Accurate diagnosis of uterine fibroids is essential in deciding if treatment is necessary, and planning appropriate treatment.n While a physical exam may suggest fibroids, other conditions such as ovarian cysts or adenomyosis may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination.
Accurate diagnosis of uterine fibroids is essential in deciding if treatment is necessary, and planning appropriate treatment.
While a physical exam may suggest fibroids, other conditions such as ovarian cysts or adenomyosis may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination. Utrasound of Submucous Uterine MyomaVaginal 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 sonohysterogram). While this will often provide additional information to the regular ultrasound, I usually learn much more by looking inside the uterus with a little telescope. This exam, called hysteroscopy, is usually a quick office procedure, that allows directly looking inside the uterus. While vaginal probe ultrasound is good for seeing close-up detail, it may not “see” deeply enough to evaluate large fibroids. An abdominal ultrasound, which requires a full bladder, is better for large fibroids but doesn’t show as much detail. As the images from MRI are SO much better than ultrasound, and I can obtain an MRI relatively inexpensively in my area, I prefer to go straight to MRI to image a large uterus with fibroids.
MRI scans provide excellent pictures of the uterus. MRI is especially helpful in evaluating a large uterus and helpful in planning a myomectomy. Adenomyosis is frequently confused with fibroids in an enlarged uterus, and the treatment is entirely different. I have seen patients who have been taken to surgery to remove fibroids only to find that there was adenomyosis instead, so they were closed back up without any treatment. MRI is especially good at distinguishing between fibroids and adenomyosis. If a woman is planning to travel a long distance to see me it is helpful to review an MRI (which can be recorded on a CD) to help plan treatment.
What is adenomyosis?
It is one of the most common conditions confused with fibroids.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. If it is localized, or forms within a fibroid or a cyst it may also be possible to remove it. Since fibroids can be removed but it may not be possible to remove extensive adenomyosis without taking out the uterus, it is important to differentiate between the two conditions. A progesterone coated IUD, the Mirena, is often helpful in treating symptoms of adenomyosis without surgery.
Editor's Note: This post was picked up from Uterine Fibroids blog: An Expert Speaks Out.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only
Unlocking placenta accreta spectrum with single-cell gene targets
April 18th 2024Discover how cutting-edge single-cell RNA sequencing unveils molecular insights into placenta accreta spectrum disorders, potentially revolutionizing diagnostics and treatments for this life-threatening pregnancy complication.
Read More
Recap on reproductive rights with David Hackney, MD, MS
December 20th 2022In this episode of Pap Talk, we spoke with David Hackney, MD, MS, maternal-fetal medicine physician at Case Western Reserve University and chair of ACOG's Ohio chapter for a full recap of where restrictions on reproductive rights have been and where they're going.
Listen
Understanding VTE and bleeding risks in gynecologic noncancer surgery
April 15th 2024Delve into the nuanced risks of venous thromboembolism and major bleeding post-gynecologic noncancer surgery, exploring procedure-specific variations and the implications for thromboprophylaxis strategies.
Read More
In this episode of Pap Talk, Gloria Bachmann, MD, MSc, breaks down what it means to be a health care provider for incarcerated individuals, and explores the specific challenges women and their providers face during and after incarceration. Joined by sexual health expert Michael Krychman, MD, Bachmann also discusses trauma-informed care and how providers can get informed.
Listen
Excessive gonadotropins in IVF: Effects on mosaicism and live birth
April 12th 2024A recent study revealed a correlation between high doses and prolonged duration of exogenous gonadotropin use during in vitro fertilization and increased embryonic mosaicism alongside diminished live birth rates, prompting reconsideration of dosage and duration protocols.
Read More
Maternal history linked to uterine fibroid risk in Black women
April 11th 2024Delve into the findings of a recent study revealing the heightened risk of developing uterine fibroids among Black women with a maternal history of the condition, shedding light on crucial implications for patient care and advocacy.
Read More