How are uterine fibroids diagnosed?
Typically, fibroids are first diagnosed during a gynecologic internal examination. Your doctor will conduct a pelvic exam to feel if your uterus is enlarged. The presence of fibroids is most often confirmed by an abdominal ultrasound. Fibroids also can be confirmed using magnetic resonance (MR) and computed tomography (CT) imaging techniques.
Diagnosis is made by pelvic examination and can be confirmed by ultrasonography, CT, or MRI. After diagnosis, a pelvic examination is repeated in 4 to 6 mo to determine if the fibroid is growing rapidly. For stable fibroids, annual follow-up is sufficient.
The presence of fibroids is most often confirmed by an abdominal ultrasound. This is a painless procedure in which a radiologist or technician moves an instrument (transducer/receiver) about the size and shape of a computer mouse across the outside surface of the abdomen. Sound waves are transmitted through the skin and allow the technician to "see" the size, shape and texture of the uterus. A picture is displayed on a computer screen as the radiologist or technician takes the ultrasound.
The best test to tell size and position of fibroids is an MRI. Fibroids contain more collagen than normal uterine muscle and, as a result, the fibroids appear distinct and darker on the MRI. Getting an MRI may be a good idea if the ultrasound is not clear or it is important to know exactly where the fibroids are. I use this test if a laparoscopic myomectomy is being considered. MRI gives me a good idea as to whether it will be possible to get all the fibroids out with the laparoscopic instruments. If ultrasound is not clear, MRI can also be used to see if submucous fibroids are present. This can be helpful if unexplained heavy bleeding is present or fertility is a concern.
In some cases, a transvaginal ultrasound may be necessary. The radiologist inserts an ultrasound probe into the vagina so the inside of the uterus can be seen even more clearly than with the abdominal procedure. There is generally little if any discomfort associated with this procedure Fibroids also can be confirmed using magnetic resonance (MR) imaging or computed tomography (CT). MR and CT also are painless diagnostic tests that can give accurate and clear information on the presence of fibroids.
Diagnostic hysteroscopy also is an option, particularly to evaluate the presence of submucosal fibroids. A long, thin probe-like instrument is passed through the vagina and cervix into the uterus, where the physician can check for growths and take samples of tissue. The lighted hysteroscope illuminates the uterus. This procedure, which can cause some discomfort, is generally performed by a gynecologist, and can be done without anesthesia or with a local anesthetic in an office. |
