Ultrasound of the endometrium: facts, controversies, and future trends

The role of ultrasound in the evaluation of the endometrium has been overshadowed by a large volume of literature about the ovaries and myometrium. In fact, aside from some investigations centering on the thickness of the endometrium in the normal woman and its relationship to the possibility of endometrial cancer, there has been little interest in the endometrium until very recently. Transvaginal sonography (TVS) has provided a: modest improvement over transabdominal sonography (TAS) to image the endometrium and evaluate pathology; however, the gynecologic community relies heavily on endometrial biopsy (EMB), dilatation and curettage (D&C), and hysteroscopy for endometrial diagnosis. The introduction of saline-infused hysterosonography (HSG) has revolutionized gynecologic ultrasound of the endometrium. The variety and frequency of endometrial disorders seen with HSG rivals and even surpasses that seen with hysteroscopy, a moderately invasive procedure. This article will attempt to define the role of ultrasound in the complex anatomy, physiology, and pathology of the endometrium.