Fibroid Diagnosis - How do I know I have fibroids?

Doctor's visit

Usually fibroids are found by your doctor/gynecologist during a routine physical examination. A pelvic examination allows a physician to feel the size and shape of the uterus. If the uterus is enlarged or irregularly shaped, then fibroids may be present. Alternatively, a women may notice new symptoms, which she then tells her doctor about.

After a doctor examines you and thinks that you may have fibroids, there are several tests that can be done to confirm the diagnosis. The first examination performed is usually an ultrasound. The other tests are more specialized and are only performed if needed to guide treatment options. Below is a brief description each type of exam.

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Ultrasonography

Many women are familiar with ultrasound from pregnancy where it is used to evaluate the growing fetus. Similarly, ultrasound is a safe and reliable way to assess the uterus and ovaries and to look for fibroids. Sound waves are used to create a picture of the uterus and ovaries. No radiation is used during this exam.

The procedure can take between 30-60 minutes to perform. The initial portion of the exam is performed with the transducer on the abdomen. Conducting gel is placed on the skin and feels wet and cool. It is often necessary to have a full bladder to better see the pelvic structures. The transducer is moved around to allow the technologist to take pictures of the uterus and ovaries.

The second portion of the exam is performed by looking internally. You will need to empty your bladder first. A special ultrasound probe will then be placed in the vagina. It is usually not painful and is inserted like a tampon. Close up pictures can then be taken of the uterus, endometrium (the lining of the uterus) and ovaries.

The radiologist reviews all the pictures and will report the results to your doctor.

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	Sonohystogram long view of the uterus - click to enlarge Sonohystogram cross section view of the uterus - click to enlarge

Sonohysterography

This is also an ultrasound procedure which uses no radiation. This exam helps to better visualize the inside of the uterus and endometrium. Submucosal fibroids and polyps can easily be identified by this method.

The exam takes approximately half an hour. It is often performed right after a period ends. The patient is positioned similar to a gynecology exam and the area is cleaned with special soap. A small catheter is inserted through the cervix and a small balloon is inflated to hold it in place. Sterile saline is injected into the uterus and ultrasound pictures are obtained. During the procedure you may experience some cramps similar to menstrual cramps. These cramps can last for a short time after the study and are a normal sensation.

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	MRI axial or cross section - click to enlarge MRI sagital view of the pelvis - click to enlarge

Magnetic resonance imaging (MRI)

It is more expensive than ultrasound but gives the doctors a reproducible, detailed picture of how many fibroids there are, how big they are and exactly where they are located. Not all women with fibroids need an MRI. All patients that are being evaluated for a uterine artery embolization will get an MRI.

MRI stands for magnetic resonance imaging. No radiation is used during this study. Pictures are obtained using a large special magnet. The exam takes approximately 45-60 minutes during which time you are asked to remain still. Before the study begins an i.v. is placed in the arm. You then lie down on a bed. The big magnet is shaped like a "donut" through which this moving bed passes. The machine makes loud clunking and tapping noises. The technologist will give you ear plugs to put in your ears during the study to dull the sound of the machine. Contrast material is then injected through the i.v. and more pictures are taken of the pelvic area. The images will be reviewed by a radiologist who will report the findings to your doctor.

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Hysteroscopy

Diagnostic hysteroscopy is another procedure for seeing inside the uterus. The test can be performed in a physician's office or in an operating room. Submucosal fibroids and polyps can be easily identified. It takes 30 minutes to complete.

To perform the test, a woman lies on her back with her feet in gynecology stirrups. A speculum is placed in the vagina. A long, slender "telescope", called a hysteroscope, is gently inserted through the cervix, into the uterine cavity. For ideal viewing, sterile saline or CO2 gas is introduced through the hysteroscope to distend the cavity. Images of the lining of the uterus, the openings of the fallopian tubes, polyps and submucus fibroids are displayed on a TV monitor for the physician and patient to see. Women experience mild cramps during the procedure. Ibuprofen (advil, motrin), taken one hour before the procedure, can alleviate the discomfort.

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