Skip to main content
SpringerLink
Log in

Normative values for ultrasound measurements of the female pelvic organs throughout childhood and adolescence

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Normative data from pelvic ultrasonography (US) of the pediatric female reproductive organs are outdated and limited by sample size.

Objective

The purpose of this study was to report normal uterine and ovarian volumes and endometrial stripe thickness in children and young adults and throughout the menstrual cycle in post-menarchal adolescents.

Materials and methods

Females ages 0 through 20 years who underwent pelvic US between January 2010 and May 2014 were identified. After excluding patients with pelvic and/or endocrine pathology, nomograms of uterine and ovarian volumes and endometrial thickness by age year were created. Data for patients ages 12 years and older with a recorded day of last menstrual period were used to create additional nomograms of volumes/thickness throughout the menstrual cycle. Student’s t-tests and linear regression were performed to assess differences in measurements between groups and association of volumes/thickness with age.

Results

During our study period, 5,647 patients underwent 6,953 pelvic US examinations. After further review, 907 examinations from 889 patients were included (mean age: 11.3±6.0 years). Mean pelvic US volumes (cm3) per organ were 25.5±27.0 (uterus), 4.5±4.7 (right ovary) and 4.0±4.1 (left ovary). Mean endometrial thickness was 4.5±3.7 mm. Right ovarian volume was significantly larger than the left (P=0.0126). Uterine volume, ovarian volume and endometrial thickness were significantly associated with age (P-values<0.0001). Plots of mean organ measurements with respect to week of menses are provided.

Conclusion

We report normal volumes of the uterus and ovaries and endometrial stripe thickness measured by pelvic US throughout childhood and adolescence with reference to the menstrual cycle. These values are significantly associated with age and vary visually by menstrual cycle week.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bridges NA, Cooke A, Healy MJ et al (1993) Standards for ovarian volume in childhood and puberty. Fertil Steril 60:456–460

    Article  CAS  PubMed  Google Scholar 

  2. Cohen HL, Shapiro MA, Mandel FS, Shapiro ML (1993) Normal ovaries in neonates and infants: a sonographic study of 77 patients 1 day to 24 months old. AJR Am J Roentgenol 160:583–586

    Article  CAS  PubMed  Google Scholar 

  3. Griffin IJ, Cole TJ, Duncan KA et al (1995) Pelvic ultrasound measurements in normal girls. Acta Paediatr 84:536–543

    Article  CAS  PubMed  Google Scholar 

  4. Haber HP, Mayer EI (1994) Ultrasound evaluation of uterine and ovarian size from birth to puberty. Pediatr Radiol 24:11–13

    Article  CAS  PubMed  Google Scholar 

  5. Ivarsson SA, Nilsson KO, Persson PH (1983) Ultrasonography of the pelvic organs in prepubertal and postpubertal girls. Arch Dis Child 58:352–354

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Orsini LF, Salardi S, Pilu G et al (1984) Pelvic organs in premenarcheal girls: real-time ultrasonography. Radiology 153:113–116

    Article  CAS  PubMed  Google Scholar 

  7. Biro FM, Greenspan LC, Galvez MP (2012) Puberty in girls of the 21st century. J Pediatr Adolesc Gynecol 25:289–294

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cesario SK, Hughes LA (2007) Precocious puberty: a comprehensive review of literature. J Obstet Gynecol Neonatal Nurs 36:263–274

    Article  PubMed  Google Scholar 

  9. Euling SY, Herman-Giddens ME, Lee PA et al (2008) Examination of US puberty-timing data from 1940 to 1994 for secular trends: panel findings. Pediatrics 121(Suppl 3):S172–S191

    Article  PubMed  Google Scholar 

  10. McDowell MA, Brody DJ, Hughes JP (2007) Has age at menarche changed? Results from the national health and nutrition examination survey (NHANES) 1999-2004. J Adolesc Health 40:227–231

    Article  PubMed  Google Scholar 

  11. Badouraki M, Christoforidis A, Economou I et al (2008) Sonographic assessment of uterine and ovarian development in normal girls aged 1 to 12 years. J Clin Ultrasound 36:539–544

    Article  PubMed  Google Scholar 

  12. Bridges NA, Cooke A, Healy MJ et al (1995) Ovaries in sexual precocity. Clin Endocrinol 42:135–140

    Article  CAS  Google Scholar 

  13. Hagen CP, Mouritsen A, Mieritz MG et al (2015) Uterine volume and endometrial thickness in healthy girls evaluated by ultrasound (3-dimensional) and magnetic resonance imaging. Fertil Steril 104:452–459 e452

    Article  PubMed  Google Scholar 

  14. Herter LD, Golendziner E, Flores JA et al (2002) Ovarian and uterine sonography in healthy girls between 1 and 13 years old: correlation of findings with age and pubertal status. AJR Am J Roentgenol 178:1531–1536

    Article  PubMed  Google Scholar 

  15. Herter LD, Golendziner E, Flores JA et al (2002) Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty. J Ultrasound Med 21:1237–1246

    Article  PubMed  Google Scholar 

  16. Orbak Z, Sagsoz N, Alp H et al (1998) Pelvic ultrasound measurements in normal girls: relation to puberty and sex hormone concentration. J Pediatr Endocrinol Metab 11:525–530

