Fibroids in Uterus – Investigations to Diagnose Uterine Fibroids

Diagnosing Fibroids in the Uterus

Most cases of uterine fibroids are asymptomatic – there is no signs or symptoms indicating a fibroid. Often uterine fibroids are detected incidentally in the course of a routine pelvic examination, when investigating the cause of infertility or during a prenatal ultrasound. In certain cases, such as in obese women, the diagnosis may become difficult at times. A fibroid may be confused with pregnancy, ovarian tumor or uterine adenomyosis and should be differentiated from uterine fibroid.

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History

Taking a careful case history is the first step in diagnosis. A woman may visit a gynecologist with complaints of :

  • menstrual irregularities
  • heavy bleeding
  • pelvic discomfort
  • lower abdominal pain
  • difficulty falling pregnant

These symptoms are not unique to uterine fibroids.  Read more on Uterine Fibroids Symptoms.

Pelvic Examination

The next step is doing a physical examination, including a pelvic examination. Sometimes, a fibroid may be large enough to be felt through the abdomen and may be mistaken for a pregnant uterus. In most cases, however, a pelvic examination is necessary and a fibroid may be detected as an enlarged, mobile, irregular uterus or a mass on the uterus. The pelvic examination is followed by one or more of the various imaging techniques below to accurately identify the shape, size, location, number and type of uterine fibroid. Read more on Types of Uterine Fibroids.

Ultrasound

Ultrasound uses sound waves to create an image of the uterus and the surrounding structures can provide further information about the fibroid in addition to detecting its presence. The shape, size, position and number of fibroids can be detected with an ultrasound examination (ultrasonography).

A variation of ultrasound is the hysterosonography. This method uses sterile saline to expand the uterine cavity and thus give a better image of the uterine lining. The case history, along with a pelvic examination and ultrasonography are usually all that will be needed to confirm the diagnosis of fibroids. Further tests may be done as required in case to exclude other conditions and to rule out cancer.

Hysteroscopy

The hysteroscope is a thin, flexible tube with a tiny camera and a light source at its end. This is inserted into the uterus through the vagina and cervix. The uterine cavity can be visualized by this device and any fibroid present can then be detected.

Hysterosalpingography (HSG)

This is a special type of x-ray of the uterus and fallopian tubes done after delivering a radio-opaque dye into the uterus through the vagina. Fibroids within the uterine cavity and changes in the size and shape of the uterus and fallopian tubes can be detected by this method. HSG is usually advised when infertility is a concern.

CT Scan and MRI

Computed tomography (CT) scans and magnetic resonance imaging (MRI) are more accurate imaging tests but are rarely needed for diagnosis of fibroids unless ultrasonography reports are inconclusive. They may be helpful in recording growth of fibroids over time.

Endometrial Biopsy

Biopsy of the uterine lining involves taking a tissue sample from the uterus by passing a small instrument through the vagina into the cervix and uterus. It may need to be done if cancer is suspected.

Laparoscopy

This is a minimally invasive surgical procedure where a small fiberoptic camera is inserted into the abdomen through a tiny incision on the abdomen, just below or through the umbilicus (belly button). Fibroids on the surface of the uterus can be seen by this method.

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