Overview of Sonography Postmenopausal Assessment, Protocols, and Interpretation
Ultrasound is the preferred method for getting images of the female reproductive system, including the uterus, cervix, ovaries, and nearby parts of the body. It’s a quick, convenient option that can be used at the bedside and doesn’t expose the patient to any radiation. This article will specifically focus on the use of this type of ultrasound in women who have gone through menopause.
Anatomy and Physiology of Sonography Postmenopausal Assessment, Protocols, and Interpretation
Changes After Menopause
As women age, they go through a natural shift in the body called menopause. It is vital to understand the alterations that take place in the body during this period, as they can affect medical imaging like ultrasounds.
Uterus
Under normal conditions, when excluding certain diseases like fibroids or adenomyosis, the size of the uterus in a woman who has gone through menopause is likely to be smaller than that of a woman of reproductive age. The measurements, including the length, height, and width of the uterus, will all generally decrease. It is known that the size of the uterus can continue to reduce progressively as one goes through menopause. Besides, in postmenopausal women, the ratio between the upper part of the uterus (corpus) and lower part of the uterus (cervix) returns to a shape similar to what is seen before puberty. The lining of their uterus, known as the endometrium, should appear thin and shrunken on an ultrasound image.
Ovaries
Similarly, the ovaries in postmenopausal women are usually smaller and more uniform in structure. On ultrasound, they may have small, dark spots (hypoechoic follicles) which are fewer than those seen in the ovaries of women of reproductive age. Because the ovaries reduce in size during menopause, it is quite common not to see the ovaries on an ultrasound scan in a woman who has been through menopause. However, this is not a cause for worry. The reduction in the size of the ovaries can continue throughout menopause.
Why do People Need Sonography Postmenopausal Assessment, Protocols, and Interpretation
A pelvic ultrasound might be suggested for women who have gone through menopause, especially if they are experiencing issues such as bleeding after menopause, pain in the lower belly, a history of ovarian cysts, a feeling of fullness or bloating in the tummy, an increase in the size of the belly, or pressure in the lower belly.
Postmenopausal Bleeding
Bleeding after menopause is a common reason for getting an ultrasound of the pelvis. The most frequent cause of bleeding after menopause is thinning of the vagina and/or uterus lining because of less estrogen. However, it can also be the first sign of endometrial cancer (cancer of the uterus lining) for about 90% of women. This means it’s crucial to quickly figure out or eliminate the possibility of cancer in patients who have bleeding after menopause.
The first non-invasive step for evaluating a patient with postmenopausal bleeding is a transvaginal ultrasound to measure the thickness of their uterine lining. Research shows that a uterine lining thickness of 4 mm or less has a high predictive value that endometrial cancer is not present. However, the thickness of the uterine lining is not very specific in detecting endometrial cancer. Therefore, women with postmenopausal bleeding and a thickened uterine lining on ultrasound should undergo further tests.
However, endometrial cancer can sometimes be present with a thin uterine lining. Therefore recurrent or persistent bleeding after menopause should prompt further tests. Endometrial sampling, which involves collecting a small sample of cells from the uterine lining for testing is the gold standard for diagnosis or exclusion of endometrial cancer. While the uterine lining thickness can guide doctors on which patients might need this further testing, it is also important to note that personal risk factors for endometrial cancer, such as obesity, diabetes, family history, or genetic conditions can increase the chance of having endometrial cancer even with a thin uterine lining.
Incidental Thickened Uterine Lining
Sometimes, women who have gone through menopause have a pelvic ultrasound for reasons other than bleeding after menopause and are found to have a thickened uterine lining. In these women who do not have any symptoms, it’s still unclear when further testing should be done. A thickened uterine lining still may indicate a higher risk of cancer.
Adnexal Masses
Abnormal growths near the uterus and ovaries, known as adnexal masses, are another common reason for a pelvic ultrasound in women who have gone through menopause. Most adnexal masses are harmless, but the risk for ovarian cancer increases with age. However, routine yearly ultrasound screening for ovarian cancer is not recommended for all postmenopausal women because many benign (noncancerous) cysts are common and ultrasound does not have high accuracy for distinguishing between benign and cancerous cysts.
Simple ovarian cysts are often seen in postmenopausal women and often go away on their own. Current guidelines suggest that simple cysts that are between 1 cm and 7 cm in diameter should be monitored at least yearly by ultrasound in a postmenopausal patient. If the cysts are larger or more complex, additional imaging or surgery may be needed.
