On what day of the cycle can a doctor prescribe a pelvic ultrasound for women?

Ultrasound examination of the pelvic organs allows you to assess the health of the reproductive system. This procedure must be carried out if pathologies are suspected. It is simple, safe and informative.

Pelvic ultrasound shows true results only on certain days of the cycle

Ultrasound does not require special preparation, but to obtain the most reliable information, it should be performed only on certain days of the cycle. The doctor will tell you what period to choose for this.

The essence of the procedure

When performing an ultrasound examination, there are two ways to see the inner layer of the uterus:

1. Transabdominal ultrasound, in which the ultrasound probe is placed directly on the anterior abdominal wall, and the uterus is visualized through it. Abdominal ultrasound is considered a less informative technique, but it also has its advantages: the ability to see the general condition of the organ being examined, the absence of any unpleasant sensations during the procedure. Conditions such as severe obesity and postoperative adhesions significantly complicate diagnosis in the transabdominal variant.

2. Transvaginal ultrasound, in which a specially shaped sensor is inserted into the vagina and makes it possible to visualize the uterus and appendages with high accuracy, since it is located as close to them as possible. In gynecology, this technique is widely used to diagnose endometritis, tumors, ectopic pregnancy, and to determine the causes of infertility. Transvaginal examination is not performed on virgins, so as not to damage the hymen, and on pregnant women after 12 weeks, as this can cause a miscarriage.

Indications

Your doctor will tell you when to do an ultrasound. Indications for ultrasound examination of the endometrium are:

• the duration of menstruation is less than three or more than seven days;
• intermenstrual bleeding;
• nagging pain in the lower abdomen without connection with menstruation;
• pain and discomfort in the lower abdomen during sexual intercourse;
• inability to become pregnant for more than 6 months with regular sexual activity;
• delay of the menstrual cycle for more than three weeks.

As a rule, this method is prescribed for diagnosing the following gynecological pathologies:

• Endometrial hyperplasia is a significant thickening of the inner layer of the uterus, which in advanced cases even leads to malignant neoplasms. The causes of hyperplasia are hormonal disorders. In this case, ultrasound is done immediately after menstruation, in the second phase of the menstrual cycle.
• Endometriosis is a pathological growth of the endometrium, considered a precancerous disease.
• Endometrial polyp is a local growth of the endometrium in the form of a benign volumetric formation on a wide or narrow “leg”, its basis is vascular or glandular tissue.
• Endometrial cancer is a malignant neoplasm that can be located in any part of the uterus. Timely ultrasound examination will identify pathological signs at an early stage.
• Endometritis is an inflammation of the internal uterine layer, most often associated with the consequences of surgical interventions and invasive procedures (diagnostic curettage, abortion). According to the nature of the course, acute and chronic variants of endometritis are possible. With endometritis, inflamed areas are highlighted in a different color on ultrasound.
• Endometrial hypoplasia is a small thickness of the uterine mucosa. The presence of such changes is often associated with insufficient blood supply or damage after an abortion with excessively deep curettage. Ultrasound for this pathology is performed in phase 1 or 2 of the menstrual cycle.

Preparation and progress of the examination

Preparation for an ultrasound largely depends on the chosen research method. But there are also general rules that must be followed before the procedure:

• 3 days before the ultrasound, you should not eat foods that contribute to the development of increased gas formation in the intestines.
• A couple of hours before the procedure, you can take medications that reduce flatulence (like Espumisan).
• It is recommended to observe sexual rest 1 day before the test.
• It is not advisable to eat food 8–10 hours before. It is better to perform an ultrasound on an empty stomach, after bowel movements.
• Transabdominal ultrasound is performed with a full bladder. To fill your bladder, about an hour before your appointment, you need to drink plenty of liquid without gas and not go to the toilet.
• Before performing a transvaginal ultrasound, on the contrary, you must first empty your bladder.

Different types of ultrasound have their own characteristics. Often, immediately before the procedure, a gynecological examination is performed to compare clinical examination data with ultrasound results. This is necessary for a more accurate diagnosis.

If the procedure is performed transabdominally, then a special gel is applied to the anterior abdominal wall, and the doctor examines the internal organs using a sensor. Due to the filling of the bladder, the pelvic organs rise higher to the abdominal cavity and become clearly visible.

In the case of transvaginal examination, the sensor is also pre-treated with gel and inserted into the vagina. With this study, the uterus and its inner layer are better visible, and the thickness of the endometrium can be measured more accurately.