    CAS  PubMed  Google Scholar 

  17. Stanhope R, Adams J, Jacobs HS, Brook CG (1985) Ovarian ultrasound assessment in normal children, idiopathic precocious puberty, and during low dose pulsatile gonadotrophin releasing hormone treatment of hypogonadotrophic hypogonadism. Arch Dis Child 60:116–119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lee SH, Joo EY, Lee JE et al (2016) The diagnostic value of pelvic ultrasound in girls with central precocious puberty. Chonnam Med J 52:70–74

    Article  PubMed  PubMed Central  Google Scholar 

  19. Garel L, Dubois J, Grignon A et al (2001) US of the pediatric female pelvis: a clinical perspective. Radiographics 21:1393–1407

    Article  CAS  PubMed  Google Scholar 

  20. Ziereisen F, Guissard G, Damry N, Avni EF (2005) Sonographic imaging of the paediatric female pelvis. Eur Radiol 15:1296–1309

    Article  PubMed  Google Scholar 

  21. Paltiel HJ, Phelps A (2014) US of the pediatric female pelvis. Radiology 270:644–657

    Article  PubMed  Google Scholar 

  22. Andolf E, Jorgensen C (1990) A prospective comparison of transabdominal and transvaginal ultrasound with surgical findings in gynecologic disease. J Ultrasound Med 9:71–75

    Article  CAS  PubMed  Google Scholar 

  23. Nazario AC, Nicolau SM, Nishimura CM (1991) Comparison between pelvic endovaginal and transabdominal sonography in the measurement of the uterus and ovaries. Rev Paul Med 109:51–54

    CAS  PubMed  Google Scholar 

  24. Levine D, Brown DL, Andreotti RF et al (2010) Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound consensus conference statement. Ultrasound Q 26:121–131

  25. Langer JE, Oliver ER, Lev-Toaff AS, Coleman BG (2012) Imaging of the female pelvis through the life cycle. Radiographics 32:1575–1597

    Article  PubMed  Google Scholar 

  26. Sargar KM, Siegel MJ (2014) Sonography of acute appendicitis and its mimics in children. Indian J Radiol Imaging 24:163–170

    Article  PubMed  PubMed Central  Google Scholar 

  27. Saxton DW, Farquhar CM, Rae T et al (1990) Accuracy of ultrasound measurements of female pelvic organs. Br J Obstet Gynaecol 97:695–699

    Article  CAS  PubMed  Google Scholar 

  28. Kelsey TW, Dodwell SK, Wilkinson AG et al (2013) Ovarian volume throughout life: a validated normative model. PLoS One 8:e71465

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kelsey TW, Ginbey E, Chowdhury MM et al (2016) A validated normative model for human uterine volume from birth to age 40 years. PLoS One 11:e0157375

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Nalaboff KM, Pellerito JS, Ben-Levi E (2001) Imaging the endometrium: disease and normal variants. Radiographics 21:1409–1424

    Article  CAS  PubMed  Google Scholar 

  31. Fukuda M, Fukuda K, Andersen CY, Byskov AG (2000) Right-sided ovulation favours pregnancy more than left-sided ovulation. Hum Reprod 15:1921–1926

    Article  CAS  PubMed  Google Scholar 

  32. Shazly SA, Badee AY, Ali MK et al (2013) The laterality of ovulation: how far does it matter? Eur J Obstet Gynecol Reprod Biol 167:8–13

    Article  PubMed  Google Scholar 

  33. Check JH, Dietterich C, Houck MA (1991) Ipsilateral versus contralateral ovary selection of dominant follicle in succeeding cycle. Obstet Gynecol 77:247–249

    Article  CAS  PubMed  Google Scholar 

  34. Potashnik G, Insler V, Meizner I, Sternberg M (1987) Frequency, sequence, and side of ovulation in women menstruating normally. Br Med J (Clin Res Ed) 294:219

    Article  CAS  Google Scholar 

  35. Queenan JT, O'Brien GD, Bains LM et al (1980) Ultrasound scanning of ovaries to detect ovulation in women. Fertil Steril 34:99–105

    Article  CAS  PubMed  Google Scholar 

  36. Fleischer AC, Kalemeris GC, Machin JE et al (1986) Sonographic depiction of normal and abnormal endometrium with histopathologic correlation. J Ultrasound Med 5:445–452

    Article  CAS  PubMed  Google Scholar 

  37. Randall JM, Fisk NM, McTavish A, Templeton AA (1989) Transvaginal ultrasonic assessment of endometrial growth in spontaneous and hyperstimulated menstrual cycles. Br J Obstet Gynaecol 96:954–959

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA

    Leah A. Gilligan, Andrew T. Trout, James G. Schuster & Alexander J. Towbin

  2. Division of Pediatric and Adolescent Gynecology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Beth I. Schwartz & Lesley L. Breech

  3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Bin Zhang

  4. Division of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Bin Zhang

  5. Department of Radiology, University of Cincinna College of Medicine, Cincinnati, OH, USA

    Andrew T. Trout & Alexander J. Towbin

Authors
  1. Leah A. Gilligan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew T. Trout
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James G. Schuster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beth I. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lesley L. Breech
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexander J. Towbin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leah A. Gilligan.

Ethics declarations

Conflict of interest

Drs. Towbin and Trout have received unrelated grant funding from Siemens Medical Solutions for ultrasound research. Dr. Trout has received unrelated grant funding from Canon Medical Systems for ultrasound research.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gilligan, L.A., Trout, A.T., Schuster, J.G. et al. Normative values for ultrasound measurements of the female pelvic organs throughout childhood and adolescence. Pediatr Radiol 49, 1042–1050 (2019). https://doi.org/10.1007/s00247-019-04419-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-019-04419-z

Keywords

Search

Navigation