Research has shown that the appearance of an ovarian mass can indicate its chances of being cancerous. For example, cysts with a single compartment are associated with an extremely low chance of cancer. Cysts that have multiple compartments, or cysts that are primarily solid, both have much higher risks of being cancerous. Therefore, a pelvic ultrasound can be used to describe the shape and structure of these masses and potentially identify their riskiness.
When a Person Should Avoid Sonography Postmenopausal Assessment, Protocols, and Interpretation
There are very few reasons why someone might not be able to have a transvaginal ultrasound. This is a test where a small device is inserted into the vagina to take pictures of the inside of the body. However, in some cases, the test may be too uncomfortable. This includes people who have never had sexual intercourse, or people who have a condition called vaginal atrophy, which means the vagina has become dry and thin.
Equipment used for Sonography Postmenopausal Assessment, Protocols, and Interpretation
An ultrasound device is required, which is used with probes that can do scans across the belly area (transabdominal) and/or through the vagina (transvaginal).
Who is needed to perform Sonography Postmenopausal Assessment, Protocols, and Interpretation?
An ultrasound, which is a type of medical scan, can be carried out by a trained healthcare professional known as a sonographer or by a doctor. The images captured by the ultrasound are typically analyzed and understood by a doctor who is either an expert in women’s health (obstetrics and gynecology) or a specialist in medical imaging (radiology).
Preparing for Sonography Postmenopausal Assessment, Protocols, and Interpretation
When doctors need to get a good look at the reproductive organs, it’s usually better if the patient’s bladder is full. This is particularly true if they’re doing a scan from outside the abdomen. On the other hand, if the scan is being performed from inside the vagina, it’s usually easier to see the organs if the bladder is empty.
How is Sonography Postmenopausal Assessment, Protocols, and Interpretation performed
When examining the female pelvis, doctors usually employ two kinds of ultrasound methods: transabdominal and transvaginal imaging.
Transabdominal
Transabdominal imaging, as the name suggests, is done by scanning the abdomen. It is not usually very useful for postmenopausal women because the normal shrinkage of the reproductive organs can interfere with the results. However, it can be beneficial for patients who have a large uterus or big pelvic masses. This method gives a broader view compared to the transvaginal method. It’s also good for patients who can’t or don’t want to have a transvaginal ultrasound. The imaging is typically done with a full bladder using special equipment known as transducers.
Transvaginal
Transvaginal scanning, on the other hand, involves inserting an ultrasound device into the vagina. This method is preferred for postmenopausal women as it provides high-resolution images. It is carried out after the patient empties their bladder. The transducer uses high-frequency waves giving detailed images. Sometimes, it’s possible to spot a small amount of clear fluid in the endometrial canal (the canal that lines the uterus) of postmenopausal women. In such situations, there’s a special way of measuring the thickness of the endometrium. Both transabdominal and transvaginal imaging techniques can help evaluate masses in the adnexa – the area where the uterus, ovaries, and Fallopian tubes are located. They can identify the origin of the mass, its size, whether it’s solid or liquid, its laterality (which side it’s on), and whether there are any growths. The ultrasound can also help find non-gynecological reasons for these masses, such as appendicitis, an abscess, pelvic kidney, or inclusion cysts in the lining of the abdomen.
Saline Infusion Sonography
Another method called saline-infusion sonography (SIS) can complement transvaginal ultrasound for exploring lesions in the endometrial cavity or if there’s trouble seeing the endometrial lining. In SIS, a small tube is inserted through the cervix to send saline into the endometrial canal. The saline expands the canal, making it easier to spot lesions like endometrial polyps or fibroids in the uterine wall.
Doppler
Lastly, Doppler ultrasound can be used to examine blood flow through vessels. It can help distinguish between a benign (not life-threatening) and a malignant (cancerous) mass. This can be especially useful when imaging a postmenopausal patient.
What Else Should I Know About Sonography Postmenopausal Assessment, Protocols, and Interpretation?
A pelvic ultrasound is a very important tool for checking the health of women who have already gone through menopause. It is particularly useful for understanding the causes of bleeding after menopause and for identifying growths near the ovaries.
By using this type of imaging technique, doctors can spot early signs of conditions like endometrial (lining of the uterus) or ovarian cysts (fluid-filled sacs in the ovaries). Catching these conditions early can lead to better health results for the patient.