Gynaecological ultrasound – guide to what a scan shows

Many gynaecological conditions progress for a long time without symptoms or present with nonspecific symptoms such as lower abdominal pain, cycle disorders, or heavy bleeding. Ultrasound enables direct assessment of the internal organs – as the first-choice method in gynaecological diagnostics, for follow-up monitoring of known findings, or for assessing a pregnancy.

Risk factors

• –Cycle disorders or irregular bleeding
• –Heavy or prolonged menstruation
• –Lower abdominal pain or dysmenorrhoea
• –Known cysts, fibroids, or endometriosis
• –Desire to have children or fertility assessment
• –Menopausal symptoms
• –Abnormal finding on gynaecological palpation
• –Follow-up for gynaecological conditions

Frequency

Gynaecological ultrasound is one of the most common examinations in gynaecology. Ovarian cysts occur in a significant proportion of women of reproductive age – most are functional and resolve spontaneously.

Typical symptoms

• –Lower abdominal or pelvic pain
• –Heavy, prolonged, or irregular bleeding
• –Pain during intercourse (dyspareunia)
• –Feeling of swelling or pressure in the lower abdomen
• –Absence of menstruation
• –Menopausal symptoms

Common incidental findings

• –Ovarian cyst as an incidental finding
• –Fibroid without symptoms
• –Endometrial thickening during menopause
• –Abnormal ovarian structure without symptoms

When is it detected?

Many findings are discovered during annual gynaecological screening – even without symptoms. Regular check-ups allow for early assessment.

At the practice of Dr. med. Anna M. Wagner at Spalenvorstadt 3 in Basel, gynaecological ultrasound is performed using a high-resolution device. In adults, transvaginal ultrasound is used as standard – it offers the best image quality, since the organs are very close to the probe. If a vaginal ultrasound is not possible or not desired, a rectal ultrasound can be performed instead: the probe is very slim and is inserted similarly to a suppository – many patients are surprised how uncomplicated this examination is. Image quality is clearly better than through the abdominal wall. Abdominal ultrasound is used additionally for large findings, in advanced pregnancy, or in children and adolescents. The findings are explained directly during the consultation.

Examinations

• –Transvaginal ultrasound: standard method, best image quality in adults
• –Rectal ultrasound: alternative when vaginal is not possible or desired – slim probe, well tolerated, better image quality than abdominal
• –Transabdominal ultrasound: additional for large findings, pregnancy, or in children and adolescents
• –Doppler ultrasound: assessment of blood flow to cysts or nodules
• –Sonohysterography (SHG) / hysterosalpingo-foam sonography (HyFoSy, ExEm-Foam): ultrasound with saline or foam contrast. Assesses both the uterine lining (polyps, fibroids, septa) and the patency of the fallopian tubes in a single examination. It is thus both diagnostic and therapeutic – flushing the fallopian tubes can increase the chance of pregnancy in the following months.
• –Follicle monitoring / cycle monitoring: ultrasound checks before ovulation, usually starting around cycle day 3–4. Monitors follicle growth, the response to hormonal stimulation, and the timing of ovulation – central to fertility treatment, insemination, and IVF preparation.

What do the findings mean?

Functional cysts usually resolve within one cycle. Persistent, solid, or complex cysts require closer monitoring or further assessment. Fibroids are assessed by location and size – most cause no symptoms. Endometrial polyps are frequently visible on ultrasound. If a suspicious finding is present, Dr. Wagner arranges further diagnostics with personal support.

Watchful waiting

Many findings – functional cysts, small fibroids, asymptomatic polyps – are initially observed. Follow-up ultrasound after 6 or 12 weeks, depending on the finding. Regression is common, treatment rarely necessary.

Medication

Hormonal therapies can be used for endometriosis, fibroids, or cycle disorders. The choice of preparation depends on the finding, age, desire to have children, and personal situation.

Surgery

Surgical procedures (hysteroscopy, laparoscopy, myomectomy) are indicated for symptomatic or large findings. Dr. Wagner performs outpatient gynaecological procedures directly at the practice or arranges a referral with personal support.

• –Regular gynaecological screening including ultrasound for known findings – at least once a year
• –Do not ignore symptoms: have lower abdominal pain, bleeding changes, or a feeling of pressure assessed promptly
• –For a family history of ovarian cancer: counselling on more frequent ultrasound screening

• Gynaecological ultrasound – examination at the practice→
• Premium check-up with ultrasound→

  Consultation, gynaecological and breast ultrasound in one appointment, CHF 490.

• Annual check-up and Pap smear→
• Breast ultrasound and breast examination→
• Ovarian cysts→
• Fibroids→
• Endometriosis→
• Fertility→
• Pregnancy ultrasound→
• Bleeding disorders→

• ↗SGUM – Schweizerische Gesellschaft für Ultraschall in der Medizin
• ↗SGGG – Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe
• ↗ISUOG – International Society of Ultrasound in Obstetrics and Gynecology
• ↗Krebsliga Schweiz – Eierstockkrebs