When is it better to do an ultrasound of the ovaries in women and what will it show? Why are a woman’s ovaries not visualized during examination? Why is the left ovary not visualized?

The ovaries are a paired organ of the female reproductive system, responsible for childbirth and the woman’s health. Any deviations from the norm in their work can be detected during an ultrasound. But sometimes the doctor cannot examine the organs, citing the fact that the ovaries are not visualized. What does this mean, how should you react to such a statement from a specialist, and should you start worrying about your own health?

Why is an ovarian ultrasound performed?

The procedure is often prescribed for preventive purposes 1-2 times a year. This allows women to monitor their well-being and promptly detect a variety of pathologies, preventing their development and degeneration into a chronic form. Most gynecological ailments can be cured at an early stage if periodically examined by a specialist.

No less often, ultrasound is prescribed to determine the effectiveness of treatment for a particular disease, to decide on the need for surgery and to choose a treatment method.

Location of organs in the pelvis, examination features

The ovaries are located between the bladder and the uterus, but in some women they may be hidden under the uterine fundus. With the onset of menopause, organs greatly decrease in size, which makes them almost invisible during ultrasound. But this is the norm, and in some cases, the lack of visualization may mean an error in the research process.

To avoid errors, the procedure should be performed like this

the patient should present for examination with a full bladder

you need to take a side position on the couch

the researcher begins work by carefully adjusting the sensitivity of the device (if the parameter is set at high frequencies, there is a chance that the right ovary will not be visible.

The left ovary is often not visible due to poor filling of the bladder: the organ is hidden behind the fundus of the uterus, not visualized during the study. If this happens, you should drink more water and repeat the procedure after half an hour.

But in some cases, the amount of liquid you drink and the settings of the device do not matter much. The organ does not appear in the doctor’s field of vision. This can happen due to excessive filling of the intestines with gases.

Other reasons

previous surgical interventions in the pelvic area

absence of ovaries from birth (rare but possible pathology)

the patient's menopausal age, when organs greatly decrease in size

full intestines (stool or air can hide the ovaries from the rays of the ultrasound machine)

organs are displaced due to developmental pathology or past illnesses

dangerous pathologies of the uterus when it changes in size

doctor errors made during the examination

Normally, on an echogram they are located as an oval, fairly defined hypoechoic formation on the sides of the uterus. The best visualization is achieved with transverse scanning, and the combination of all types of scanning (linear, convex and sector) allows one to approach 100% of their detection. Without much difficulty, it is possible to locate the ovaries with cystic changes and the presence of follicles in them. Obstacles to ovarian echolocation may include:

- strong echo reflection from the adhesive process due to postoperative interventions on the pelvic organs, from gas from intestinal loops, the contents of the rectal ampulla;

- high density of the peritoneum with pelvioperitonitis;

— the presence of a dense fat layer, scars of the anterior abdominal wall, etc.

ovaries

Normally, the echographic dimensions of the ovaries correspond to a length of 3.5 x 3.7 cm, a width of 1.8 x 2.5 cm and a thickness of 1 x 1.3 cm. It should be noted that in most, the ovaries react to cyclic changes and significantly increase in size by the middle of the menstrual cycle due to the appearance of one or more follicle, which can reach a diameter of 2.5 cm. It is generally accepted that in healthy women the size of the ovary should not exceed the largest diameter in the area of the body closer to the fundus of the uterus. With the onset of menopause, the ovaries decrease in size by almost half, the contours become uneven, wrinkle, and echogenicity increases.

Pathology

Among the developmental defects, it is possible to identify anovaria, which is extremely rare, by echography. The failure to detect ovaries using echography in the absence of other congenital pathology of the internal genital organs, the absence of any clinical signs of the manifestation of this pathology do not give reason to believe that they do not exist. Hypoplasia, hyperplasia and bifurcation are more common. However, due to the wide anatomical variation in size in different age groups, echography is not very informative for diagnosing and differentiating this pathology.

Damage

Damage to the ovaries can occur with pelvic injuries. In these cases, the echo picture is the same as with apoplexy. The ovaries are located as an oval formation with uneven discontinuous contours of low echogenicity, around which liquid (blood) can be located along the side wall of the uterus and in the uterine space. When clots form in the area of damage, echogenic signals of different sizes and shapes are located.

Inflammatory diseases

Of the inflammatory diseases of the ovaries, the first place is oophoritis, which is usually secondary, that is, it occurs as a result of disease of the tubes, and therefore, in practice, salpingoophoritis is more common - inflammation of the appendages (ovaries and tubes).

On the echogram, the size of the ovary in acute oophoritis is enlarged, the contours are outlined, due to edema, sound conductivity is reduced, sometimes in dynamics it is possible to see foci of necrosis (small abscesses) in the form of hypoechoic areas that can merge and lead to complete melting of its tissues - pyovarium (located as thin-walled round echo-negative formation). When increasing the operation of the device against the background of echo negativity, small-point echo signals (decay elements) are located in the formation, which can sometimes be in a suspended state.