When can pregnancy be detected?

Thanks to positive experience and reviews, gynecological ultrasound is safely performed in the early stages of pregnancy. It allows you to determine the location of the fertilized egg and eliminate the risk of developing an ectopic pregnancy. Normally, it should be located inside the body of the uterus. At 6-7 weeks of gestation, the head, arms, legs, and torso of the fetus can be visualized.

The optimal time for the first study is 10 - 12 weeks, when it is already possible to determine the fetal heartbeat and the thickness of the collar zone. If there is a deviation from the norm, there is a risk of developing Down syndrome. Next comes the second screening at 22-23 weeks of pregnancy, when the likelihood of developing defects of internal organs is established or excluded. At this time, it is already possible to determine the sex of the child.

The third screening is performed upon reaching 31-32 weeks of pregnancy. At this time, it is possible to determine late developmental deviations, the degree of maturity of the placenta, the condition of the child and amniotic fluid. Ultrasound is performed using a transabdominal probe. Interim diagnostics are prescribed if there are indications or if the pregnant woman’s well-being worsens.

Source

Decoding

When decoding, pay attention to the following indicators:

1. Location of the uterus. There may be congenital anomalies such as bends, torsions, and non-physiological location. During pregnancy, the uterus normally tilts forward.
2. Dimensions of the uterus. Their increase may be a sign of pregnancy, endometritis or tumors. Small sizes indicate underdevelopment - infantilism.
3. Contours of the uterus. Normally they are smooth and clear. Blurred boundaries may indicate the presence of an inflammatory process. Lumpy edges indicate the possible growth of a space-occupying lesion. When the uterus is split into two sections, they speak of such a structural anomaly as a bicornuate uterus.
4. Echogenicity of the uterine walls. A change in the density and structure of a section of the uterine wall often indicates the presence of a tumor or local inflammation.
5. Condition of the appendages. The presence of pathology of the fallopian tubes, ovaries, and the presence of ectopic pregnancy is assessed. The tubes are normally not visible at all on ultrasound. The ovaries can be changed due to apoplexy, polycystic disease, tumors.
6. Endometrial thickness. The results of measuring the thickness of the endometrium make it possible to diagnose its hypo- or hyperplasia.

Ultrasound before menstruation

The doctor will best determine which day is suitable for examining the pelvic organs. Usually this time is from 3 to 5 days after menstruation. However, in some cases, the doctor may suggest undergoing the procedure before menstruation.

An ultrasound is performed in the second half of the cycle if a woman is undergoing infertility treatment. This is necessary to determine on what day ovulation occurs. The doctor will also monitor the condition of the follicle. The uterus itself should normally be located strictly in the center; no compactions or neoplasms should be visualized in its cavity.

Immediately before menstruation, the size of the uterus is determined using ultrasound. It should be at its maximum at this time.

An ultrasound of the pelvic organs a few days before menstruation can identify a number of diseases:

• During this phase of the cycle, the existing uterine fibroids are clearly visualized. This is a benign neoplasm.
• Before menstruation, the first signs of endometriosis can be detected. This is evidenced by small bubbles located inside the uterus.
• Cervical cancer can also be diagnosed using an ultrasound before menstruation. The device will show the size of the tumor and its location.

For a full examination of the ovaries, repeated ultrasound examinations may be required at different phases of the cycle. In addition, in the second half of the cycle, a study of the fallopian tubes is often performed. No matter what day of the luteal phase the procedure is performed, it will show the presence of salpingitis - inflammation of the fallopian tubes. This pathology is fraught with the formation of adhesions, which further reduces patency and leads to infertility.

Uterine fibroids are well visualized before menstruation

Endometriosis concept

Endometriosis in gynecology is a chronic disease that causes benign growth of the intrauterine membrane in various atypical places in the female body.

This disease ranks second among the causes of female infertility.

This disease is insidious in that it does not manifest itself in any way for many years. And the many forms of endometriosis and the varieties of its manifestations seriously complicate the diagnosis of this pathology.

What exactly may be the cause of endometriosis is still not fully understood. It is believed that the disease is based on immune and endocrine disorders of the body. However, the main impetus for its development are the various consequences of endometrial trauma for the following reasons:

• scraping;
• abortions;
• use of intrauterine contraceptives.

All of the above factors seriously affect female hormonal levels and the cyclical nature of its development.

