Ultrasound of the pelvis in postmenopause

Study of the pelvis in postmenopausal women

1. Uterus. In postmenopause, the uterus becomes much smaller in size and more homogeneous by echostructure: the endometrium is not traced.
2. Ovaries in postmenopause. Ovaries small and often very difficult or impossible to visualize them with ultrasound. In the event that they still are visualized, they look hyperechoic, without follicles and are often almost isoechogenic to the surrounding tissue.

Position of the uterus

The uterus can be rotated in such a way that the uterine body is defined behind the neck (retroversio state). The body of the uterus can be rejected anteriorly (anteversio).

If the body of the uterus is tilted toward the cervix, it is in antejlexio. If the body of the uterus is tilted back from the cervix, this condition is called retroflexio.

In cases where the uterus is not visualized, it is necessary to find out whether there was a history of hysterectomy. If there is an indication in the medical history of surgical intervention, carefully look for the stump of the cervix, since it is possible not a hysterectomy, but a supravaginal amputation.

When the normal echostructure of the pelvic organs is not clearly visualized, give the patient more fluid to fill the bladder.

Ovaries

Ovaries may occupy a different position, but they are always behind the bladder and uterus. Most often they are found on the spot of appendages, from the side.

The ovary can be located in the ophthalmic space or above the bottom of the uterus. In postmenopausal women, the ovaries are small and often not visualized.

If there are difficulties in visualizing the uterus and ovaries, slide the uterus manulously through the vagina and continue scanning in different planes to refine the anatomical details. This technique can be used in the presence of low-lying pelvic formations.

In the absence of visualization of the ovaries, the following technique can be used:

1. Place the patient in the position on the side and scan the opposite ovary through the filled bladder.
2. Reduce the sensitivity level of the instrument. If the sensitivity is too high, the ovary can be poorly identified against the background of the surrounding parameter and may not be visualized.

If the ovaries are still poorly visualized, this may be due to too large or insufficient filling of the bladder. Adequate is considered such filling, at which the bladder covers the bottom of the uterus, if the bladder is not full enough. Give the patient more water. Repeat the test after 30 minutes, try to visualize the ovaries.

If the bladder is full, it moves the ovaries down from the uterus or laterally to the lumbar muscle. Ask the patient to partially empty the bladder (give her a special measuring container for filling). Then repeat the test.

Even if the bladder is filled adequately, the ovaries can be visualized poorly due to screening by intestinal gases. This often happens if the ovaries are located higher than usual.

If necessary, scan the patient in a vertical position or in a vertically oblique projection. This will help to displace the gas-filled intestinal loops, while the ovaries are visualized more clearly.

If the normal anatomy is not clearly defined, carefully enter 20 ml of body temperature water into the vagina and scan over the pubis. The fluid will surround the cervix and facilitate the identification of organs. This method is especially useful in conducting a differential diagnosis between hysterectomy and supravaginal amputation in cases where it is not possible to conduct a clinical trial.

If it becomes difficult to visualize behind-the-ear formations, inject 200 ml of warm water into the rectum, then examine this area. Air microbubbles will be visualized in the form of bright hyperechoic structures, clearly delimiting the front wall of the rectum, which facilitates the recognition of lesions in the gut lumen, for example fecal masses, which are the most common cause of diagnostic errors.

Normal ovaries

When the ovaries are visualized, determine if there is any displacement of the surrounding structures. Determine the state of the internal structure of the ovaries and the presence or absence of acoustic pseudo amplification. If anoechogenic structures are visualized in the thickness of the ovaries or at their periphery, it is possible that these are follicles. Reduce the level of sensitivity in the study of the ovaries, since the normal ovaries have a high acoustic conductivity and deepening is observed. Measure each ovary.

Examine the tissue around the ovary for the presence of cystic, solid or fluid-containing formations. Look for fluid in the anteater area. Examine both ovaries.

Ovaries are normally not located in front of the uterus. At an atypical location, turn the patient to reveal the fixation of the ovary with a solder and determine if it is significantly enlarged.

The sensitivity of the instrument should change when examining different structures in a small pelvis to obtain an optimal image. The relationship between pelvic organs can be better determined by slow, constant scanning for about 10 seconds.

Follicular apparatus of the ovary

The follicles are visualized in the form of small-cystic anechoic structures in the thickness of the ovary or along its periphery and are better visualized when establishing a low sensitivity level of the device. Depending on the phase of the menstrual cycle, cystic structures can reach 2.5 cm in diameter. Simple cysts with a diameter of more than 5 cm can be physiological and can change, become smaller or disappear).

If the presence of cystic tumor formation is expected, dynamic follow-up is needed - a study in the early and late phase of the menstrual cycle. Follicular cysts regress, while nonfunctional cysts do not change their size. If you still have doubts, conduct a survey next month.

The physiological cyst in the ovary can have a diameter of up to 5 cm. Cysts of this size should be re-examined at the end of the menstrual cycle or during the next cycle.