In chronic oophoritis, the ovary may have normal or slightly enlarged dimensions, blurred contours, increased echogenicity, and heterogeneous tissue structure. However, these changes are nonspecific, since they also occur during atrophic processes as physiological phenomena.

Thanks to the pelvic organs, the most important event in the life of every girl occurs - the onset of pregnancy, which the majority of the female population dreams of. Therefore, after undergoing an ultrasound examination, some are shocked and puzzled by its results: what does “the ovary is not visualized” mean, what is it and is there any threat? The main task facing a woman in such a situation is not to lose heart. There are many reasons why the ovaries are not detected. They require more detailed consideration.

Anatomical location of the pelvic organs

Before considering the reasons why the ovaries are able to hide from view, it is necessary to understand the structure of the pelvic organs. It contains the following organs:

the rectum, through which processed food comes out;
the bladder in contact with the walls of the vagina and the uterus;
the vagina, which is adjacent to the cervix and passes through the urogenital diaphragm;
the uterus, which is pear-shaped and consists of muscles; performs reproductive function;
two ovaries, which produce hormones and are responsible for the maturation of eggs;
fallopian tubes that connect to the ovaries on either side of the uterus.

Why are the ovaries not located on ultrasound?

The specialist may say that the ovaries are not located. What does it mean? Why is this happening? In simple words, if the ovary is not visible on an ultrasound, this means that the monitor shows the absence of an organ, i.e. it is not defined. With its presence, on the ultrasound picture in the conclusion they write that they are determined. In frequent cases, organs may not be located due to the incompetence of the gynecologist, who, due to his incompetence, simply could not see the organs on the monitor or adjust the sensors.

Normally, the contours of the ovaries in a healthy woman are uneven and clear. Fuzzy contours may indicate inflammation, cystic formations, or the presence of a corpus luteum. Blurred - they speak of a disease such as salpingoophoritis - inflammation of the uterine appendages. With a fuzzy outline and reduced size of the ovaries, the ultrasound picture indicates the probable onset of menopause.

Other cases of an undetectable left or right ovary include pathologies, endocrine disorders, and body characteristics.

Visualization also depends on the correctness of the ultrasound examination and the operation of the instruments. During transabdominal ultrasound, the patient should drink a lot of water to fill the bladder, since if there is a lack of fluid, the left ovary may disappear behind the uterus. Before a transvaginal ultrasound, you should empty yourself, because the sensor is inserted into the vagina and its location to the organs becomes close, and the liquid during this study makes it difficult to see what is happening inside.

Is it possible to do ultrasound diagnostics during menstruation? Read the article Ultrasound of the pelvic organs and menstruation

Intestinal disorders

The first most popular organic reason for not seeing the left or right ovary is a large accumulation of intestinal gases, flatulence, and fullness of the intestines after eating. As a rule, in the next study the organ appears in the field of view.

Previous surgical interventions

After gynecological operations, the organ is not located, because the stress suffered by the body can disrupt its functioning for a certain time, as a result of which the organ may shrink, down to the size of a pea.

Taking birth control pills

OK drugs are used to treat hormonal disorders and contraception. They suppress the hormones produced by the ovaries in order to prevent the eggs from maturing, thereby eliminating the possibility of ovulation for fertilization.

Since hormones are closely related to processes in the pelvis, internal organs may become invisible to the equipment due to the effect of hormonal pills on reproductive function. While taking contraceptives, ultrasound is less informative.

Anovulatory cycle

It happens that the ovary is not examined by a specialist during the examination due to the lack of ovulation. There are two reasons for its absence:

temporary hormonal imbalance, in which the body’s normal state returns in the next menstrual cycle.
serious hormonal disorders or pelvic diseases (for example, polycystic disease).

If more than two cycles in a row the ultrasound does not show a normal result, there is no ovulation, most likely it is necessary to examine the endocrine system.

Hormonal disorders

If the patient refuted the reasons listed above, and the ovary was not visualized after repeated examination, it is recommended to take tests for female sex hormones:

Prolactin;
Estradiol (estrogens);

Remember! Only an experienced specialist can accurately determine the reason why the ovaries are not visualized

Other reasons

The following circumstances may also cause a missing organ during examination:

adhesions in the genitals or abdominal cavity;
premenopause and menopause;
congenital absence or abnormal development of the ovary;
enlarged uterus;
organic displacement of the organ due to past pathology.

