menstrual bleeding, severe dysmenorrhea (menstrual pain), vaginal bleeding, and bloating. Pathologies such as uterine fibroids, endometrial polyps, and adenomyosis are easily detected with ultrasound. The dimensions of the uterus and endometrium are measured and evaluated according to age and hormonal status.

Ultrasound is indispensable in the diagnosis, classification, and follow-up of ovarian cysts. Follicular cysts, corpus luteum cysts, dermoid cysts (teratomas), endometriomas (chocolate cysts), and masses suspicious for malignancy are differentiated from one another by their ultrasound appearance. It is routinely used in the annual gynecological examination and lays the groundwork for further investigation when suspicious findings are present.

During the infertility process, follicle monitoring, endometrial thickness measurement, and evaluation of the uterine anatomy are routinely performed with transvaginal ultrasound. In IVF cycles, daily follicle growth is monitored with this method. In the early weeks of pregnancy, confirmation of the heartbeat, placental evaluation, and follow-up of high-risk pregnancies are also carried out with ultrasound.

Which Pathologies Can Ultrasound Detect?

Uterine fibroids are among the findings most frequently encountered by gynecologic ultrasound. Classified into three basic types — submucosal, intramural, and subserosal — the size, number, and location of fibroids are determined in detail with ultrasound. Endometrial polyps and adenomyosis can also be evaluated with ultrasound; in unclear cases, the evaluation is complemented with hysterosonography.

Ovarian cysts are pathologies frequently encountered by ultrasound. Simple anechoic cysts are mostly of follicular origin and benign; they resolve on their own within a few cycles. Complex cysts with septa, solid components, or increased blood flow on color Doppler raise suspicion of malignancy; in these cases, the evaluation is performed together with tumor markers such as CA-125.

An endometrioma, also called a chocolate cyst, is a type of ovarian cyst that develops due to endometriosis. On ultrasonography, it is recognized by its characteristic “ground glass” appearance. In addition, conditions such as ectopic (tubal) pregnancy, tubo-ovarian abscess, pelvic adhesions, and a retroverted uterus can also be evaluated with ultrasound.

Preparation Before a Gynecologic Ultrasound

For a transabdominal ultrasound, the bladder should be kept full by drinking plenty of water 1-2 hours before the procedure. A full bladder pushes the pelvic organs upward, making them more clearly visible. For a transvaginal ultrasound, a full bladder is not required; on the contrary, an empty bladder is preferred.

No special preparation is needed before the procedure. Current medication use, any known allergies, and the date of the last menstrual period should be reported to the physician. At her clinic in Ankara, Prof. Dr. Melahat Atasever provides patients with comprehensive information about the procedure beforehand, addressing any possible concerns. The ultrasound procedure does not require anesthesia, and normal eating can continue on the day of the appointment.

How Is a Gynecologic Ultrasound Performed?

For a transabdominal ultrasound, the patient lies on her back on the examination table. After conductive gel is applied to the abdominal area, the probe is moved at various angles to obtain images. The uterus and both ovaries are scanned systematically; dimensions are measured and any abnormal masses are identified.

For a transvaginal ultrasound, the patient assumes the examination position with her legs placed in stirrups. After a single-use sterile cover and lubricating gel are applied to the probe, it is gently placed into the vagina. The probe is rotated upward, downward, and to the sides to evaluate the uterus, both ovaries, and the fallopian tube regions. If color Doppler is needed, it is activated at this stage.

The images are displayed on the screen; the physician interprets the findings in real time and records them. Measurements are taken with millimetric precision and stored digitally. The procedure usually takes 10-20 minutes; the duration may vary depending on the complexity of the pathology being evaluated.

The Safety of Gynecologic Ultrasound

Since ultrasonography uses sound waves, it contains no ionizing radiation. Thanks to this feature, it can be safely repeated in any period, including pregnancy. In all comprehensive studies conducted to date, no harmful effect on mother or baby has been detected. It is used worldwide as the first-line diagnostic tool in gynecology and obstetrics.

For transvaginal ultrasound, since the probe is protected with a single-use sterile cover, the risk of infection is extremely low. The procedure is painless or causes only mild discomfort.