Synopsis
Select transabdominal ultrasound, transvaginal ultrasound, hysteroscopy or endometrial sampling from the clinical question, interpret endometrial measurements in context, and prevent a reassuring scan from delaying cancer assessment.
- Name the imaging question before ordering: pregnancy location, endometrium, fibroid mapping, adenomyosis, ovarian mass, torsion, abscess or device position require different timing and interpretation.
- Transvaginal ultrasound usually provides higher-resolution views of endometrium and adnexa; seek specific consent, offer a chaperone and provide a transabdominal or deferred alternative when declined.
- Transabdominal ultrasound gives a wider pelvic overview and can help with large masses or when transvaginal scanning is unsuitable, but a full bladder and lower resolution can limit detail.
Key red flags
Postmenopausal bleeding requires urgent cancer-pathway assessment; a thin endometrium reduces probability but persistent or recurrent bleeding still needs review.
Any bleeding after established menopause is abnormal and enters urgent assessment; recurrent bleeding remains important after an initially reassuring thickness.
Investigation priorities
Obtain detailed views of endometrium, myometrium, ovaries, adnexa and early pregnancy.
Management branches
Heavy menstrual bleeding requires investigation because history or examination suggests structural or endometrial disease.
- Use outpatient hysteroscopy first when persistent intermenstrual bleeding or risk factors suggest a cavity or endometrial lesion, explaining biopsy and treatment possibilities.
- Use pelvic ultrasound first for a palpable uterus, suspected pelvic mass or difficult examination, and prefer transvaginal scanning when adenomyosis is suspected.