Instead of making disappointing diagnoses, it is recommended to find out whether the absence of an organ in conclusion is a consequence of improper preparation for the examination, a doctor’s error, a short-term malfunction, or the presence of feces in the intestines. In most cases, girls who are shocked by the absence of an organ in the examination results and according to the doctor turn out to have ordinary intestinal gases, lack of ovulation, or interaction with an incompetent doctor.

oyaichnikah.ru

The ovaries are not visualized, what does this mean? | WHO?WHAT?WHERE?

Why is an ovarian ultrasound performed?

No less often, ultrasound is prescribed to determine the effectiveness of treatment for a particular disease, to decide on the need for surgery and to choose a treatment method.

Location of organs in the pelvis, examination features

To avoid errors, the procedure should be performed like this

the patient should present for examination with a full bladder

you need to take a side position on the couch

the researcher begins work by carefully adjusting the sensitivity of the device (if the parameter is set at high frequencies, there is a chance that the right ovary will not be visible.

Other reasons

previous surgical interventions in the pelvic area

absence of ovaries from birth (rare but possible pathology)

the patient's menopausal age, when organs greatly decrease in size

full intestines (stool or air can hide the ovaries from the rays of the ultrasound machine)

organs are displaced due to developmental pathology or past illnesses

dangerous pathologies of the uterus when it changes in size

doctor errors made during the examination

kto-what-gde.ru

Ultrasound of the pelvis in postmenopause

Pelvic examination in postmenopause

Uterus. In postmenopause, the uterus becomes significantly smaller in size and more homogeneous in echo structure: the endometrium is not visible.
Postmenopausal ovaries. The ovaries are small and often very difficult or impossible to visualize with ultrasound. When they are visualized, they appear hyperechoic, lack follicles, and are often nearly isoechoic to the surrounding tissue.

Position of the uterus

The uterus can be rotated so that the body of the uterus is located behind the cervix (retroversio condition). The body of the uterus may be tilted anteriorly (anteversio).

If the body of the uterus is inclined towards the cervix, it is in antelexio. If the body of the uterus is tilted back from the cervix, the condition is called retroflexio.

In cases where the uterus is not visualized, it is necessary to determine whether there has been a history of hysterectomy. If there is a history of surgery, carefully look for the cervical stump, as supravaginal amputation rather than hysterectomy is possible.

When normal pelvic echostructures are not clearly visible, give the patient more fluid to fill the bladder.

The ovaries can occupy different positions, but are always located behind the bladder and uterus. Most often they are found at the site of the appendages, on the side.

The ovary may be located in the retrouterine space or above the fundus of the uterus. In postmenopausal women, the ovaries are small and often not visualized.

If difficulty visualizing the uterus and ovaries occurs, manually displace the uterus through the vagina and continue scanning in different planes to clarify anatomical details. A similar technique can be used in the presence of low-lying pelvic formations.

In the absence of visualization of the ovaries, the following techniques can be used:

Place the patient in the lateral position and scan the contralateral ovary through a full bladder.
Reduce the sensitivity level of the device. If sensitivity is too high, the ovary may be poorly identified against the surrounding parametrium and may not be visualized.

If the ovaries continue to be poorly visualized, this may be due to the bladder being too full or too full. Adequate filling is considered to be such that the bladder covers the fundus of the uterus, but if the bladder is not full enough. Give the patient more water. Repeat the study after 30 minutes, try to visualize the ovaries.

If the bladder is full, it pushes the ovaries down from the uterus or laterally onto the psoas muscle. Ask the patient to partially empty the bladder (give her a special measuring cup for filling). Then repeat the test.

Even if the bladder is adequately filled, the ovaries may be poorly visualized due to shielding by intestinal gases. This often happens if the ovaries are located higher than usual.

If necessary, scan the patient in an upright or vertical oblique view. This will help dislodge gas-filled intestinal loops, allowing the ovaries to be more clearly visualized.

If normal anatomy is still not clearly defined, carefully inject 20 ml of body temperature water into the vagina and scan above the pubis. The fluid will surround the cervix and make it easier to identify the organs. This method is especially useful in making a differential diagnosis between hysterectomy and supravaginal amputation in cases where clinical testing is not possible.

If you have difficulty visualizing a retrouterine mass, inject 200 ml of warm water into the rectum, then examine the area. Air microbubbles will be visualized as bright hyperechoic structures that clearly delimit the anterior wall of the rectum, which facilitates the recognition of formations in the intestinal lumen, such as fecal masses, which are the most common cause of diagnostic errors.

Normal ovaries

Once the ovaries are visualized, determine if there is any displacement of surrounding structures. Determine the condition of the internal structure of the ovaries and the presence or absence of acoustic pseudo-amplification. If anechoic structures are visualized in the thickness of the ovaries or along their periphery, it is possible that these are follicles. Reduce the sensitivity level when examining the ovaries, as normal ovaries have high sound conductivity and there is deep enhancement. Take measurements of each ovary.

