Diagnosis of uterine fibroids is usually straightforward. After a pelvic exam, a hysteroscopy, or other diagnostic tool is ordered to rule out conditions with similar symptoms. The Pelvic Exam
Most fibroids are detected during a routine pelvic exam. As the doctor palpates the abdomen, he or she can feel unusual growths or solid areas in the uterus. After diagnostic tests confirm the presence of fibroids, another pelvic exam will be scheduled four to six months later. This second exam checks for unusually rapid growth of the fibroid. If it is stable (i.e., not growing rapidly) and not causing any symptoms, semi-annual or annual follow-ups will be enough to monitor the growth.
Although a pelvic exam detects fibroids, the possibility of other conditions must be ruled out. To do this, a number of diagnostic procedures may be ordered. Most often, a simple x-ray or abdominal ultrasound is enough to confirm the diagnosis. Some needs (such as determining the location of the fibroid) may require more sophisticated procedures.
A transvaginal ultrasound is a specialized ultrasound technique. The sonic probe is placed directly into the vagina. This allows the transvaginal ultrasound to view the uterus with greater clarity than an abdominal ultrasound.
A hysterosalpingogram, or HSG, is an x-ray procedure that checks the shape of the uterus. During a hysterosalpingogram, the uterus is filled with iodine, allowing the organ to show up on an x-ray in greater detail. Possible side effects of HSG include infections, and spotting for a couple of days following the procedure. In the rare occasion when the spotting worsens into blood flow, seek immediate medical care.
During a hysteroscopy, a hollow, thin tube called a hysteroscope is passed through the vagina and the cervix, into the uterus. The hysteroscope lights up the interior of the uterus, and relays pictures to a television screen. Hysteroscopy also allows tissue samples (biopsies) to be taken for microscopic analysis.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to construct 3-dimensional computerized images of internal organs. Magnetic resonance imaging is only sometimes used in fibroid diagnosis.
Computed Tomography (CT Scan)
Like the MRI, a computed tomography scan (CT scan, CAT scan) is occasionally used to diagnose fibroids. The CT scan takes multiple x-rays of the uterus, which are compiled into a 3-dimensional image by computer.
Diagnostic differentiation is required because other conditions can be mistaken for fibroids. Inflammation of the uterine lining, cervical cancer, and even pregnancy can mimic fibroid growth. Other conditions that need to be ruled out are discussed below.
Endometriosis occurs when the uterine lining grows outside of the uterus and onto other organs in the pelvic area. Endometriosis symptoms resemble severe fibroid symptoms. A woman with endometriosis may experience chronic pain, pain during intercourse, and severe menstrual cramps. Other possible symptoms include unusually heavy blood flow during menstruation, infertility, and bowel problems.
Endometrial hyperplasia is a benign condition caused by excessive growth of the uterine lining. Abnormal bleeding outside of menstruation is one of the commonest symptoms. Risk factors for endometrial hyperplasia include diabetes and obesity. The years just before menopause is a time of high risk.
Ovarian cysts are sacs of fluid that grow in or on the ovaries. Ovarian cysts are very common, and most do not cause symptoms. Cysts can cause menstrual irregularities, pelvic pain, nausea, and a feeling of abdominal pressure. Occasionally, ovarian cysts can be life threatening. If you have ovarian cysts, severe abdominal pain, pain accompanied by fever, or vomiting requires prompt medical attention.