The size of the mass in three dimensions, its location, consistency, and borders (well-/ill-defined) should be determined for a diagnostic approach to masses. Generally, most diagnoses can be made by transvaginal ultrasonography; however, a combination of transabdominal and transvaginal scan should be considered as they have different advantages and disadvantages. Follicular ovarian cysts comprise the most common cystic adnexal mass seen in women of reproductive age. Luteal cysts are characterized by peripheral blood flow at Doppler examination and menstrual disturbances. Recently three-dimensional (3D) or volume ultrasonography has been added to the gynecologic assessment armamentarium. The availability of noninvasive ultrasonography has resulted in improved care for infertile women. The ability to diagnose and decide on appropriate treatment is invaluable in helping women to achieve better fertility outcomes where identified pathology is detrimental, but also in improving patient well-being where this may be more serious, such as malignancy, and is dealt quickly.

A transvaginal scan (TVS) is performed with an empty bladder using a curvilinear, multifrequency, endocavity transducer with a typical central frequency of 6.5MHz. A fibroid outline is usually well visualized by TVS, even in the very small lesion, because of the pseudocapsule. The mixed tissue make-up of the fibroid produces a heterogeneous echo pattern on an ultrasound scan and can be highly attenuating of the ultrasound beam in some lesions. The most common gynecological symptoms of fibroids are menorrhagia and dysmenorrhea and, when significantly enlarged, they can also cause compression of adjacent pelvic structures. Most studies that have examined the relationship between fibroids and miscarriage rates have looked predominantly at intramural fibroids, with few data available on impact of submucosal fibroids. Myolysis is ablation of a fibroid mass by use of radiofrequency (RF) electricity, cryoprobes or focused ultrasound.