Key Points

• Ultrasound of the uterus may be performed transvaginally (TVUS), transabdominally (TAUS), or even transcervically or laparoscopically with specifically designed instrumentation.
• In generał, TVUS provides the best information, but it may be limited when the uterus is very large, and impossible with certain clinical situations such as a virginal individual or one who has experienced sexual trauma.
• While ultrasound generally is good at identifying uteri without leiomyomas, there are often limitations in characterizing the leiomyomas according to the FIGO classification system, and, in particular distinguishing amongst Types 0, 1, 2, and 3 leiomyomas when sonohysterography, hysteroscopy, and/or MRI may be superior.
• Many of the limitations of standard, two dimensional (2-D) ultrasound can be overcome with three dimensional (3-D) ultrasound techniques, that have the additional value of image storage for evaluation by other examiners.
• Gynecologists are encouraged to perform their own ultrasounds when possible; using reports to interpret the leiomyoma phenotype is often insufficient.