With endometriosis, foci of endometrial growth are periodically rejected (in accordance with the phases of a woman’s menstrual cycle). At the beginning of the cycle, the endometrium grows, reaching its maximum thickness towards the end of the cycle and being shed during menstruation.

It is with the cyclical behavior of endometriotic lesions that the timing of ultrasound examination in this disease is associated.

Main forms and symptoms of endometriosis

Endometriosis usually affects women of reproductive age. Often this disease is discovered unexpectedly, for example, during a preventive examination.

It is transvaginal ultrasound that is considered the main method for identifying this pathology.

The types of this disease are distinguished from the location of the foci of tissue proliferation:

• adenomyosis;
• perineal, cervical and vaginal;
• pipe;
• ovarian.

Women suffering from endometriosis may most often experience the following unpleasant symptoms:

• duration of menstruation and their pain;
• the appearance of clots during menstruation;
• chronic pain in the lower abdomen, starting in the middle of the cycle;
• spotting brown discharge outside the menstrual cycle (in the middle, a few days before and after the cycle);
• pain during sexual intercourse, urination, defecation, exertion;
• infertility for unknown reasons.

Advantages and disadvantages of performing an ultrasound during menstruation

Usually, ultrasound diagnostics are not performed during menstruation. However, sometimes such an examination is necessary. For example, with an ultrasound during menstruation:

1. In the first (1-3) days of the cycle, polyps, fibroids or hyperplasia are best diagnosed.
2. If menstruation is irregular or a woman is being treated for infertility, then the examination is carried out in the 1st half of the cycle, then repeated every two weeks (the interval can be 20 days). The number of procedures and the time of their implementation are determined in each case purely individually.
3. For severe bleeding, which may indicate dangerous pathologies.
4. The nature of the neoplasm (physiological or pathological) is clarified.

When is it necessary to undergo an ultrasound?

With endometriosis, it is extremely important to identify this pathology as early as possible. However, the asymptomatic nature of this disease or its minor manifestations lead to the diagnosis being made at an already advanced stage.

The diagnosis of endometriosis is not easy to recognize: it is often made with a gap of 10-12 years.

Therefore, there are a number of symptoms in which you should suspect something is wrong and get a referral for an ultrasound:

• duration, abundance and pain of menstruation;
• cycle disorders;
• frequent brown discharge;
• painful urination;
• excessive emotionality;
• increased body temperature;
• the appearance of anemia in a blood test or its signs (weakness, pallor, yellowness of the skin, fatigue, dizziness).

Tests for diagnosing endometriosis

Endometriosis diagnosis is a difficult issue.

The complexity of the course of this pathology often leads to difficulties in identifying it during ultrasound diagnostics. In this case, patients with unclear symptoms are prescribed other additional research methods.

Only a specialist can decide what types of tests to prescribe for this disease. In some cases, only the laparoscopic method (low-traumatic surgical method) can establish a final conclusion.

Diagnostic methods for detecting endometriosis

• Cytological examination: used for screening diagnosis of many uterine pathologies, however, this method is not able to reveal the full picture of the disease.
• A study on tumor markers: in case of endometriosis, it is indicative, since their number is increased here. In this case, it is possible to assess the severity of the disease and the effect of the therapy. Typically, this method is used in parallel with analysis of hormones (progesterone, prolactin, testosterone).
• Colposcopy: a colposcope is inserted through the vagina using special solutions (acetic acid, iodine, Lugol's solution). However, the method has contraindications (not earlier than 1 month after an abortion and 2 months after childbirth or uterine surgery, intolerance to the medications used).
• Biopsy: A piece of tissue is removed for examination. It is used immediately after menstruation. It requires highly qualified specialists: a surgeon and a pathologist. Otherwise, the disease can be missed. After local anesthesia, a tube with a piston is inserted to collect tissue. After 10-14 days, the result is ready. With this method, the diagnostic accuracy is about 98%.
• Computed tomography: allows you to determine the pathology, its type and connection with other female organs.
• Magnetic resonance imaging: has high resolution and diagnostic accuracy of up to 96%. In this case, nuclear magnetic resonance is used. This method is associated with maintaining the patient's immobility, so it is contraindicated in patients with claustrophobia, patients with pacemakers and hearing aids, and seriously ill patients. This is a painless method; it is only accompanied by noise.
• Laparoscopy: makes a diagnosis with high accuracy - up to 96%. Endometriosis is diagnosed in and outside the uterus. A laparoscope with a flexible cable and lenses connected to a video camera is inserted through a small puncture in the abdominal wall. The device distributes foci of pathologies by color and shape, determining their size and degree of maturity. This is a progressive, low-traumatic method, without complications in the form of scars or any pain. The recovery of patients after it is rapid: laparoscopy is considered the “gold standard” among all types of examinations.
• Hysteroscopy: In this method, the hysteroscope is inserted through the cervix. It is also used to treat pathologies. The procedure requires anesthesia (local or general). To straighten the uterus, carbon dioxide or liquid (saline or saline solution) is first injected into it. This study is carried out on days 8-10 of the cycle. Hysteroscopy has several advantages: the absence of adhesions due to low trauma, excellent viewing of the walls of the uterus, and a minimum of complications.

