Gynaecological Ultrasound: Specialist Pelvic Imaging in London

Ultrasound is the foundation of modern gynaecological assessment. For the conditions I see in my practice every day — fibroids, ovarian cysts, endometriosis, adenomyosis, uterine abnormalities, and early pregnancy — pelvic imaging provides information that simply cannot be obtained through clinical examination alone. What distinguishes the ultrasound I offer from a standard scan service is that I perform and interpret the scan myself, as a specialist gynaecologist, integrating every finding directly with your clinical history and symptoms in real time. An image without context tells only part of the story; my aim is to give you the complete picture.

What Is a Gynaecological Ultrasound?

Gynaecological ultrasound uses high-frequency sound waves to generate detailed images of the pelvic organs: the uterus, ovaries, fallopian tubes, and surrounding structures. It is entirely safe, involves no ionising radiation, and is well tolerated by the vast majority of patients.

There are two approaches, and I use both depending on the clinical question:

Transvaginal ultrasound (TVS) involves a slender probe, covered with a disposable sterile sheath and gel, being gently placed in the vagina. Because the probe is in close proximity to the pelvic organs, it produces significantly clearer and more detailed images than scanning through the abdominal wall. It is the preferred approach for most gynaecological assessments and is the standard of care in specialist gynaecological practice. You will always be asked for your consent, and the procedure will be explained fully before it begins.

Transabdominal ultrasound (TAS) uses a probe placed on the surface of the lower abdomen with gel applied to the skin. It provides a wider field of view, which can be useful for assessing larger structures (such as a significantly enlarged uterus) or when a transvaginal approach is not appropriate or preferred.

What Can Be Assessed

A specialist gynaecological ultrasound in my practice can evaluate:

• Uterine size, shape, and position — identifying congenital abnormalities (bicornuate, septate, or arcuate uterus), an enlarged or retroverted uterus, and structural changes
• Endometrial thickness and appearance — critical for assessing abnormal uterine bleeding, postmenopausal bleeding, and endometrial pathology; I measure the endometrium at its thickest point and assess its echogenicity
• Fibroids (uterine leiomyomata) — number, size, and location (submucosal, intramural, or subserosal), which determine their clinical significance and treatment options
• Ovarian size, morphology, and follicle count — assessment of antral follicle count (AFC) relevant to fertility; identification of polycystic ovarian morphology in the context of PCOS assessment
• Ovarian cysts — characterising cysts as simple, complex, haemorrhagic, or endometrioma; applying IOTA criteria or ADNEX modelling to assess the probability of malignancy
• Adenomyosis features — myometrial heterogeneity, asymmetric myometrial thickening, cystic changes within the myometrium, and interrupted junctional zone
• Endometriosis markers — ovarian endometriomas, free fluid in the pouch of Douglas, obliteration of the posterior cul-de-sac, bladder nodules, and signs of deep infiltrating disease
• Early pregnancy assessment — viability, gestational age, location (to exclude ectopic pregnancy), and fetal cardiac activity
• IUD/IUS position verification — confirming correct placement or identifying displacement of an intrauterine device
• Pelvic free fluid — assessing for abnormal collections that may indicate haemorrhage, infection, or ovarian hyperstimulation

What to Expect During Your Scan

Before the scan begins, I will explain exactly what the procedure involves and answer any questions you have. Your consent and comfort are my priority throughout.

For a transvaginal scan, you will be asked to empty your bladder beforehand. You will lie on the examination couch with your legs supported, and the procedure takes approximately 10–20 minutes depending on the complexity of the assessment. The transducer probe is slim and designed for comfort; most women find it no more uncomfortable than a cervical smear, though sensations vary.

Crucially, I do not simply hand you a written report at the end. I explain what I can see as we go, and at the close of the scan I review my findings with you in full. We discuss what the images show, what they mean in the context of your symptoms, and what the next steps should be. You will leave with clarity rather than uncertainty.

Why Specialist Scanning Matters

There is an important distinction between a scan performed by a sonographer or radiographer, with findings reported in writing to a clinician who may not have been present, and a scan performed and interpreted by the gynaecologist responsible for your care.

When I perform your scan, I bring the full clinical context to the image in real time. I can redirect the probe in response to what I am seeing; I can correlate a tender area on examination with what appears on ultrasound; I can apply specific scanning protocols for endometriosis assessment that are not part of standard radiology practice. The result is a more nuanced, clinically meaningful assessment. A finding that might appear incidental on a standard report may be highly significant when interpreted alongside your symptoms — and vice versa.

When Is a Gynaecological Ultrasound Recommended

• Heavy, irregular, or prolonged menstrual bleeding
• Pelvic pain, whether cyclical or continuous
• Suspected fibroids or ovarian cysts on clinical examination or previous imaging
• Investigation of endometriosis or adenomyosis
• Fertility assessment (including antral follicle count, uterine anatomy)
• Early pregnancy monitoring (viability, dating, ectopic exclusion)
• Postmenopausal bleeding requiring endometrial assessment
• Assessment prior to or following insertion of an intrauterine device
• Incidental finding of pelvic abnormality on previous imaging
• General pelvic health check as part of a well-woman assessment

Limitations and When Further Imaging Is Needed

Ultrasound, even in expert hands, has its limitations. While transvaginal ultrasound is excellent for identifying ovarian endometriomas and assessing the uterus, it is limited in its ability to map deep infiltrating endometriosis involving the bowel, rectovaginal septum, ureters, or bladder wall. For these situations, pelvic MRI is the imaging modality of choice, and I will refer for this when clinically indicated.

Similarly, certain ovarian masses that appear indeterminate on ultrasound may require MRI or CT for further characterisation. And where laparoscopy is required — either for definitive diagnosis of endometriosis or for the surgical management of pelvic pathology — I will discuss this openly and arrange appropriate referral or surgical planning.

What to Expect at Your Consultation

Your appointment will begin with a focused clinical consultation, during which I take a detailed history of your symptoms, menstrual pattern, and relevant past medical history. The ultrasound follows, and findings are discussed with you immediately. Depending on what is identified, we will outline a management plan — whether that involves a prescription, further investigations, a follow-up appointment, or onward referral. You will never be left with unexplained findings or a list of tests without a clear explanation of why they are needed.

I believe that good imaging is the beginning of a good diagnostic conversation — and I look forward to having that conversation with you.