Examine the tissue around the ovary for cystic, solid, or fluid-containing lesions. Look for fluid in the retrouterine space. Examine both ovaries.

The ovaries are normally never located in front of the uterus. If the location is atypical, rotate the patient to identify ovarian adhesion fixation and determine whether it is significantly enlarged.

The sensitivity of the device must vary as different structures in the pelvis are examined to obtain optimal images. The relationship of the pelvic organs may be better determined by slow, continuous scanning over approximately 10 seconds.

Follicular apparatus of the ovary

Follicles are visualized as small cystic anechoic structures in the thickness of the ovary or along its periphery and are better visualized when the sensitivity of the device is set to a low level. Depending on the phase of the menstrual cycle, cystic structures can reach 2.5 cm in diameter. Simple cysts larger than 5 cm in diameter may be physiological and may change, become smaller or disappear).

If the presence of a cystic tumor formation is suspected, dynamic observation is necessary - research in the early and late phases of the menstrual cycle. Follicular cysts regress, while nonfunctional cysts do not change in size. If in doubt, do your research next month.

A physiological cyst in the ovary can have a diameter of up to 5 cm. Cysts of this size should be re-examined at the end of the menstrual cycle or during the next cycle.

ilive.com.ua

The ovary is not detected on ultrasound | Culinary recipes

The ovaries are a paired organ of the female reproductive system. The onset of pregnancy and the woman’s health in general depend on their normal functioning. Therefore, it is regularly necessary to undergo preventive ultrasound examinations. If a woman has symptoms of a gynecological disease, then she needs to undergo an ultrasound examination for diagnosis. Today this is the most accessible and informative method of examination for making a diagnosis.

Why is an ovarian ultrasound prescribed?

For prevention, it is enough to undergo an ultrasound examination 1 or 2 times a year. This approach will help avoid many serious women's diseases. In addition, it will be possible to diagnose them at an early stage of development and prescribe treatment in a timely manner. As a rule, most diseases in gynecology are much easier to cure at the initial stage than in the acute stage.

If a woman has already visited a medical center for various symptoms and has already undergone treatment, the doctor will prescribe an ultrasound for diagnosis. The following symptoms should be the reason to contact a specialist and undergo an examination:

Menstrual cycle of varying length or absence;

Painful periods and long cycle times;

Painful sensations in the suprapubic abdomen and nagging pain;

Infertility;

The appearance of discharge mixed with blood in the intervals between menstruation.

The doctor also prescribes an ultrasound examination if it is necessary to determine the duration of pregnancy. When treating infertility, ultrasound diagnostics shows how the corpus luteum matures in the ovary and whether it is there at all: whether pregnancy occurs depends on this.

Indications for ultrasound

Ultrasound allows you to accurately determine the gestational age and the number of embryos in the uterus, and monitor their development. In addition, the doctor can confirm or deny the development of the following diseases:

All types of pathology of the endometrium of the uterus;

Tumors and other neoplasms on and near the ovaries;

Salpingitis;

Inflammatory processes in the pelvic organs, including the ovaries;

Various pathologies of the cervix;

Since simultaneously with the ovaries, the doctor can examine other pelvic organs, such diagnostics are comprehensive and help to detect hormonal imbalances and the functions of the genitourinary system.

Features of ultrasound of the ovaries

The examination can be carried out in several ways - transvaginally and transabdominally. This makes it possible to more fully visualize the organ. The first method involves inserting a special sensor into the patient's vagina. No preparation is required, and the conductor gel is applied directly to the scanner.

A transabdominal examination is a scan of the pelvic organs through the wall of the abdominal cavity. Before this, it is necessary to fill the bladder to better visualize the ovaries. However, it happens that an ovary is not detected on ultrasound. This could be for several reasons:

The ovary was removed by surgery;

This is a congenital pathology, and it happens that two organs are missing at once;

The ovaries decrease in size due to wasting and are difficult to visualize;

There are myomatous nodes in the uterus and this makes it enlarged and covers the ovaries;

The patient has multiple adhesions in the organs, which is why they are increased in size and also cover the ovary;

Bloating can also interfere with the detection of an ovary on ultrasound.

eda-zakuska.ru

2018 Blog about women's health.

It is often difficult to study the functioning of the ovaries using a conventional ultrasound examination, because the ovary is simply not visible. But this in no way means that it is not in a woman’s body.

In what situations is the ovary not visible on ultrasound?

Difficulties when examining a patient’s ovaries during ultrasound diagnostics may arise:

After surgery on the uterine tubes or the ovaries themselves;
With a large uterus;
When the uterus is deformed from myomatous nodes;
In case of severe pathology of the uterine tubes;
In case of a severe polyetiological disease of the uterus, the occurrence of which can have many reasons: age-related changes in the female body, work in a hazardous enterprise, changes in the immune system or neuropsychic irritants.

