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See Dr Morton’s manage periods and understand endometriosis enhance women’s health through life and tackle severe abdominal pain
Essentially an ultrasound scan is a diagnostic tool used for imaging abnormalities in the body including in the gynaecological area. It uses an ultrasound probe called a transducer, which is placed against the woman’s skin and high frequency ultrasound pulses are beamed into their body. These ultrasound waves are reflected from tissue interfaces which are then picked up by the ultrasound probe and converted into a picture. Unlike in X-ray imaging which relies on differences in density, ultrasound depends on reflection from tissue interfaces.
Ultrasound was developed late in World War II from sonar – that ‘pinging’ device used to detect submarines
In fact, ultrasound was developed at the end of the Second World War from sonar – that ‘pinging’ device used to detect submarines. In the original ultrasound machines people sat in a huge bath of water; now ultrasound machines are small and compact producing high resolution images.
There are two main techniques of ultrasound used in gynaecology. One of these is a scan where the ultrasound probe is placed over the pelvis using the bladder as a window (that is why people are often asked to attend with a full bladder to displace bowel which interferes with the ultrasound beaming away from the pelvis) and the uterus and ovaries are visualised through the bladder. This full bladder technique is useful but suffers from some lack of resolution problems particularly in relation to ovarian analysis. In order to more approximate the probe to the target organ, internal transvaginal ultrasound scanning was developed. In this a longitudinal probe is passed into the vagina in the region of the cervix and the probe is moved transversely to show the uterus and ovaries. This technique gives much more accurate information regarding the uterus and ovaries and of the womb. Frankly, pelvic scans using full bladders now are really a bit old fashioned and if the operator is skilled at transvaginal scanning it is really no longer necessary for gynaecological scans to ask the woman to attend with a full bladder with all the discomfort that that involves.
Ultrasound scanning can detect fibroids which affect around 20-30% of women
With regard to the uterus, some of the common problems that ultrasound scanning can pick up are fibroids which affect approximately 20-30% of the population: they are benign growths in the uterus and may give rise to heavy bleeding which we call menorrhagia or they may grow large and compress adjacent organs.
For more information on fibroids click here
Another condition which we will be talking about in later articles is adenomyosis where cells from the lining of the womb migrate into the muscle of the womb causing heavy bleeding and painful periods. Again, this condition can also be imaged using ultrasound. A further important application of ultrasound in gynaecology is imaging the lining of the womb. There are a number of diseases which can affect this, some of them are benign, but in other cases malignancy can affect the lining of the womb. Transvaginal scanning is able to measure the width of the lining of the womb and determining whether this is abnormally thickened. If picked up early, cancer of the lining of the womb, ie endometrial cancer, can be readily cured.
Another very important application of gynaecological ultrasound is in assessment of the ovaries. Benign ovarian cysts occur commonly in the ovaries and may give rise to symptoms and are readily detectable by ultrasound. Ovarian cancers can be detected by ultrasound and also benign tumours of the ovaries. Obviously with regard to malignancy the earlier that cancers are picked up the easier they are to treat and Stage I cancer of the ovaries for example (that is the earliest stage) has a cure rate of around 90%. As the stage at which the tumour is picked up goes up so the cure rate goes down. It is therefore vital that if women have symptoms which may in any way be related to ovarian pathology (or for that matter any gynaecological symptoms) that they get a rapid ultrasound examination.
One of the main problems is the fact that in the UK we have poorer rates of cancer survival generally compared to other countries due to delay in diagnosis. This partly relates to our healthcare system which is very much queue related. There are many examples in this country of people who just simply wait too long to have the relevant diagnostic test. In fact, in the UK we are one of the poorer performing countries in the western world in terms of delays in people getting diagnostic tests. If you have gynaecological symptoms, you should insist on having the relevant tests as rapidly as possible. One thing to bear in mind concerning ultrasound of the pelvis and, in particular, transvaginal scanning, is that it needs to be carried out by an experienced operator as it is an operator dependent investigation, in other words the skill of the operator is relevant to the accuracy of the scan. I am sorry if that information is a little worrying to you but I am afraid that those are the facts.
Ultrasound examinations are not infallible and if gynaecological symptoms persist and ultrasound examinations are equivocal or unhelpful then a more accurate examination is an MRI scan. MRI stands for magnetic resonance imaging. This is a more complex investigation which involves being scanned in a tunnel using magnetism and radio frequency pulses. We will be talking about this investigation later in the series.