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a Chapter 39 Doppler Ultrasonography for Benign Gynecologic Disorders, Ectopic Pregnancy, and Infertility 573
uteri and endometriosis are reported in increasing
numbers. The effect of GnRH analogs, essentially a
medically induced menopause, might be assessed in a
semiquantitative manner using transvaginal sonography
and color Doppler flow analysis. It has been our
observation that women distant from menopause exhibit
an increased resistance flow pattern and higher
RI [5]. The utility of this modality for exploring benign
conditions of the uterus continues to expand.
Endometrium
Transvaginal sonography greatly enhances imaging of
the uterine cavity and endocervix. It is now possible
to identify small submucous myomas, endometrial
polyps, distortions of the endometrial cavity, and the
exact location of an intrauterine device (IUD). Measurement
of the total thickness of the endometrium
is facilitated by transvaginal scanning (Fig. 39.5). The
measurement should be obtained in the sagittal plane
and reported in millimeters. Literature accumulated
to dat suggests that endometrial thickness in the postmenopausal,
non-hormone-replaced individual should
be less than 6 mm (Table 39.1). A thickness of 6 mm
or more is suspect [6, 7]. Pathologic conditions seen
in the setting of increased endometrial thickness include
endometrial hyperplasia, endometrial polyps,
and adenocarcinomas of the endometrium (Fig. 39.6).
Among a screened population at our institution, more
than 2,000 women underwent transvaginal sonography
and color Doppler analysis, with assessment of the endometrial
cavity as well. There were 20 asymptomatic
women who underwent endometrial sampling or
biopsy based on a report of the endometrium being
greater than 6 mm. None of the women had symptoms
(i.e., postmenopausal bleeding or staining) (Table
39.2). There were three cases of adenocarcinoma
Table 39.1. Previous studies on endometrial thickness
Study
Reason
for consult
No.
Cutoff
thickness
(mm)
Result (disease)
Klug and Referred 215 10 Benign (