A gynaecological ultrasound is a safe and effective way to assess the uterus, ovaries, and surrounding pelvic structures. It is commonly requested to investigate symptoms such as pelvic pain, abnormal bleeding, fertility concerns, or to check the position of an intrauterine device.

This guide explains some of the more common pelvic conditions that may be identified during a gynaecological ultrasound and what they may mean for you.

Please note: The information in this article is general in nature and provided for educational purposes only. It does not replace medical advice, diagnosis, or treatment. Please consult your GP or specialist for personalised care.

Table of contents

1. Endometrial thickness
2. Fibroids
3. Endometrial polyps
4. Müllerian anomalies
5. Adenomyosis
6. IUCD (Mirena) placement
7. Polycystic ovarian morphology (PCOM)
8. Ovarian cysts
9. Superficial endometriosis
10. Deep endometriosis
11. Pelvic adhesions
12. What happens after your ultrasound

Conditions commonly identified on gynaecological ultrasound

Endometrial thickness

The endometrium is the lining of the uterus. Its appearance and thickness change throughout the menstrual cycle, becoming thicker after ovulation and thinner after a period. In post-menopausal women, the endometrium is usually much thinner.

Measuring endometrial thickness helps assess causes of abnormal bleeding, hormonal influences, and response to medications. A thickness outside the expected range does not automatically mean something is wrong, but it may prompt further investigation depending on age, symptoms, and medical history.

Fibroids

Fibroids are common, benign growths arising from the muscular wall of the uterus. They vary widely in size, number, and location, and many women are unaware they have them.

Depending on their position, fibroids may contribute to heavy or prolonged periods, pelvic pressure, pain, or fertility concerns. Ultrasound helps map fibroids accurately, which assists doctors in determining whether monitoring, medical management, or further treatment is appropriate.

Endometrial polyps

Endometrial polyps are localised overgrowths of the uterine lining. They are usually benign and can vary in size from a few millimetres to several centimetres.

Polyps may cause irregular bleeding, spotting between periods, or bleeding after menopause. Ultrasound helps identify suspected polyps and assess their size and attachment, supporting decisions about further testing or removal if symptoms are present.

Müllerian anomalies

Müllerian anomalies are congenital differences in the shape or structure of the uterus that develop before birth. Examples include a septate uterus or a bicornuate uterus.

Many women with these variations have no symptoms and only discover them during imaging. In some cases, these anomalies may affect menstruation, fertility, or pregnancy outcomes. Ultrasound plays an important role in identifying uterine anatomy and guiding further assessment if needed.

At QUFW, 3D ultrasound will be used to assess the uterine cavity for Mullerian anomalies. All of our machines at QUFW have 3D capabilities.

Adenomyosis

Adenomyosis occurs when tissue similar to the endometrium grows within the muscular wall of the uterus. This can cause the uterus to appear enlarged or irregular.

It is often associated with heavy periods, painful periods, or chronic pelvic discomfort. Ultrasound looks for specific features that suggest adenomyosis, although findings can be subtle and may overlap with other conditions. Specialist imaging experience improves detection and reporting. Adenomyosis is commonly seen between 40-60 but has been confirmed in younger women.

IUCD (Mirena) placement

Ultrasound is commonly used to assess the position of an intrauterine contraceptive device, such as a Mirena, especially if symptoms like pain or abnormal bleeding occur.

A correctly positioned device sits within the uterine cavity. Ultrasound can identify displacement, embedment, or expulsion. This information helps your doctor decide whether the device can remain in place or needs adjustment or replacement.

Polycystic ovarian morphology (PCOM)

PCOM refers to an ovarian appearance characterised by multiple small follicles arranged around the ovary. This is a descriptive ultrasound finding rather than a diagnosis.

Many women with PCOM have no symptoms and normal hormone levels. PCOM is only one feature considered when assessing for polycystic ovary syndrome (PCOS). A diagnosis of PCOS requires clinical symptoms and blood tests in addition to ultrasound findings.

Ovarian cysts

Ovarian cysts are fluid-filled sacs that can develop as part of the normal menstrual cycle. Most are functional cysts that resolve without treatment.

Ultrasound helps classify cysts based on their appearance, size, and internal features. Some cysts may require follow-up imaging, while others may explain pelvic pain or discomfort. The majority of ovarian cysts are benign.

Superficial endometriosis

Superficial endometriosis involves small deposits of endometrial tissue on the surface of pelvic organs. These deposits are often too small to be directly seen on ultrasound.

Even when superficial endometriosis is not visible, ultrasound can assess pelvic anatomy and exclude other causes of symptoms. Imaging findings are considered alongside clinical history, particularly pain patterns and response to treatment. Learn more about endometriosis here.

Deep endometriosis

Deep endometriosis occurs when endometrial tissue grows deeper into pelvic structures, such as ligaments, bowel, bladder, or uterosacral regions. Any invasion beyond the peritoneal surface can be considered as deep endometriosis.

Specialist gynaecological ultrasound techniques allow targeted assessment of areas commonly affected. Identifying deep endometriosis helps guide management decisions, surgical planning, and referral to appropriate specialists. Learn more about endometriosis here.

Pelvic adhesions

Adhesions are bands of scar tissue that can form following surgery, infection, or inflammation. They may restrict normal movement of pelvic organs.

Adhesions are not always directly visible on ultrasound, but reduced organ mobility or altered anatomy can suggest their presence. Symptoms vary and may include pain, discomfort, or fertility concerns, while some women experience no symptoms at all.

What happens after your ultrasound

Your ultrasound report is sent to your referring doctor, who will discuss the findings with you. Some results require no action, while others may lead to monitoring, further imaging, or referral to a specialist.

Reassurance and next steps

Many pelvic findings are common and manageable. A normal ultrasound is also a frequent and reassuring outcome. When something is identified, it does not always mean treatment is required.

Your healthcare team will guide you through the results and discuss the most appropriate next steps for your situation.

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