Fibroids
Diagnosis

Usually, fibroids are found during a routine gynecologic visit with a pelvic examination. A pelvic exam allows the doctor to feel the size and shape of the uterus; if it is enlarged or irregularly shaped, fibroids may be present. Or, you may notice new symptoms and inform your doctor.

If your doctor thinks you may have fibroids after performing the exam, there are several tests that can confirm the diagnosis. The first is usually an ultrasound. The other tests are more specialized and are only performed if needed to guide treatment options. Below is a brief description of each type of exam.

• Ultrasound. Many women are familiar with ultrasound from pregnancy, when it is used to evaluate the growing fetus. Ultrasound is also a safe and reliable way to look for fibroids. In the test, sound waves are used to create a picture of the uterus and ovaries. Ultrasound does not use radiation.
  
  The procedure takes between 30 to 60 minutes. The initial portion of the exam is performed with the transducer on the abdomen. Conducting gel is placed on the skin, which feels wet and cool. The transducer is moved around as the technologist takes pictures of the uterus and ovaries.
  
  The second portion of the exam is performed internally. You will need to empty your bladder first. A special ultrasound probe will then be placed in the vagina. It is usually not painful and is inserted like a tampon. Close-up pictures are then taken of the uterus, endometrium (the lining of the uterus) and ovaries. The radiologist reviews all the pictures and will report the results to your doctor.
• Saline hysterosonography. This is also an ultrasound procedure which uses no radiation. The exam helps us better visualize the inside of the uterus and endometrium. Submucosal fibroids and polyps can easily be identified by this method.
  
  The exam takes about half an hour. It is often performed right after the woman finishes her menstrual period. A small catheter is inserted through the cervix and a small balloon is inflated to hold it in place. Sterile saline is injected into the uterus and ultrasound pictures are taken. During the procedure you may experience some cramping, similar to menstrual cramps. The cramps may last for a short time after the procedure — this is normal.
• Magnetic Resonance Imaging (MRI). MRI is more expensive than ultrasound but gives doctors a reproducible, detailed picture of the number, size and exact location of the fibroids. Not all women with fibroids need an MRI. All patients that are being evaluated for a uterine artery embolization will get one, however. MRI uses a large, special magnet to take pictures of the body. The test does not use radiation.
  
  The exam takes about 45 to 60 minutes, during which time you are asked to remain still. Before the study begins, an intravenous (IV) line is placed in your arm. You then lie down on a moveable bed. The big magnet is shaped like a donut, through which this moving bed passes. Contrast material is injected through the IV and pictures are taken of the pelvic area. These images will be reviewed by a radiologist who will report the findings to your doctor.
• Hysteroscopy. Diagnostic hysteroscopy is another procedure for seeing inside the uterus. The test can be performed in a doctor's office or in an operating room. Submucosal fibroids and polyps can be easily identified with this test. It takes 30 minutes to complete.
  
  For the test, you will lie on your back with your feet in gynecology stirrups. A speculum is placed in the vagina. A long, slender telescope, called a hysteroscope, is gently inserted through the cervix into the uterine cavity. For ideal viewing, sterile saline or CO2 gas is introduced through the hysteroscope to inflate the cavity. Images of the lining of the uterus, the openings of the fallopian tubes, polyps and submucus fibroids are displayed on a TV monitor. Women experience mild cramps during the procedure. Taking ibuprofen (Advil, Motrin) one hour before the procedure can alleviate the discomfort.