Menopause Society Practice Exam 2026 - Free Menopause Study Guide and Practice Questions

In evaluating abnormal uterine bleeding, the initial imaging goal is to rapidly characterize the uterus and endometrium with clear, pelvic-focused detail. Transvaginal ultrasound fits this purpose best because it provides high-resolution images of the endometrial lining, uterine cavity, fibroids, polyps, and other pelvic structures without radiation. It helps distinguish common structural causes and guides immediate management.

Abdominal ultrasound can be helpful if transvaginal access is not possible or to get a broader pelvic view, but it generally offers less detailed visualization of the endometrium and intrapelvic soft tissues. Pelvic X-ray isn’t useful for this problem because it doesn’t visualize soft tissues like the endometrium or fibroids, so it doesn’t contribute to the evaluation of AUB.

Pelvic MRI, while offering excellent soft-tissue contrast and detailed characterization of fibroids, adenomyosis, and other complex pelvic pathology, is more expensive and less accessible. It is typically reserved for situations where ultrasound findings are inconclusive or when specific, detailed tissue characterization is needed for surgical planning or diagnosis. Therefore, it is not considered first-line imaging for evaluating abnormal uterine bleeding.