When is the best time to perform an ultrasound for endometriosis?

The answer to the question “when to do an ultrasound for endometriosis” is associated with the characteristics of the physiological processes of the female organs in various phases of the menstrual cycle. It is best to examine the female organs and identify this disease on days 23-25 ​​of the menstrual cycle. In phase 1 of the cycle (from 1 to 11 days) and during the period of ovulation, it is extremely difficult to diagnose endometriosis with sufficient accuracy. This is due to the uneven echogenicity of the uterine endometrium, which can be falsely interpreted as a manifestation of other ailments (endometritis, etc.)

But the secretory phase of the cycle (from 16 to 28 days) is characterized by maximum echogenicity.

In this case, the line of closure of the mucous membranes is erased, allowing ultrasound to detect many pathologies of the endometrial uterine layer.

Ultrasound examination of the ovaries

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If we talk about determining the functioning of the ovaries, then on days 5-7 of the cycle, a gynecological ultrasound will be more effective. As a result of the study, the following information can be obtained:

• Dimensions - normally their length is 30-41 mm, thickness - 14-22 mm, width - 20-31 mm.
• The location of the organs should be on the sides of the body of the uterus, at a slight distance from it, while the ovaries should not be identical to each other, or have an oval shape.
• At the beginning of the menstrual cycle, follicles are visualized at different stages of maturity. If the study is carried out in the second phase of the cycle, then the corpus luteum should already be visualized, which will indicate the onset of ovulation.

Manifestation of endometriosis on ultrasound

What can an ultrasound scan show for endometriosis?

Ultrasound diagnostics can show different results depending on the type of disease. The following forms of endometriosis are known:

• nodal;
• focal;
• diffuse (internal type).

On ultrasound, diffuse endometriosis manifests itself:

• structural metamorphosis of the uterine wall (oval or round);
• contourless structure;
• cystic areas (up to 30 mm);
• interstitial type nodes (without going beyond the organ).

The focal form of endometriosis on ultrasound can manifest itself:

• different thickness of the uterine walls;
• cystic cavity (from 2 to 16 mm);
• increased echogenicity of the muscular wall of the uterus with smooth, clear contours.

With endometriosis of the uterus, the following will be detected:

• blurred and uneven endometrial tissue;
• nodal structures;
• asymmetry of the uterine walls.

Ovarian endometriosis often manifests itself:

• finely punctuated tissues with a heterogeneous structure;
• rounded neoplasms (on the side or back of the uterus);
• interspersed with foci of various shapes, structures and sizes.

The accuracy of ultrasound diagnostics for endometriosis is about 80%. With normal women's health, gynecologists usually refer the patient for an ultrasound scan at least once a year. For confirmed endometriosis, ultrasound examination is usually prescribed once every six months. It is especially important to contact a gynecologist for women with a “complicated” gynecological history (difficult childbirth, infections, abortions, miscarriages, etc.). Maintaining one’s own women’s health largely depends on the woman herself.

• Endometritis and endometriosis are common gynecological diseases. The first implies an inflammatory process in the inner layer of the uterus, and the second is the spread or growth of the inner layer of the uterus beyond its limits, to other organs and tissues.

  Both diseases can lead to serious consequences, but diagnosing them at an early stage is quite difficult.

  Primary diagnosis of endometriosis, like endometritis, is most often done through ultrasound examination of the uterus. This method helps to differentiate the disease, determine its severity and select the optimal treatment tactics.

  On what day of the cycle should I do an ultrasound? What can the results show? Is it possible to see, for example, endometrial cancer using ultrasound? Read the answers to these and other questions in the article.

