Pelvic Ultrasound: A Window Into the Pelvis
A pelvic ultrasound is one of the most common tests ordered in gynecology. If you’ve been having pelvic pain, abnormal bleeding, irregular cycles, or fertility questions, this is often one of the first tools your provider reaches for.
Pelvic ultrasound is safe, widely available, and gives a real-time look at what’s happening inside the pelvis. It’s typically ordered early in an evaluation, sometimes alongside blood work and well before procedures like biopsies. Ordering an ultrasound doesn’t automatically mean something serious is suspected. It usually means your provider is starting with the most appropriate step.
What Is A Pelvic Ultrasound?
A pelvic ultrasound uses sound waves, not radiation, to create images of the pelvic organs. It’s noninvasive and commonly performed in both outpatient clinics and imaging centers. While it doesn’t answer every question, it often provides key information that helps guide care or narrow down possibilities.
Why Is A Pelvic Ultrasound Ordered?
Pelvic ultrasounds are commonly ordered to evaluate:
• Abnormal uterine bleeding
• Pelvic pain or pressure
• Suspected fibroids
• Ovarian cysts
• Irregular or unpredictable cycles
• Fertility concerns
• Follow-up of previously seen findings
How Is Pelvic Ultrasound Done?
A complete pelvic ultrasound usually includes two parts.
Transabdominal ultrasound uses a probe on the lower abdomen and requires a full bladder to create a clearer view. It provides a global overview of the pelvis.
Transvaginal ultrasound uses a slender probe inserted into the vagina with a sterile cover and lubricant. It is typically similar in size to, or smaller than, a speculum and provides much more detailed images of the uterus, ovaries, and uterine lining.
What If You Don’t Want A Transvaginal Ultrasound?
A complete pelvic ultrasound usually includes two parts, both of which work together to evaluate the pelvis.
Transabdominal Ultrasound
A probe is placed on the lower abdomen. This part requires a full bladder, which helps create a clearer “window” so the pelvic organs are easier to see. It gives a broad, global view.
Transvaginal Ultrasound
This portion provides much more detail. A slender probe is inserted into the vagina using a sterile cover and plenty of lubricant. The probe is typically similar in size to, or smaller than, a speculum, though it’s used very differently. This part is done with an empty bladder and gives the clearest images of the uterus, ovaries, and uterine lining.
What If You Don’t Want (or Can’t Have) a Transvaginal Ultrasound?
A transvaginal ultrasound isn’t the right choice for everyone, and that’s okay. Some common reasons include:
• Very young patients
• Intact hymen
• Significant pelvic pain or vaginismus
• History of trauma
• Gender dysphoria
In these cases, providers can often start with transabdominal imaging. Sometimes that’s enough to answer the clinical question, and if it isn’t, your provider may discuss other options, such as MRI. The most important thing to know is that nothing happens without your consent, and you get a say in what you’re comfortable with.
What is Being Evaluated?
Uterus
Ultrasound evaluates the uterus for size, shape, and position. The report may comment on abnormalities such as fibroids, features that could suggest adenomyosis, or congenital differences in uterine structure.
Endometrium (Uterine Lining)
The endometrium is evaluated for thickness and overall appearance. Thickness varies depending on age and where you are in your cycle. The lining may also show patterns that suggest polyps or other pathology, although ultrasound alone usually can’t confirm a diagnosis.
Ovaries
Ultrasound evaluates the ovaries for size, general appearance, and cysts. It may also describe follicles or follicle counts, which are simply developing eggs and can be completely normal. In certain situations, blood flow to the ovary is assessed, especially if severe pain raises concern for torsion.
Fallopian Tubes
Fallopian tubes usually aren’t visible at all. If a tube is seen, it’s typically because something is abnormal, such as dilation or fluid buildup.
What Are The Limitations?
• It cannot rule out endometriosis. Endometriosis may only be visible on ultrasound in cases of large cysts or more advanced disease, but a normal ultrasound does not necessarily mean you don’t have it.
• It cannot explain every cause of pelvic pain.
• It does not diagnose cancer on its own.
• A normal ultrasound does not mean symptoms aren’t real or important.
Common Findings (And What They Usually Mean)
Fibroids
Fibroids are benign growths of the uterine muscle and are very common. Depending on age and the population studied, they’re seen in roughly 30–70% of people with a uterus by adulthood. Many people with fibroids have no symptoms at all. Whether a fibroid matters depends far more on its size, location, and what you’re experiencing than on the word “fibroid” itself.
Simple Ovarian Cysts
Simple cysts are common and often temporary. Small cysts frequently resolve on their own and may not be clinically significant, especially if you’re not having symptoms.
Corpus Luteum / Corpus Luteal Cyst
The corpus luteum is a normal structure that forms after ovulation. It can sometimes look dramatic on imaging and may be labeled as a cyst, but it usually resolves on its own.
Hemorrhagic Cyst
A hemorrhagic cyst is a type of functional cyst that contains blood. It can be painful, but it’s often self-limited and commonly resolves without intervention.
Follicles / Follicle Count
Follicles are developing eggs. Seeing follicles is normal, and a follicle count is often noted during fertility evaluations.
Thickened Endometrium
The lining may be described as thickened depending on cycle timing, age, and symptoms. What’s considered “normal” varies widely, so context matters.
Hydrosalpinx
A hydrosalpinx is a fluid-filled fallopian tube. It may or may not be clinically meaningful, and it does not tell you whether the tube is open. Tubal patency requires specialized imaging.
“Polycystic Appearing Ovaries”
This means the ovary has more follicles than average. On its own, this does not diagnose PCOS, but in the right clinical context, it can point in that direction. It’s something to discuss further with your provider.
Free Fluid
A small amount of free fluid in the pelvis can be normal, especially around ovulation.
Special Pelvic Ultrasounds (Sometimes Called “The Water Ultrasound”)
Sometimes additional steps are added during ultrasound to improve visualization.
Saline Infusion Sonogram (SIS)
An SIS involves placing a small amount of sterile fluid into the uterus during ultrasound. This helps outline the uterine cavity and can make polyps or submucosal fibroids easier to see.
Hysterosalpingo-Contrast Sonography (HyCoSy)
HyCoSy uses contrast during ultrasound to assess the fallopian tubes and can provide information about whether tubes appear open.
These are specialized studies and are only ordered when they’re helpful. Other tests that evaluate the fallopian tubes, such as Hysterosalpingogram (HSG), are discussed separately.
How To Prepare
Typically they will start the scan with a full bladder, so do not urinate beforehand, and follow whatever instructions you are given when you scheduled the appointment. It is best to wear comfortable clothing as you will get undressed and into a gown prior to the ultrasound. Make sure you speak up and ask to pause or stop if anything is uncomfortable.
How And When Are Results Interpreted?
The ultrasonographer (technician who does the scan) may sometimes tell you preliminary findings, but the images first need to be read by a physician that reviews the study at a later time and generates the report. Your clinician will then interpret the findings in the context of your individual health.
Bottom Line
A pelvic ultrasound is a tool, not a verdict. It offers a window into the pelvis and helps guide care, but it’s only one piece of the puzzle. You deserve clear explanations, not just a report.
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