Detecting and treating uterine fibroids in a timely manner requires an accurate diagnosis, especially when fibroids don’t present with symptoms. An early diagnosis prevents small fibroids from growing larger and causing more extreme symptoms.
Pelvic exams are performed regularly at annual OBGYN appointments but are not effective in the diagnosis and management of fibroids. A pelvic exam only indicates how big the uterus is but can completely miss the presence of uterine fibroids. Even if an OBGYN is able to manually feel fibroids or other unidentifiable lumps during a pelvic exam, they may not be able to determine the number and size of the fibroids.
It’s important to always ask your doctor for an ultrasound, even though it may not be discussed at the time of your appointment. This is especially true in many OBGYN practices where the focus is mainly on obstetrics, not gynecological conditions like fibroids. An ultrasound is a simple, inexpensive and very effective method for diagnosing the size, number and location of fibroids in the uterus.
Abdominal ultrasounds examine fibroids through the abdomen, whereas transvaginal ultrasounds examine fibroids through the vagina. Transvaginal ultrasounds are more effective for diagnosing fibroids because the ultrasound device is placed directly on the uterus through the vagina.
An ultrasound is usually the first test performed to confirm a diagnosis of fibroids, and the test typically takes no longer than 45 minutes. Ultrasound imaging allows a physician to easily see the number, location and size of any fibroids present. Ultrasounds are cost-effective and are used to monitor growths that are enlarging or causing symptoms.
Compared to an ultrasound, an MRI is a more expensive technique for imaging fibroids. Although it is more sensitive than an ultrasound, it is not necessary for the majority of fibroid patients.
An MRI of the pelvis typically takes about an hour and shows the size and location of fibroids in more detail. It may also show fibroids that can be missed with an ultrasound. This can help determine appropriate treatment options and may be useful in women with a larger uterus or more complex cases. An MRI can also help to see whether coexisting GYN conditions like adenomyosis are present, a finding that may also change the recommended treatment method.
A hysteroscopy is used to evaluate the uterine cavity. Office hysteroscopy procedures have become more popular with OBGYNs because they can be easily performed in the office. Growths that are identified in an office visit usually cannot be removed during the same appointment, and most patients will require an operating visit for treatment. For this reason, office hysteroscopy is not recommended routinely for evaluation and treatment of fibroids.
Because a hysteroscopy is a surgical procedure, patients undergo anesthesia, and the operating visit takes a few hours. Patients may experience side effects like cramping and slight bleeding after the procedure.
A hysterosalpingogram (HSG) is an evaluation of the uterine cavity and the tubes, using a radiopaque dye passed into the uterus through the cervix. Radiopaque means the dye can be seen with fluoroscopy — a radiological test that shows the dye passing through the uterus and the tubes. It is mostly used to ensure that the fallopian tubes are open, a helpful test when infertility is a concern. Although it can identify fibroids, polyps or scarring in the cavity, it is generally not used for diagnosing fibroids.
Pelvic exams may be helpful but are very limited in their ability to identify the size, number and location of fibroids. Because pelvic exams are inexact, pelvic masses can also be confused with fibroids in the absence of imaging. Pelvic exams have other significant limitations in patients who have undergone prior surgery, have coexisting GYN conditions such as endometriosis or are heavier with a larger uterus. Depending on the severity of fibroids or other conditions, pelvic exams may be painful both during and after the exam, even though most pelvic exams only take a few minutes.
Because abnormal bleeding is a main symptom of fibroids, your doctor may order a series of blood tests to rule out blood disorders or thyroid issues. A complete blood count (CBC) test may show low iron levels or anemia, a common complication of heavy bleeding due to fibroids. However, a blood test on its own will not reveal the presence of fibroids. If anemia is diagnosed, one of the above imaging tests should be performed to diagnose or rule out fibroids.
There are currently no blood tests available that can diagnose fibroids.
Getting a Diagnosis
If you think you have fibroids, an expert fibroid specialist at CIGC can evaluate your case to give you an accurate diagnosis and provide a treatment plan to address symptoms and prevent further complications. Schedule a consultation today to have a specialist put you on the path toward relief.
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- Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 2009;19(3):222-231. doi:10.4103/0971-3026.54887
- ACOG technology assessment no. 8: Sonohysterography. Obstet Gynecol. 2012;119(6):1325. doi:10.1097/AOG.0b013e31825af435