|How Are Fibroids Diagnosed?
As uterine fibroids do not always cause obvious symptoms, they are usually discovered during a routine pelvic exam and then confirmed by imaging tests such as an ultrasound or trans-vaginal scan.
A pelvic examination involves physically checking the reproductive organs, uterus (womb), ovaries, vagina, vulva, cervix and fallopian tubes. Typically it is carried out to help determine if a woman is pregnant, or if a woman reports a specific problem involving the reproductive organs such as heavy periods, vaginitis infections or vaginal dryness. The physician will perform an external examination first to rule out other conditions. He will visually inspect the vaginal region looking for any irritations, abnormal growths, discharges or skin lesions. He will then feel the Bartholin's and Skene's glands which lie in the entrance of the vagina. Any lumps could signal cysts. Next he will carry out a bimanual examination by inserting two gloved fingers into the vagina while pressing down on the abdomen with the other hand. He will check the size, firmness, shape and position of the womb. Any abnormalities usually indicate either pregnancy or uterine fibroids. If the doctor feels fibroids on or around the uterus he will be able to describe how large or small they are. He may compare them to everyday items such as nuts, grapes or even oranges (if particularly large). Or he may compare it to pregnancy, saying for example that the fibroids have made your uterus the size it would be if you were 5 months pregnant (see fibroids and weight gain).
Once the physician determines the presence of fibroids, he will then recommend a diagnostic test to confirm this. These will also used to rule out the presence of other conditions such as polyps or endometriosis. Imaging tests take a picture of the inside of your body, but at these are not always conclusive. Sometimes more invasive procedures are necessary for a definite diagnosis.
An ultrasound scan uses sound waves to produce pictures on the internal body. A transducer is placed on the abdomen and is rolled back and forth while images are gathered on a nearby monitor. It is the same prenatal ultrasound scan used to confirm a pregnancy. Some doctors, if fully equipped, can perform an ultrasound in their office along with the pelvic examination. If fibroids are visible you will be referred to a gynecologist who is a specialist in the female reproductive system.
A transvaginal scan is another type of ultrasound scan where the clinician places a probe called a transducer into the vagina. The probe is covered with a condom and gel to ease insertion. The probe sends out sound waves which bounce off the body and sends pictures to a monitor nearby. In some cases, if the uterus is not clearly visible, a special transvaginal scan called a saline infusion sonography (SIS) is used (also known as a hysterosonography or sonohysterography). Salt water is injected into the uterus first; this helps to outline any abnormal growths more clearly.
Magnetic Resonance Imaging (MRI)
This test uses radio waves and magnets to produce a picture of the uterus. An MRI scan is more expensive than an ultrasound (about $2,500 on average compared to $270 to $360 for an ultrasound) and is usually only required where very large fibroids have been detected and more information is required. An MRI can show the location of the fibroids and can help a doctor differentiate between fibroids and adenomyosis. This differentiation is important because both conditions require different treatments. With adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the womb to thicken and enlarge. It can cause heavy bleeding and severe pain. Adenomyosis is difficult to treat without removing the uterus. Fibroids on the other hand can be removed by myomectomy (see also, fibroids treatment options).
A diagnostic hysteroscopy can be carried out in a gynecologist's office. It involves inserting a thin telescope called a hysteroscope through the vagina and cervix until it reaches the uterus. A video camera is attached to the end so that the doctor can view the uterus clearly. It can also be used to rule out other possible causes of bleeding such as polyps, endometriosis or cervical cancer. The procedure only takes a few minutes and can be completed with local anesthesia. The doctor may also use the opportunity to take a small biopsy of the uterine lining for lab testing. An operative hysteroscopy involves a similar procedure but different instruments are inserted which allow the surgeon to remove growths. It is normally carried out in surgery.
Usually carried out under local anesthetic, the doctor inserts a thin scope through a tiny incision made near the belly button. The scope has a light and camera attached to the end so that pictures can be taken for analysis afterwards. A biopsy may also be taken to send to labs for testing. This can rule out leiomyosarcoma, a rare form of cervical cancer which can mimic a fibroid (it occurs in less than 3 out of every 1,000 women suspected of having fibroids). Diagnostic laparoscopy is normally carried out as a day case and is considered the 'gold standard' method for assessing problems of the pelvic organs. An operative laparoscopic myomectomy is often used for the removal of fibroids, but this is a more extensive surgery requiring 4 weeks recovery.
Questions To Ask Your Doctor
If you receive a diagnosis of fibroids, the following is a list of questions to ask your doctor:
• How many fibroids do I have?
• What size are they?
• How quickly did they grow?
• Will they grow more, and if so, how will I know if they are growing?
• Do you know where the fibroids are located?
• What type of fibroids do I have?
• What medical problems can I expect?
• Which test is best to track the progress of my fibroids?
• What treatment options do you recommend if symptoms persist?
• I'm pregnant, will this make any difference? See: fibroids during pregnancy
Always seek a second opinion if your doctor does not answer your questions satisfactorily.
For a quick recap and overview: What are uterine fibroids?
Signs and symptoms: What are breast fibroids?