What do the findings of a normal‑size retroverted, anteflexed uterus with normal endometrial and junctional zone thickness, no fibroids, and a small amount of physiologic free pelvic fluid indicate?

Normal Pelvic Ultrasound Findings in a Reproductive-Age Woman

Your ultrasound report describes a completely normal pelvic examination with no concerning findings. Let me explain each component:

Uterine Position and Shape

"Retroversion and anteflexion" describes the normal anatomic position of your uterus—it is tilted backward (retroversion) while the body of the uterus bends forward relative to the cervix (anteflexion). 1

• This positional variant occurs in approximately 20–30% of women and is considered a normal anatomic variation 1
• Retroversion can occasionally make transvaginal ultrasound visualization more challenging, but does not indicate pathology 1
• This position does not cause symptoms, does not affect fertility, and requires no treatment 1

Normal Uterine Size and Endometrium

The report confirms your uterus is normal in size, with normal endometrial thickness and a normal junctional zone (the inner layer of the myometrium). 1

• Normal endometrial thickness varies by menstrual cycle phase: typically 4–8 mm in the proliferative phase (days 6–14) and 8–16 mm in the secretory phase (days 15–28) 2
• The junctional zone is the innermost myometrial layer that appears as a low-signal band on imaging; normal thickness is 5–12 mm 1, 2
• These findings effectively exclude endometrial hyperplasia, polyps, and malignancy 1

Absence of Fibroids

"No fibroids are present" means there are no benign smooth-muscle tumors (leiomyomas) in your uterus. 1

• Fibroids are extremely common, affecting at least 25% of women during their reproductive years 3
• Their absence is a normal finding and requires no follow-up 1

Small Amount of Free Pelvic Fluid

A small amount of fluid in the pelvis is physiologic (normal) and varies with your menstrual cycle. 4

• The cul-de-sac (pouch of Douglas, the space behind the uterus) may contain a small to moderate amount of anechoic (clear, echo-free) fluid depending on menstrual phase 4
• This fluid is produced by normal ovulation and peritoneal surfaces 4
• Physiologic fluid is anechoic (completely clear on ultrasound) without internal debris or echoes 4
• Trace to small amounts of clear fluid are normal; moderate to large amounts, or fluid with internal echoes (debris), would be pathologic and concerning for blood, infection, or ruptured ectopic pregnancy 4

Clinical Significance

This ultrasound report documents a structurally normal pelvis with no abnormalities requiring treatment or follow-up. 1

• If you are experiencing abnormal uterine bleeding, the next step would be endometrial sampling (biopsy) rather than repeat imaging, particularly if you are ≥45 years old or have risk factors for endometrial cancer 1, 5
• If you are asymptomatic, no further evaluation is needed 1
• The retroverted position does not require monitoring or intervention 1