Do not be upset if during the examination the specialists did not see the ovary on the ultrasound. You just need to use a different method. For convenience and information, ultrasound diagnostics of the ovaries often resort to transvaginal examination (endovaginal sound examination or transvaginal ultrasound). Transvaginal ultrasound is performed through the vagina.

Prerequisites for the transvaginal examination method

Your gynecologist may refer you for a transvaginal ultrasound in the following cases:

Pain in the pelvic area;
Infertility;
Bleeding or irregular menstrual cycle;
Suspicion of ectopic pregnancy;
Neoplasms on the female internal genital organs identified during a physical examination of the patient.

How to prepare for a transvaginal ultrasound?

No special preliminary preparation is required. The only condition is an empty bladder. Already in the office, the doctor will ask you to completely undress from the waist down, take a horizontal position on the couch and relax the muscles of your lower body. The procedure is absolutely painless. You may feel some discomfort from the pressure of the sensor on the vaginal walls.

How is an endovaginal sound examination performed?

For maximum diagnostic information, it is very important to correctly position the sensitive sensor. It is most convenient to examine the ovaries when the woman lies on the couch with her knees bent. To prevent injury and infection of the vagina, a condom is placed over the sensor. Before insertion, the condom is lubricated with a special gel that reduces friction to a minimum.

Health hazards during transvaginal ultrasound diagnostics

Unlike X-rays, ultrasound examination is absolutely safe for a woman’s health. This method has only positive characteristics. Today, in every medical center, diagnostic doctors use ultrasound equipment. The speed and accuracy of the procedure helps to diagnose unwanted deviations from the norm in women’s health in a timely manner. The painlessness of the procedure helps eliminate unnecessary anxiety for the patient.

cimax-kino.ru

Corpus luteum on ultrasound after ovulation: what does it mean?

The corpus luteum on an ultrasound after ovulation is a natural process in the female body, which means the release of a mature egg and a high chance of conception. By the time menstruation occurs, the temporary gland self-destructs, the effect on the body of progesterone, which causes acne in many women, enlargement, breast soreness during PMS decreases, and a new cycle begins.

The second name for the corpus luteum (LC) is the luteal gland.

What methods will help you find out about the presence of a corpus luteum?

There are two ways to find out about the existence of a temporary gland:

Ultrasonography. The most reliable method that allows you to clearly see the picture of what is happening on the monitor, determine the size, likelihood of conception, and the effect of VT on the reproductive organs.
Analysis for the hormone progesterone. Relying on this method alone is not enough, because situations with hormonal imbalance occur.

If a woman is tracking her ovulation with the goal of becoming pregnant, then the most common sense solution is to use two methods simultaneously.

Corpus luteum after ovulation on ultrasound

On ultrasound, the gland looks like a round, soft sac located on one of the ovaries or on 2 at once. In the latter case, a multiple pregnancy is likely if the egg is successfully fertilized.

After ovulation has taken place, the gland appears almost immediately, gradually increasing in size. To assess the state of reproductive function, especially the ovaries, it is recommended to do ultrasound three times per cycle:

on days 7-10 of the cycle. At this time, the mucous membrane of the uterus is quite thin and allows you to see hidden pathologies, and the ovaries are “refreshed” after menstruation;
on days 14-16 of the cycle. The follicle is just beginning to grow, so a study is ordered to find out whether there is ovulation, pathology, or the development of a neoplasm or not;
on days 22-24 of the cycle. The body begins to prepare for menstruation, so specialists look at changes in the ultrasound picture after ovulation: what happens to the follicle, whether it has transformed into a cyst, whether it has disappeared, etc.

A three-time study will accurately show the picture of the functioning of the genital organs, and will also indicate the specific day of ovulation, because the individuality of each organism knows no boundaries: the follicle can begin to develop much earlier than the 14th day of the cycle, and later than the 24th.

Table of sizes of the corpus luteum after ovulation based on the ultrasound findings:

Cycle day/phase	Size	Peculiarities
13-17 Vascularization phase	12-20 mm	Accelerated formation of the luteal gland, greatest activity. The most successful period for fertilization.
19-29	24 mm	There is an increase in size. By this time, conception has either taken place, or the egg has died, and the body gradually begins to prepare for menstruation.
Withering phase (the day of the cycle is individual)	7-17 mm	Withering and reduction in size begins, the gland changes at the cellular level with the death of the egg. On ultrasound, after ovulation, the corpus luteum becomes convex and purple in color. If pregnancy has occurred, the withering phase does not occur.
Degradation phase (after withering, the day of the cycle is individual)	–	Dystrophy occurs, VT looks like a scar that resolves itself. There is a sharp decrease in hormones, followed by menstruation.

