Diagnosing Fibroids

Uterine fibroids, also called uterine myomas, fibromyomas or leiomyomas, are non-cancerous growths in the muscular wall of the uterus. Although specific causes of fibroid development are still unclear, many researchers have linked them to both genetic predisposition and subsequent development of susceptibility to hormone stimulation.

Uterine fibroids are very common; more than 30% of women of childbearing age suffer from them. Generally, fibroids may start developing in women when they are in their 20s. However, most women do not experience any fibroid symptoms until they are in their late 30s or 40s, making it hard for women to know whether or not they have fibroids.

Getting a Diagnosis

In the absence of symptoms, it is usually difficult to ascertain whether fibroid tumors exist or not. However, your gynaecologist can detect their presence during a routine pelvic examination, during which your doctor feels the size and shape of your uterus. Over the course of the examination, your doctor may detect some abnormalities, such as an enlarged or irregularly shaped uterus.

After a thorough pelvic examination, your doctor may ask whether you have recently experienced any symptoms, such as heavy vaginal bleeding, pelvic pain, lower back pain or pain during sexual intercourse. These symptoms may indicate to your doctor the presence of fibroids. However, not all fibroid tumors can be detected this way, or they may be confused with other similar conditions. Therefore further testing is routinely pursued in order to confirm a fibroid diagnosis.

Blood Test

Your blood sample will be taken primarily to determine whether you are anemic, or iron-deficient, which can be caused by chronic blood loss, and whether your levels of reproductive hormones produced by your ovaries are normal. Medications will be prescribed to restore your iron levels or regulate your reproductive hormones if either of these are found to be abnormal.

Endometrial Biopsy

In order to pinpoint the exact cause of abnormal bleeding, your doctor might remove a few cells from the lining of your uterus for endometrial biopsy. For this test, you will need to lie down on the examining table with your knees bent and feet suspended in footrests.

Your doctor will insert a narrow tube into your uterus through your vagina and cervix, and, with the aid of suction, she will remove some tissue from the lining of your uterus. Endometrial biopsy normally doesn’t require anaesthesia and can be easily performed in your doctor’s office.

Uterine Ultrasound

Ultrasound is a painless, safe and reliable way to assess the uterus, ovaries and to look for uterine fibroids. In this process, sound waves, not radiation, are used to create pictures of your uterus. The entire procedure takes about 30 to 60 minutes and can be performed in your doctor’s office without anaesthesia. Your doctor can perform either a transabdominal ultrasound or transvaginal ultrasound.

For transabdominal ultrasound, you will need to drink several glasses of water to ensure that your bladder is full. This is done to improve the quality of images. Conducting gel is also applied on the skin. Your doctor will then move the transducer around the gelled area while sound waves are bounced back to a monitor. Your doctor will get a clear look at your reproductive organs from the monitor.

For close up pictures of the uterus, endometrium and ovaries, transvaginal ultrasound is performed. For this examination, you will need to empty your bladder. Your doctor will insert a special ultrasound probe in your vagina in much the same way as you insert tampons. This probe will then send sound waves back to the monitor, producing a detailed image of your uterus.

Hysterosonography

Also called sonohysterography, this procedure is similar to ultrasonography, but it provides a better visual of the uterus and endometrium. Moreover, submucosal fibroids can easily be identified through this method. The entire process normally takes about 30 minutes and can be performed in your doctor’s office.

For hysterosonography, you will be asked to lie down just as you would for a pelvic examination. Your doctor will clean the area with a disinfectant soap. He will then insert a catheter through your vagina and cervix into your uterus. A sterile saline solution will then be injected to expand the uterine cavity in order to make it easier to detect fibroids. An ultrasound probe placed in the vagina will then take pictures.

During the procedure you may experience some cramps similar to menstrual cramps. You don’t have to worry because they are normal and will gradually subside after a short while.

Hysterosalpingography

This procedure is performed in a radiology suite and does not require any anaesthesia. In this test, your doctor will insert a catheter into your cervix to release a special dye. The dye will make visible any abnormalities in your uterine cavity and fallopian tubes and make them visible on X-ray images.

Hysteroscopy

Diagnostic hysteroscopy is a 30-minute procedure, performed in the doctor’s office or in an operating room, normally under local anaesthesia. It is an ideal process to detect submucosal fibroids.

To perform the test, you will be asked to lie on your back with your feet suspended in gynaecology stirrups. Your doctor will insert a long, slender telescope called a hysteroscope into your uterus through your cervix. A sterile saline or CO2 gas will be introduced to inflate your uterine cavity through the hysteroscope. Images of your uterus will then be displayed on a TV monitor.

Magnetic Resonance Imaging (MRI)

In this procedure, magnets and radio waves are used to create excellent images of the uterus. However, not all doctors agree with using MRI as it is a much more expensive procedure than other forms of testing. While MRI can provide clear images of the uterus, similar images can be obtained through other, less expensive diagnostic procedures.

These tests are not only useful for diagnosing fibroids; they can also help your doctor determine whether the symptoms you are experiencing are due to uterine fibroids or if some other condition, such as uterine polyps, hormonal dysfunction or adenomyosis, is to blame. Once your doctor has correctly diagnosed you with uterine fibroids, an appropriate course of treatment, either medicinal or surgical, can be prescribed.