Healthcast 636 – Why does BioBalance Health® require a vaginal ultrasound before treating female patients?

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. At BioBalance Health we use the information from a vaginal probe ultrasound, combined with information from your medical history questionnaire, and an extensive fasting blood panel to determine whether an individual woman is a candidate for estradiol and testosterone bioidentical pellets. We also review the collated information to determine if we need more tests before we see a new patient.  The ultrasound of the pelvis gives us a visual picture of the ovaries and uterus of a woman. It is necessary to know if a patient is menopausal yet to interpret a new patient's ultrasound.  We obtain that information from your blood lab and medical history from the patient questionnaire.  All three pieces of information are essential to our treatment plan.  What can we discover from the vaginal ultrasound?   We are ruling out (making sure a woman doesn't have these pelvic problems): Several of these conditions preclude the use of estradiol in any form, some require a visit to your gynecologist for treatment before we add estradiol to your hormones and some of these conditions increase the risk of side effects.   1.    Endometrial Cancer 2.    Endometrial hyperplasia 3.    Endometrial polyps 4.    Fibroids 5.    Ovarian cancer 6.    Ovarian cysts 7.    PCO  **We use the vaginal ultrasound to determine the risk of bleeding on HRT.  ***For the first 3 uterine pathologies listed above we look at the measurement of  the Endometrial Thickness (ET), or finding an endometrial polyp necessitates  a visit to her GYN for evaluation, and most probably an endometrial biopsy or D&C. This pathologic test will rule in or out Endometrial cancer, endometrial hyperplasia.   The other diagnoses are determined by looking at the uterine size, contour, whether there are uterine fibroids, and looking at the ovaries for cysts or masses and the presence or absence of fluid in the cul-de-sac (area behind the uterus).  Why would we order a Vaginal Probe US for our hormone pellet patients after the first visit, while they are taking estradiol?  1.    Uterine bleeding is nonresponsive to treatment 2.    Uterine size is getting larger (patient complains of pain or pressure) 3.    High risk patients with recurrent uterine bleeding 4.    To follow the growth of fibroids 5.    To check the ovaries in patients who have a Family History of ovarian cancer (generally we have the patient's GYN follow this). 6.    To follow a benign looking cyst seen on the first US for growth.