need answers regarding ultrasound

I had a ultrasound due to a 3 month period and pelvic pain on my right side.  I heard back from my gyn that everything is "perfectly normal" so I went to the hospital to get a copy of the ultrasound report to see for myself.
Can you tell me what these things mean and if they are truely normal?  I don't think constant bleeding and pain is normal.  I am 42 yrs old.  Here's what I didn't understand:
1. Uterus demonstrates diffusely heterogeneous echogenicity. Could be related to multiple small fibroids.
2. No discrete uterine mass is identified.
3. Endometrial stripe thickness measures up to 8mm.
4. Small amount of fluid found in endometrial canal and free fluid found in pelvis.
5. There is a 1.6 cm right ovarian cyst.  May likely represent a dominant follicle.

None of this sounds normal to me but I wouldn't know. The ultrasound report did recommend a "clinical correlation" but again my gynecologist did not address any of this.  I had to beg for the ultrasound in the first place - he asked me to just wait it out.

thank you so much!

[Machelle Seibel, MD]

A three month period and pelvic pain on your right certainly side sounds like there could be a problem. An ultrasound is a good place to begin. Here is what your report means. They do not see a mass but the uterus has a thick lining even though you have been bleeding. One would expect it to be thin with bleeding. You have a small cyst on your ovary but that could just be the developing egg for this month an is not likely a problem. Overall, the uterus muscle seems a bit fuller than usual. None of this sounds like anything terribly bad is happening, but still there are things to consider doing to help sort it out.

Several possible things to consider are having an endometrial biopsy done. This involves an office procedure in which a thin instrument is placed into the uterus and a few cells scraped out. This tissue is looked at under a microscope and can tell if there is a problem. You might also need either a D&C which is done in the operating room with anesthesia and the lining is completely scraped off. this diagnosis the problem and also often 'cures' it. You could also have a hysteroscopy done which involves placing a thin telescope into the uterus and looking to see if there are any polyps (benign growths) that are both common and cause bleeding and can make the lining look thick. You could also have adenomyosis, a condition where the lining grows into the muscle of the uterus and makes it harder for the bleeding to stop and it can also cause cramps and pain.

Consider starting to take a multivitamin and iron tablets. Three months of bleeding can cause anemia. With a little more investigation, it should be possible to solve this problem.
Machelle M. Seibel, MD