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Indications for ultrasound diagnostics of the endometrium

Why is it so difficult to determine the presence of endometrial diseases and this can only be done by ultrasound or using similar diagnostic methods? Because damage to the inner mucous membrane of the uterine body often occurs without any symptoms that would indicate to a woman a problem. In some cases, endometriosis can have such weak and blurred symptoms that a woman does not even suspect that she has any gynecological disease.

Ultrasound examination of the endometrium is indicated in the presence of the following symptoms and complaints:

Often women do not pay attention to these signs, considering them a variant of the norm or a minor deviation that does not require seeing a doctor. As a result, the disease imperceptibly transforms into a chronic form that is difficult to treat.

Deviations from the norm

You should not look for an answer to the question: “Which gynecological ultrasound is better?” Because any method of conducting research can reveal certain deviations. Naturally, modern sensors are highly sensitive and can detect deviations in the photo. Which of these can be determined by ultrasound? For example, anomalies in the development of the genital organs, uterus, appendages.

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Thanks to this study, its structure can be visually determined. It happens that a woman’s uterus has a septum, is divided into two or one part (bicornuate, unicornuate with one fallopian tube), is very small in size or is completely absent (agenesis). Without gynecological ultrasound, it would be difficult to detect such abnormalities. As well as the presence of fibroids, polyps, endometriosis and others.

Optimal time and procedure for diagnostics

When to do an ultrasound for endometriosis or on what day of the cycle is one of the most important questions that interests women. Indeed, depending on the day of the cycle, the thickness of the endometrium and its structure also change. For certain types of gynecological examinations, there are optimal periods in the menstrual cycle when the results are most informative, accurate and reliable.

Experts recommend doing an ultrasound at the end of the second period of the cycle, that is, immediately before the start of menstruation. This is explained by the fact that it is on the 25-28th day of the 30-day cycle in the uterine cavity, on its inner layer, that areas with existing anomalies begin to grow. The thickness of the endometrium increases, its nodules are clearly visible. This condition of the inner surface of the uterus is also called “lush endometrium.”

If a woman’s cycle lasts not 30 days, but more or less, and she does not know when the second period of the cycle is coming to an end, it is better to do an ultrasound after consultation with a gynecologist. The specialist will help you calculate the optimal day for the procedure, and endometritis on ultrasound, if any, will be visible as clearly as possible.

Sometimes, in order to verify the presence of a disease, the examination needs to be repeated. The second ultrasound of the endometrium is usually done a week after the end of menstruation, when the thickness of the endometrium is normally at its minimum. In some cases, the study is carried out at the end of the menstrual cycle for several months (cycles) in a row.

Ultrasound examination of the uterine cavity is performed transvaginally. That is, the device’s sensor scans the uterine cavity through the vagina.

If a young girl who has not had sexual intercourse or a woman who is not sexually active is being examined, an ultrasound can be done rectally - through the anus. There are no other options, since conducting an examination externally, through the abdominal cavity, for this disease is not informative and useless.

Before performing an ultrasound, no preparation is required other than careful hygienic procedures of the genitals. You may need to drink several glasses of water and not urinate for 30 to 50 minutes before the ultrasound. A moderately full bladder will facilitate the examination.

Research of the uterus and ovaries

The examination of these pelvic organs is carried out during the second period of the menstrual cycle when a woman is undergoing treatment for infertility. At this time, an ultrasound will show the condition of the follicle and confirm the onset of ovulation. In addition, it is possible to monitor the condition of the uterus itself. It should be located in the center of the pelvis, have a homogeneous structure without any formations. An ultrasound before menstruation will show its size - they differ depending on what day of the cycle it is. Before menstruation, the uterus should be at its largest size. Using an ultrasound machine, you can obtain specific data. What diseases of the uterus can an ultrasound scan performed before menstruation show:

• Uterine fibroids are a benign tumor. A woman can pay attention to various symptoms herself and consult a doctor. But an ultrasound examination will help to accurately determine the presence of this problem. Thanks to timely detection, fibroids can be effectively treated;
• Endometriosis. An ultrasound before menstruation does not make it possible to diagnose this disease with 100% accuracy. But, thanks to it, you can detect characteristic symptoms - small bubbles in the muscular cavity of the uterus and carry out all the necessary additional research;
• Cervical cancer is a malignant tumor. An ultrasound before menstruation will be able to show the size that the tumor has reached, the location of its location and spread, as well as its effect on nearby organs.