Tests & Diagnosis of Fibroids

How Does The Doctor Find Out You Have Fibroids?

Many women learn they have fibroids when their doctor performs a routine pelvic exam. A uterus that is enlarged or irregular in shape is a sign that a woman may have fibroids. Certain tests help the doctor to be sure of the diagnosis.

• Ultrasound. During this test, sound waves too high-pitched to be heard travel from a handheld instrument that is placed gently on the abdomen or in the vagina. The sound waves "bounce" of internal organs and return to the instrument. This creates a picture of the internal organs that can be seen on a screen. If there are fibroids in the uterus, they can be seen in the picture. The doctor can measurethe fibroids and can also see if anything else is causing enlargement of the uterus.

An ultrasound exam usually takes 15 to 30 minutes. The test does not use X-rays and has no known risks. It is safe to do an ultrasound test on a woman who is pregnant. (The handheld instrument is placed on the abdomen of a pregnant woman.) A woman may feel some discomfort because she needs to have a full bladder during the test.

• Magnetic resonance imaging (MRI). This test uses powerful magnets to create a picture of the internal organs. It does not use X-rays, and it is not necessary to have a full bladder. The test takes 30 to 45 minutes. MRI tests are not done routinely because they are much more expensive than ultrasound tests. It is safe to do an MRI test on a woman who is pregnant.

What happens during an MRI test?

The woman lies inside a large hollow tube. If she feels uncomfortable in this enclosed space, a mild tranquilizer may help her relax. She may be given earphones to listen to music or earplugs to block out some of the loud noise made by the magnet (which sounds like a muffled jackhammer).

If the doctor suspects fibroids, why might he or she order an MRI test?

The doctor may decide to order an MRI:

• If the ovaries are difficult to see during the ultrasound test
• If the doctor wants to see the structure of the fibroids in more detail
• CT scan. If MRI is unavailable, the doctor may request a CT scan of the pelvis. CT stands for computerized tomography. A CT scan uses X-rays. It is more expensive than an ultrasound test and may not provide any more information than the ultrasound test did. For these reasons, it is rare for a doctor to order a CT scan for suspected fibroids. A woman cannot have a CT scan if she is pregnant.
• Hysteroscopy. This test allows the doctor to look directly into the cavity of the uterus. The doctor may decide to do a hysteroscopy if a woman is having heavy bleeding, is having trouble becoming pregnant, or if fibroids are suspected of causing other fertility problems. (for example, a miscarriage). A woman cannot have a hysteroscopy if she is pregnant.

What happens during a hysteroscopy?

A thin telescope called a hysteroscope is gently inserted through the cervix and into the uterus. Enlarging the opening of the cervix to insert the hysteroscope can cause cramping and mild bleeding. Doctors generally advise women to take a mild pain medication before and, if necessary, after the procedure.

A hysteroscopy may be done in a doctor's office (with local or no anesthesia) or in an operating room (with local or general anesthesia).

• Uterine X-ray. This test is another option for diagnosing fibroids in women who are having bleeding or fertility problems. A woman cannot have a uterine X-ray if she is pregnant.

What happens during a uterine X-ray?

An instrument is gently inserted into the opening of the cervix. Dye is injected, filling the uterus. The doctor can see the shape of the uterine cavity and can take X-ray pictures of the uterus and fallopian tubes. The doctor can see if the tubes are blocked because the dye will not pass through them. This test may cause cramping. Doctors generally advise women to take a mild pain medication an hour or so before the test, which is done in a radiology suite (with local or no anesthesia). The dye is harmless (unless a woman has an allergy to iodine or shellfish) and it is quickly removed from the body.

Medical names for this test are hysterosalpingogram (or HSG) and uterotubogram.

• Endometrial biopsy. In this test, a small piece of the lining of the uterus (the endometrium) is removed and examined under a microscope. The doctor may suggest an endometrial biopsy if a woman is having heavy or lengthy periods. The purpose of the test is to rule out other causes for the bleeding, such as infection, a polyp, or cancer.

What happens during an endometrial biopsy?

A thin tube is gently passed through the cervix to obtain a piece of tissue from the lining of the uterus. This takes only a few minutes. The test may cause cramping. It can usually be performed in a doctor's office with local or no anesthesia.

• Dilatation and curettage (D&C). This test is another way to obtain a small (or somewhat larger) piece of the lining of the uterus. It might be done instead of an endometrial biopsy if more tissue is needed or if an endometrial biopsy cannot be done.

