Diagnosis

Diagnosis

Because there are often no symptoms, you may only find out you have fibroids when your doctor doing a routine bimanual pelvic exam.
During this routine office exam, the clinician evaluates the size and shape of the uterus and surrounding pelvic structures by inserting two fingers of one hand into the vagina while palpating the patient's abdomen above the pubic bone with the other hand.

During this exam, a uterus with fibroids often feels enlarged and/or irregular and may be felt abdominally above the pubic bone. In contrast, a non-pregnant uterus without fibroids is not palpable above the pubic bone.

 

If you have symptoms and think you might have fibroids, see your doctor.

If your doctor says you do have fibroids, ask

  • if there is more than one
  • where they are
  • how large they are


This will help you better understand your symptoms and decide what action to take, if any.

 

But fibroids that are causing symptoms may be missed some times, if the examiner relies just on this examination.

If your doctor does discover a lump in the wall of your uterus she may want to confirm a fibroid diagnosis with additional tests.

 

Other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. 
For this reason, a vaginal ultrasound examination at the time of the first visit who has symptoms of abnormal bleeding or cramping should be done.
Since fibroids can be removed individually, but adenomyosis can be treated with medication or a progesterone coated IUD (intrauterine device), it is important to differentiate between the two conditions before a treatment plan.

And it is also common to have some adenomyosis in addition to fibroids!
 

Imaging studies such as

  • Ultrasonography
  • MRI (magnetic resonance imagery)
  • CT (computed tomography)


may be useful in confirming the diagnosis.

 

The combination of your ultrasound results and the results from your pelvic exam is usually enough to confirm a diagnosis of fibroids.

If the ultrasound results are unclear, your doctor may suggest a a direct visualisation of your uterus.

 

Also in patients experiencing

  • profuse and/or prolonged menstrual flow (menorrhagia)
  • recurrent pregnancy losses


direct assessment of the uterine cavity is important because the presence of a submucous fibroid can be missed on traditional ultrasound.
 

Below are the available direct assesment tools;

  • hysteroscopy
  • laparoscopy


They can all aid in a more definitive diagnosis of fibroids.

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Use of Pelvic Ultrasound Scan in Fibroids

 Ultrasound technology has been used for over 35 years and studies show it is safe.
It does not use radioactive material to produce an image.

An ultrasound uses high-frequency sound waves to get an image of your internal organs.
The 'echoes' produce an on-screen image.
This can help determine if the lumps are fibroids or another type of tumour.
If you do have fibroids, the image will reveal their size and location.
It can also provide more detailed information about the size and location of fibroids.
 

On ultrasound examination adenomyosis will often appear as diffuse thickening of the wall, while fibroids are seen as  round areas with a discrete border.
Since adenomyosis is usually a diffuse process, it only occasionally can be removed without taking out the whole uterus.
There are two types of ultrasound used to diagnose fibroids.

You may be given an abdominal ultrasound, a vaginal ultrasound or both.

  • An abdominal pelvic ultrasound is best at finding large fibroids.

It uses a probe, which is pressed on the outside of the abdomen to produce an image.
The picture is clearer when the bladder is full so you will be asked to drink up to a litre of water beforehand and wait to urinate until after the test is complete.
The scan itself is not painful (the doctor simply moves the probe over your belly), but waiting for your appointment with a full bladder may be uncomfortable.

  • A transvaginal ultrasound is used to find small fibroids.

The scanner (probe) will be put into your vagina and may be a little uncomfortable.
You do not need to have a full bladder for this scan and it should not be painful.
It only takes a few minutes to do, it is not painful and it rapidly provides valuable information.
It is possible to fill the uterus with a liquid during the ultrasound (saline enhanced sonography or sonohysterogram).