If the size of the luteal gland at the end of the monthly cycle is from 12 to 15 mm, then this indicates a reverse development of VT. A value of 24-30 mm indicates the possible presence of pregnancy, which is proceeding normally. From 30 mm or more – the appearance of a VT cyst, in which case therapy is prescribed and pregnancy planning is postponed. But if it has already occurred, careful monitoring is carried out during the first trimester. There is no serious threat.

The constant presence of the luteal gland also indicates a cystic formation. The normal “life” of VT is 13-14 days, until the onset of menstruation.

What does the absence of the luteal gland mean?

If there is no corpus luteum in the ultrasound picture, probable causes include:

Anovulatory cycle or late ovulation. If the gland is not visible, then ovulation will either not occur at all, or it will happen later.
Follicular cyst. The follicle has not matured, has not grown to its size, has stopped developing, has not ruptured, turning into a formation that often disappears on its own in the next cycle due to a temporary failure (if follicular cysts appear systematically or do not resolve well, the reason lies in the woman’s reproductive health).
Infertility and other pelvic diseases. Follicles may not develop at all. In this case, a thorough examination is necessary, searching for the root cause and eliminating it.

Every woman has anovulatory cycles, during which the corpus luteum is absent - this is a normal and natural process. However, the systematic occurrence of anovulatory cycles is a serious reason to undergo examination.

oyaichnikah.ru

Ovarian ultrasound reveals cysts, infertility and cancer | Clinic Diana in St. Petersburg

Ultrasound examination is widely used to diagnose a huge number of pathologies of the human body. It is also indispensable when examining a woman’s reproductive system. Ultrasound of the ovaries is an accessible and absolutely harmless method for studying the shape, size, location and structure of the organ, as well as the follicular apparatus.

Indications for ultrasound of the ovaries

It is rarely performed as an independent procedure. As a rule, an ultrasound of the ovaries is performed in conjunction with an ultrasound examination of the pelvic organs. In some cases, the procedure is prescribed if it is necessary to assess the functional activity of the ovaries. This is mainly necessary when diagnosing the causes of female infertility.

In this case, an ovarian examination is performed to measure the dominant follicle when a woman has been unable to become pregnant for a long period. In this case, over a certain period, the doctor observes the follicle and records the occurrence or absence of ovulation. This examination of the ovaries is called folliculometry.

Also, indications for prescribing ultrasound of the ovaries are:

irregular menstrual cycle, absence of menstruation (if not during pregnancy);
regular nagging or sharp pain in the lower abdomen;
pain during sexual intercourse;
too scanty or heavy menstrual bleeding;
unusually severe menstrual pain;
breast disease;
suspicion of infertility;
inflammation of the appendages;
suspected pathology;
preparation for pregnancy;
preparation for IVF;
preventive examination.

What pathologies does ultrasound examination of the ovaries reveal?

Ultrasound of the ovaries is a fairly effective method in identifying pathologies, and with its help it is possible to detect some diseases even at the preclinical (before the onset of symptoms) stage, and those pathologies that cannot be detected using other research methods.

An ovarian cyst (functional and pathological) is a benign neoplasm characterized by the formation of a fluid-filled protrusion on the ovary (or both at once). The pathology is dangerous due to degeneration into a malignant tumor, provocation of infertility, peritonitis or disruption of the functioning of neighboring organs.
Polycystic ovary syndrome is a hormonal disease in which the ovaries increase in size and accumulate many cysts. The disease provokes infertility because it prevents ovulation from occurring, i.e. release of eggs from the ovary.
Salpingo-oophoritis is a joint infectious and inflammatory process in the ovaries and fallopian tubes. Independent inflammation of the ovary - oophoritis - is a fairly rare occurrence. The pathological process is caused by infection (streptococci, staphylococci, chlamydia, etc.). Most often it comes from the vagina and uterus along the ascending route.
Ovarian torsion is a serious pathological condition in which the nutrition of the ovary is disrupted. Requires immediate medical attention.
Malignant tumors - cancer.

Sonography technique

There are three ways to examine the ovaries using ultrasound. The doctor chooses a specific method taking into account the patient’s medical history.

Transabdominal - carried out using an external sensor through the abdominal wall. This method is the most comfortable, but the least informative; it can only be used to identify gross organ dysfunction. It is usually used during a general gynecological examination, for virgins and women with vaginal malformations.
Transvaginal - performed using an intracavitary sensor (transducer), which is inserted into the vagina. The method is the most accurate and informative, since the sensor is located in close proximity to the internal organs. May be accompanied by minor discomfort during insertion of the sensor. This type of ultrasound is contraindicated for virgins and for vaginal malformations.
Transrectal - carried out using an intracavitary sensor (thinner than for TVU), which is inserted into the rectum. The method is absolutely painless, but very uncomfortable for the woman. It is carried out in individual cases when TAU turned out to be insufficiently informative, and TVU cannot be performed for objective reasons (virginity, atresia (fusion), severe stenosis (narrowing) of the vaginal opening, etc.).

