Menopause is ovarian exhaustion, leading to atrophy of the organs of the reproductive system. Transvaginal scan is the investigation of choice for evaluating these changes in the reproductive organs. Altered uterocervical ratio, decrease in uterine size, and thin endometrium are the typical uterine changes in normal cases. Ovaries appear solid-looking, with a decrease in size and in the number of follicles. Certain abnormalities are more common in the postmenopausal age. These include endometrial malignancy, cervical malignancy, and ovarian malignancies. These, on ultrasound, present as heterogeneous masses involving the endometrium, cervix, or ovaries, respectively. Fluid in the endometrial cavity may be the first presenting sign of cervical or endometrial malignancy, and free fluid in the pelvis may indicate ovarian malignancy; however, this may sometimes also be a normal finding. Doppler and three-dimensional (3D) power Doppler especially play a very important role in identifying the typical vascular characteristics of malignancy, thus being instrumental in the early diagnosis of these lesions.
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