Normal uterine size for a nulliparous menstruating female is up to 8 cm in length and 3 to 5 cm in transverse and AP diameter. Maximal uterine size for multiparous women may be 1 to 2 cm greater in each plane. The empty uterus is a thick-walled, muscular organ with moderate echogenicity. It contains a central hyperechoic (endometrial) stripe that represents the opposed surfaces of the endometrial cavity. In the nonpregnant patient, the appearance of the endometrium is variable depending on the phase of the menstrual cycle. Early in the cycle the proliferative endometrium usually measures 4 to 8 mm in width ( Fig 10.9.-1). Later during the secretory phase, the endometrium generally measures 7 to 14 mm and displays increased echogenicity ( Fig 109-5). The echogenicity and size of the menstrual endometrium are variable and dependent on the amount of blood and clot present within the uterus. The endometrium of the postmenopausal patient without hormonal replacement therapy is generally less than 9 mm in width. The combination of postmenopausal vaginal bleeding and increased endometrial width is suspicious for endometrial carcinoma and requires further evaluation. A markedly thickened postpartum endometrium suggests the presence of retained products of conception.

FIG. 109-5. The uterus with a thickened and hyperechoic endometrial stripe (secretory phase) is visualized on this transabdominal image in the longitudinal plane. Two nabothian cysts can be seen at the cervix, immediately posterior to the angle of the bladder.

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