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Diagnosing Uterine Fibroids

Ultrasound examination is helpful when diagnosing uterine fibroids

Fibroids may be felt during a pelvic exam, but many times myomas that are causing symptoms may be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, when diagnosing uterine fibroids an ultrasound examination should be performed at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if an abnormality is felt upon examination.

Vaginal probe ultrasound only takes a few minutes to do, is not uncomfortable, and rapidly provides invaluable information if the examiner is experienced in looking at uterine abnormalities. It is possible to fill the uterus with a liquid during the ultrasound (saline enhanced sonography or sonohysterogrami). Your doctor may also decide to perform a hysteroscopy to provide additional information to the regular ultrasound. A hysteroscopy exam is usually a quick in-office procedure, that allows directly looking inside the uterus. MRI scans also provide an excellent picture of the uterus. Usually the cost of the exam is not justified, as all of the information needed to plan treatment (or not to treat) can be obtained by other methods.

One of the most common conditions confused with fibroids is adenomyosis.

In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. On ultrasound examination this will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border. Adenomyosis is usually a diffuse process, and rarely can be removed without taking out the uterus. Since fibroids can be removed, it is important to differentiate between the two conditions before planning treatment. It is also common to have some adenomyosis in addition to fibroids.