The duration of the procedure is about 15 – 20 minutes.

How to prepare for the procedure

Each research method requires special preparation in order to obtain the most accurate and informative result.

Transabdominal ultrasound of the ovaries

This type of study requires careful preparation, including a slag-free diet and cleansing the intestines of gases. 2-3 days before the procedure, you must stop eating foods that cause flatulence (carbonated drinks, beans, fresh fruits and vegetables, yeast and dairy products, etc.). One day before, start taking adsorbent drugs (smecta, espumizan, activated carbon, etc.).

During the procedure, the bladder must be full, so the woman needs to drink 1 liter of liquid (non-carbonated and non-dairy) an hour before the procedure and not urinate.

Transvaginal ultrasound of the ovary

Special preparation for such an ultrasound is not needed, since the only condition for its implementation is an empty bladder. Immediately before the procedure, the woman simply needs to urinate. If there is a tendency to increased gas formation, two days a day, start taking medications that reduce flatulence (smecta, espumizan, activated carbon, etc.).

Transrectal ultrasound

Preparation for such an ultrasound is similar to preparation for a transvaginal examination. Additionally, 9–10 hours before, it is necessary to clear the intestines of feces using a cleansing enema (1–1.5 l), microenemas, glycerin suppository or laxative.

The timing of the study depends on its purpose. If the ultrasound is planned, then it is performed on the 5th – 6th day of the menstrual cycle and no later than a week after the end of menstruation. In severe situations, an ultrasound is performed on the day symptoms are detected. If it is necessary to evaluate the functioning of the ovaries, the procedure is prescribed three times (on days 8-9, days 14-15 and days 22-23 of the menstrual cycle).

How is the procedure performed?

Transabdominal method. The patient lies with her back on the couch and exposes her stomach. The doctor applies a special gel to the area of the abdomen projected to the ovaries to improve contact with the sensor, and then scans the ovaries by moving the device over this area.

Transvaginal method. The patient exposes part of the body below the waist and lies with her back on the couch, bending her knees. The doctor carefully inserts a cavity sensor into the vagina, onto which he previously put a condom to prevent the entry of foreign microflora and lubricated it with lubricant. The transducer is inserted shallowly, approximately 5–8 cm.

Transrectal method. The patient exposes the lower part of the body and lies sideways on the couch, bending her knees. The doctor slowly and carefully inserts a sensor into the anus, onto which a condom has previously been put on and a lubricant has been applied to reduce discomfort and unpleasant sensations for the woman to a minimum.

During the examination, the doctor evaluates the structure of the ovaries, their condition, size, location, confirms or denies the presence of pathological changes and inclusions. Upon completion of the procedure, he gives the patient an ultrasound report, with which the woman must contact the treating specialist to receive treatment.

Interpretation of ultrasound of the ovaries: norms

Normally, the ovaries are located on the sides of the uterus at a short distance from it, often asymmetrically. On the monitor they are visualized as oval, fairly defined, hypoechoic formations, while the ovaries are not identical to each other, the difference in their sizes is minimal. Their surface is considered normal to be lumpy due to the follicles maturing in them. The more time has passed since the beginning of the cycle, the larger these tubercles are.

Normally, the ovaries should be free of cystic, tumor-like and other formations, and the organ itself should not be enlarged. The interpretation of the results contains an indication of the sizes of the ovaries and follicles.

Standard indicators for ovarian size are presented in the table. Values may vary depending on the patient’s age, cycle phase, number of pregnancies, etc.

After the onset of menopause, the ovaries decrease in size and volume by almost 2 times (on average to 2 cm3), their silhouette becomes uneven, wrinkled, and their echogenicity increases.

Normally, the ovaries consist of a capsule and follicles of varying degrees of maturity, the number of which on the left and right may differ. In healthy women, the following follicle indicators are visualized depending on the phase of the menstrual cycle:

Why are the ovaries not visible on ultrasound?

In some cases, the doctor cannot recognize the ovary on an ultrasound. This may happen for the following reasons:

congenital absence of ovaries;
removal during surgery;
premature organ depletion;
severe bloating;
high density of the abdominal wall with pelvioperitonitis;
severe adhesive disease of the pelvis;
dense fatty layer or scars on the anterior abdominal wall.

In this case, a repeat study is usually carried out, in preparation for which an obligatory emphasis is placed on getting rid of flatulence with the help of medications.

Ovarian pathologies and their signs on ultrasound

Some conditions, such as luteal cyst (corpus luteum cyst) and follicular cyst, are considered “normal” and do not require treatment because they usually heal spontaneously as soon as hormonal levels change. Other cysts and diseases are pathological and require mandatory treatment.

On ultrasound, the cyst looks like a formation of 2.5 cm with liquid inside, having a different structure and degree of staining.

