Understanding Your Pelvic Ultrasound Report
Pelvic ultrasound results explained — how to read a transvaginal or pelvic ultrasound report, what the normal values are, and what the images actually show.
If you are reading your pelvic ultrasound report and wondering what it all means, you are in the right place. Whether the scan was performed transabdominally, transvaginally (TVS), or both, the report follows the same route through the pelvis: the uterus, the endometrium (the womb’s lining), each ovary, and the surrounding areas. This guide walks that route in order — the terminology, the normal reference values, and real scan images showing what normal looks like — so you can read your own report line by line. For how any ultrasound report is structured, start with our general report guide; for individual terms, the glossary goes A–Z.
The uterus — position, size and texture
The report opens with the uterus’s position: anteverted (tilted forwards — the commonest presentation, around 80% of women), retroverted (tilted backwards), or axial (pointing straight up towards the head). All three are normal anatomical variants — position alone is almost never a finding to worry about, just useful information for any future procedures.
Size is reported either subjectively (“the uterus is normal in size”) or as three measurements in millimetres — length, depth and width — which vary with age and whether you have had children. A “bulky uterus” means larger than typical, most often from fibroids or adenomyosis, and the report will say which. The myometrium (the muscular wall) is described next: a smooth, homogeneous texture is normal, while fibroids — extremely common benign muscle growths — are individually measured and located (subserosal on the outer surface, intramural within the wall, submucosal indenting the cavity), because location determines whether they matter for symptoms or fertility.
The endometrium — the lining and its thickness
The endometrium is the lining of the womb, and its thickness in millimetres is one of the most-read numbers in any pelvic report. Crucially, it is a moving target: the lining builds and sheds with the menstrual cycle, so normal ranges roughly from 1 to 14 mm depending on the day of your cycle — thin just after a period, thickest before one. A good report interprets the number against your cycle stage, which is why the same measurement can be normal on day 22 and noteworthy on day 3. After menopause the lining is assessed on different, stricter criteria — particularly if there has been any bleeding, which always warrants review, as our guide to postmenopausal bleeding explains.
An endometrium thicker than expected for the cycle stage has a shortlist of causes — polyps, submucosal fibroids, hyperplasia (overgrowth of the lining) and, less commonly, cancer — which is why an unexpected measurement leads to follow-up rather than conclusions: often a repeat scan timed to your cycle, or referral for a closer look. Serial monitoring of exactly this measurement is its own service, explained on our endometrial thickness scan page.
The ovaries — volume, follicles and cysts
Each ovary is described by appearance and by size or volume — normal ovarian volume is roughly 1.2 to 9.4 cm³, varying with age and cycle. Small fluid-filled follicles are a normal, healthy feature of ovaries in the reproductive years — they are eggs maturing, not cysts to worry about, and counting them (the antral follicle count) is how fertility assessment uses this same image.
Where the report describes a cyst, the name is doing precise work: follicular cysts and corpus luteum cysts are functional — part of the cycle’s normal machinery, usually resolving by themselves; haemorrhagic cysts have bled internally and typically settle; endometriomas are cysts of endometriosis; simple cysts are thin-walled fluid sacs graded by size; and polycystic-appearing ovaries describes a pattern of many small follicles — an appearance, which only becomes the syndrome (PCOS) when combined with clinical criteria. Our guide to ovarian cyst symptoms covers what each type means in practice. Occasionally an ovary cannot be seen — usually hidden by bowel gas or position, especially transabdominally — and the report saying so is honesty about views, not a finding.
The surrounding areas — adnexae, pouch of Douglas and free fluid
The examination finishes with the adnexae (the regions either side of the uterus containing the ovaries and fallopian tubes) and the pouch of Douglas (the space behind the uterus — the lowest point of the pelvis). A small amount of free fluid in the pouch of Douglas is a common, frequently physiological finding, particularly around ovulation — context decides whether it means anything. The fallopian tubes are not normally visible on ultrasound at all; they only appear when abnormally distended by fluid — a hydrosalpinx (fluid-filled tube) or pyosalpinx (infected fluid) — so a report that does not mention your tubes is a report describing normal tubes.
Then comes the impression: the answer to the question the scan was asked. Normal versus abnormal in a pelvic report is rarely about one scary word — it is the pattern of position, sizes, textures and the reference values above, read against your symptoms and cycle. At IUS London that reading happens with you in the room: findings are shown and explained on screen at the scan, and the written report follows, usually within two hours.
Pelvic ultrasound reports — your questions answered
How do I read my pelvic ultrasound report?
What is a normal endometrial thickness?
What is a normal ovarian volume?
What do anteverted and retroverted mean?
What does free fluid in the pouch of Douglas mean?
Why couldn’t the scan see one of my ovaries?
The report cluster
The examination behind the report — transabdominal and transvaginal, explained and booked.
About the scan →
Start HereUnderstanding Your ReportHow every ultrasound report is structured, and the stock phrases translated.
Read the guide →
A–ZUltrasound GlossaryEvery recurring report term, defined in plain English.
Open the glossary →
A pelvic scan explained while you watch
Transabdominal and transvaginal scanning by HCPC-registered sonographers, findings shown to you on screen, and a written report — usually within two hours — your GP can act on.
Kensington, London W8 4ED
3 mins from Notting Hill Gate
References: Merz E., Ultrasound in Obstetrics and Gynaecology, Vol. 2, 2nd ed., Thieme, 1997; Goldberg BB, McGahan JP., Atlas of Ultrasound Measurements, Elsevier Health Sciences, 2006; SIGN guideline 61, Investigation of Post-Menopausal Bleeding, 2002. This guide is general information, not individual medical advice — your own report should always be interpreted with the clinician it was written for. If in doubt, speak to your GP or call NHS 111.
Written and clinically reviewed by the HCPC-registered sonographers who perform this scan at IUS London — a CQC-registered diagnostic ultrasound clinic (Provider ID 1-2775844974). Your own findings are explained to you at the scan and set out in your report.
Author: Yianni Kiromitis, Senior Sonographer, HCPC RA38415
Medically reviewed: 31 July 2026
