A gynaecological ultrasound examination can be performed transabdominally, transvaginally or, in exceptional cases, transrectally. Irrespective of the route of examination it is always important to optimise the image and to perform a systematic examination. There are two reasons to adopt a systematic scanning technique. First, it will ensure that a complete pelvic examination is performed. Second, if one always scans all the organs in the pelvis in a systematic way, he/she can build up a reference of what is normal, which increases confidence in detecting pelvic pathology. The uterus and ovaries are smaller in postmenopausal women than in women of fertile age. The endometrium has uniform ultrasound morphology because there are no cyclical hormonal changes. The ovaries contain no follicles but one or more inclusion cysts no larger than 10 mm are seen in healthy postmenopausal women.