Transvaginal Ultrasound & Endometrial Cancer
Endometrial cancer, or cancer of the lining of the uterus, is the most common gynecologic malignancy. Luckily, most women who have endometrial cancer show symptoms, such as abnormal vaginal bleeding, long before the cancer spreads to other parts of the body.
A number of risk factors may contribute to the development of endometrial cancer, including obesity, irregular periods and family history. No effective screening method currently exists for women who may be at risk for endometrial cancer. A diagnostic aid such as ultrasound, placed in the vagina or transvaginally, as opposed to the abdomen, can help doctors discover the nature of symptoms.
A transvaginal ultrasound produces images of the internal organs when the ultrasound probe is placed in the vagina. This allows physicians to get a better view of the uterus as well as the ovaries. This procedure is particularly helpful for treating women who are postmenopausal and experiencing vaginal bleeding.
Postmenopausal and premenopausal women differ in regards the endometrium. In premenopausal women — those who are able to have children — the lining of the uterus changes with the menstrual cycle, becoming very thick and able to nurture a fertilized egg. If an egg is not fertilized in the cycle and no pregnancy occurs, the lining is shed during the menstrual period.
In contrast, normal postmenopausal women — those who are beyond child-bearing years— don't have a thickened endometrial lining, since they no longer produce the hormones that stimulate the growth of the lining of the uterus. Therefore, these women should not have any type of vaginal bleeding. If they do have postmenopausal bleeding, these women should see a physician immediately.
Most doctors use a transvaginal ultrasound and a biopsy, or tissue sample, of the endometrium to help them evaluate patients with postmenopausal bleeding. The ultrasound is used to determine the thickness of the endometrium, which should not exceed 4 to 5 millimeters in postmenopausal women. Normal thickness can reliably exclude cancer in most cases. However, an endometrial biopsy is the most effective procedure, outside of surgery, to confirm if endometrial cancer is present.
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- American Cancer Society. Signs and Symptoms of Endometrial Cancer
- American Cancer Society. Tests for Endometrial Cancer
- US National Library of Medicine. Medline Plus. Abnormal uterine bleeding
- American Cancer Society. Tests for Endometrial Cancer. 2018.
- Chen L, Berek JS. (2017). Patient education: Endometrial Cancer Diagnosis and Staging (Beyond the Basics). Goff B, ed. UpToDate. Waltham, MA: UpToDate Inc.
- Sweet MG, Schmidt-Dalton TA, Weiss P, Madsen KP. Evaluation and Management of Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician.2012 Jan 1;85(1):35-43.
- The American College of Obstetricians and Gynecologists. Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women. 2013.
- The American College of Obstetricians and Gynecologists. Frequently Asked Questions: Abnormal Uterine Bleeding. 2017.
Jason D. Hurt is a physician and researcher with expertise in women's health, specifically women's cancers. He holds an M.D. from Texas Tech University Health Sciences Center.