Ovarian damage	The ovaries have the appearance of oval hypoechoic formations with an uneven intermittent contour; fluid (blood) or echogenic signals of various sizes and shapes (blood clots) may be detected along the lateral uterine wall or in the uterine space
Salpingo-oophoritis, oophoritis (acute form)	Increased ovarian size; clear, defined contour; reduced sound conductivity due to swelling; hypoechoic areas can be detected - foci of necrosis (small abscesses)
Salpingo-oophoritis, oophoritis (chronic form)	Normal or slightly enlarged ovarian size; fuzzy, blurred outline; increased echogenicity of the organ; heterogeneous tissue structure
Dermoid cyst	Visible round neoplasm with thickened walls from 0.7 to 1.5 cm, which contains various hyperechoic inclusions inside
Endometrioid cyst	The formation is relatively small in size (up to 7 cm in diameter) with a double contour; unilateral localization - behind or to the side of the uterus; medium and increased echogenicity of non-displaceable fine suspension
Polycystic ovary syndrome	Increased size of the ovaries (volume more than 7 cm3); cysts are found in both ovaries (from 10 pieces in each of them) with a diameter of 2 to 8 mm; location of cysts along the periphery of the ovarian structure
Malignant tumor	A cyst that has several chambers and spreads to neighboring organs; unclear contents of the cyst; accumulation of fluid in the pelvis or abdominal cavity

Any pathology detected on ultrasound of the ovaries must be confirmed by other research methods, only after which an accurate final diagnosis can be made.

Research Alternative

There are many alternative methods for examining the ovaries, among which the most commonly prescribed are:

computer and magnetic resonance imaging;
puncture of the pouch of Douglas followed by cytological analysis of the washout;
diagnostic laparoscopy (laparotomy) with express biopsy and taking smears.

Ultrasound of the ovaries is the most universal method of examination and stands out among the rest.

Its advantages are as follows:

non-invasive (without tissue trauma) research method;
painless;
much cheaper and more accessible than other methods;
absolutely harmless to the body - no ionizing radiation is used, so it can be carried out repeatedly;
perfectly visualizes soft tissues, unlike x-rays;
ideal for monitoring intrauterine development of the fetus;
shows the state of the body in “real time”, thanks to which it is possible to diagnose even an acute disease without resorting to puncture of the posterior vaginal vault and biopsy.

Where to do an ultrasound of the ovaries in St. Petersburg, the cost of the examination

You can sign up for an expert pelvic ultrasound, which includes a full examination of the ovaries, at the DIANA clinic (St. Petersburg) on our website. The price of a comprehensive examination will be only 1000 rubles. In this case, the study will be carried out using a new Doppler device (manufactured by SAMSUNG MEDISON). Here you can take any tests. We work seven days a week and seven days a week!

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2018 Blog about women's health.

Pelvic examination in postmenopause

Uterus. In postmenopause, the uterus becomes significantly smaller in size and more homogeneous in echo structure: the endometrium is not visible.
Postmenopausal ovaries. The ovaries are small and often very difficult or impossible to visualize with ultrasound. When they are visualized, they appear hyperechoic, lack follicles, and are often nearly isoechoic to the surrounding tissue.

Position of the uterus

The uterus can be rotated so that the body of the uterus is located behind the cervix (retroversio condition). The body of the uterus may be tilted anteriorly (anteversio).

If the body of the uterus is inclined towards the cervix, it is in antejlexio. If the body of the uterus is tilted back from the cervix, this condition is called retroflexio.

When normal pelvic echostructures are not clearly visible, give the patient more fluid to fill the bladder.

The ovaries can occupy different positions, but are always located behind the bladder and uterus. Most often they are found at the site of the appendages, on the side.

The ovary may be located in the retrouterine space or above the fundus of the uterus. In postmenopausal women, the ovaries are small and often not visualized.

In the absence of visualization of the ovaries, the following techniques can be used:

Place the patient in the lateral position and scan the contralateral ovary through a full bladder.
Reduce the sensitivity level of the device. If sensitivity is too high, the ovary may be poorly identified against the surrounding parametrium and may not be visualized.

Even if the bladder is adequately filled, the ovaries may be poorly visualized due to shielding by intestinal gases. This often happens if the ovaries are located higher than usual.

If necessary, scan the patient in an upright or vertical oblique view. This will help dislodge gas-filled intestinal loops, allowing the ovaries to be more clearly visualized.

Normal ovaries

Examine the tissue around the ovary for cystic, solid, or fluid-containing lesions. Look for fluid in the retrouterine space. Examine both ovaries.

Follicular apparatus of the ovary

A physiological cyst in the ovary can have a diameter of up to 5 cm. Cysts of this size should be re-examined at the end of the menstrual cycle or during the next cycle.