What happens during a D&C?

The opening of the cervix is gently enlarged (dilated) by inserting metal probes of increasing thickness. Then, a scraping instrument is passed through the enlarged opening of the cervix to obtain a piece of tissue from the lining of the uterus. A D&C is performed in an operating room. Local or general anesthesia may be used.

The doctor also needs to rule out other problems that can cause the same symptoms as fibroids. For example, an imbalance of hormones may cause heavy periods. A bladder infection can cause a frequent need to urinate.

Diagnosis of Fibroid Tumors

Diagnosis of fibroids can be done in several ways:

• Internal diagnosis of the womb to check the growth as an increased size points to existence of fibroids
• Ultra sound is one of the most effective diagnostic tool that can confirm the presence of fibroids
• MRI scan is suggested when the fibroid is large and makes ultra sound difficult
• Endometrial biopsy in which a small tissue is taken and tested for the existence of fibroid

What is the Best Way to Make the Diagnosis of Fibroids?

Fibroids are most commonly diagnosed during a pelvic examination. Fibroids are benign tumors of the uterine muscle wall and, as such, cause the uterus to feel larger than normal and irregular. If the size of the uterus is hard to determine or the diagnosis is uncertain, a pelvic ultrasound can be helpful. An ultrasound exam is fairly accurate at determining the sizes and positions of fibroids within the uterine wall. However, sometimes the exact position of the fibroids is hard to accurately determine with ultrasound.

The best test to tell size and position of fibroids is an MRI. Fibroids contain more collagen than normal uterine muscle and, as a result, the fibroids appear distinct and darker on the MRI. Getting an MRI may be a good idea if the ultrasound is not clear or it is important to know exactly where the fibroids are. I also use this test if a laparoscopic myomectomy is being considered. MRI gives me a good idea as to whether it will be possible to get all the fibroids out with the laparoscopic instruments. If ultrasound is not clear, MRI can also be used to see if submucous fibroids are present. This can be helpful if unexplained heavy bleeding is present or fertility is a concern.

How to find out if you have fibroids

Because there are often no symptoms, you may only find out you have fibroids when you go for an internal examination. If you have symptoms and think you might have fibroids, see your doctor. You may be referred to a gynaecologist who should be able to diagnose whether you have fibroids or another condition. The doctor will give you a vaginal examination to feel your uterus for lumps or bulges.

If your doctor says you do have fibroids, ask if there is more than one, where they are and how large they are. This will help you better understand your symptoms and decide what action to take, if any.

Your doctor may want to confirm a fibroid diagnosis with additional tests:

Ultrasound scan

An ultrasound uses sound waves to get an image of your internal organs. This can help determine if the lumps are fibroids or another type of tumour. It can also provide more detailed information about the size and location of fibroids.

You may be given an abdominal ultrasound, a vaginal ultrasound or both. An abdominal ultrasound is best at finding large fibroids. Before your appointment you will be asked to drink up to a litre of liquid so that you have a full bladder for the test. The scan itself is not painful(the doctor simply moves the probe over your belly),but waiting for your appointment with a full bladder may be uncomfortable.

A vaginal ultrasound is used to find small fibroids. The scanner (probe) will be put into your vagina and may be a little uncomfortable. You do not need to have a full bladder for this scan and it should not be painful.

If the ultrasound results are unclear, your doctor may suggest a hysteroscopy or laparoscopy.

Hysteroscopy

A hysteroscopy examines the inside of your womb by using a small telescope (hysteroscope) which is inserted into your womb through your vagina. Hysteroscopy can also be used to take a biopsy (tissue sample) of the lining of the womb. You may be given a local anaesthetic, general anaesthetic or in some cases, neither. If you do not have an anaesthetic, the procedure may be slightly painful. Hysteroscopy is done in hospital and you can usually go home the same day.

Laparoscopy

Where a hysteroscopy (see above) looks at the inside of the womb, a laparoscopy looks at the size and shape of the outside of the womb. It can also be used to take tissue samples. The procedure involves making a small cut (about 1cm wide) in the lower abdomen, just below the belly button, and inserting a thin telescope (the laparoscope). You may also have a probe inserted into your vagina to help move your womb so the laparoscope can see it from different angles.

The operation usually takes about 30 minutes and is done in hospital. You will be given a general anaesthetic before the procedure and will have a few stitches afterwards. Sometimes air is pumped into the abdomen as part of the procedure and this may leave you feeling bloated.