Postmenopause/ Postpatum Pelvis

What happens in postmenopausal ovaries? (5)

- Atrophy with age following menopause - Lack of follicles - Visualisation can be difficult - Volume of >8cc considered abnormal - Detection rates vary

C-section scars: - are they common - is there pathology related?

C-section scars are common Can be pathology related like fluid tracking or ectopic pregnancies within scar

- Is endometrial carcinoma common? - Why are there less fatalities than ovarian cancer?

Most common gynaecological cancer Less fatalities than ovarian cancer because it is usually symptomatic -90% of patients have abnormal uterine bleeding.

Why can the patient be scanned TA? (postpartum)

The increased size of the uterus acts as a window

Do cystic areas in postmenopausal ovaries require follow up?

Cystic areas <1cm are normal but >1cm require annual follow up

What needs to be considered with a postmenopausal patient? (5)

- Is the patient truely postmenopausal? - Is the patient symptomatic - Is the patient on HRT or Tamoxifen? - Does the endometrium demonstrate a normal sonographic appearance? - What is the endometrial measurement

What is - Menopause - Early Menopause - Late Menopause

- Menopause: 1st year following final menstrual period - Early Menopause: First 5 years following final menstrual period - Late Menopause: >5 years following final menstrual period

Endometrial Carcinoma: - Ultrasound appearance (5)

- Thickening of the endometrium (often more irregular and homogenous than endometrial hyperplasia) - Irregularity of endometrial-myometrial border (suggests invasion of myometrium) - Low resistance vascularity - Endometrial cysts - Associated hydrometer or haematometra

What is the appearance of the postpartum uterus? (6)

- Variable appearance (can be similar to RPOC and endometritis) - Bulky (returns to normal size by 8weeks) - Inner myometrium may be hyperechoic DONT mistake this for endometrium - Echogenic foci due to air - Small amounts of fluid - Heterogenous areas (clot)

What are reasons for thickened endometrium?

- endometrial hyperplasia - endometrial polyp - submucosal fibroid - Adenomyosis - Endometrial carcinoma

What happens to the postmenopausal uterus? (3)

- undergoes atrophy approaches cervix in size - calcifications are normal - endometrium appears thin

What is the most common cause of postmenopausal bleeding? What is the role of ultrasound in postmenopausal bleeding?

Endometrial atrophy is the most common cause of abnormal bleeding. Ultrasound I helpful in determining which patient need further evaluation/ biopsy. Endometrial atrophy appears as normal thin endometrium

What are four types of Hormone Replacement Therapy? What is the corresponding endometrial appearance on ultrasound?

Unopposed Oestrogen: - Thick and sometimes heterogenous (not often used anymore because of increased risk of breast ca.) Combined Oestrogen-Progesterone: - Thin and atrophic endometrium Sequential Oestrogen/Progesterone: - Thickness varies with phase of cycle (should be assessed in early proliferative phase) Tamoxifen: - Thick, cystic spaces. - Border between endometrium/ myometrium may be difficult to assess. - (increased risk of endometrial ca, hyperplasia and polyps)

Why do RPOC (retained products of contraception) occur? What is the typical ultrasound appearance? (4)

Usually occur when pregnancy does not carry to term Appearance: -Echogenic mass within endometrium - May appear heterogenous - Presence of vascularity increases likelihood of RPOC but lack of vascularity doesn't exclude it - Associated fluid in endometrial canal