gynecology and obstetrics
Uterine Fibroids
Diagnosis of Uterine Fibroids
Imaging (ultrasonography, saline infusion sonography, or MRI) The diagnosis of uterine fibroids is likely if bimanual pelvic examination detects an enlarged, irregular, mobile uterus. If an enlarged, irregular, mobile uterus is a new finding or if pelvic examination findings have changed (eg, increased uterine size, possible adnexal mass, fixed mass, new finding of tenderness), imaging studies should be done to evaluate for fibroids or other gynecologic pathology (eg, Female Pelvic Mass ). Imaging may also be done if the patient has new symptoms (eg, bleeding, pain). When imaging is indicated, ultrasonography (usually transvaginal) is typically the preferred first-line test. If submucosal fibroids with an intracavitary component are suspected due to abnormal uterine bleeding, saline infusion sonography may be done. In saline infusion sonography, saline is instilled into the uterus, enabling the sonographer to more specifically visualize the uterine cavity. If ultrasonography, including saline infusion sonography (if done), is inconclusive, MRI is usually done. If available, MRI should be performed in a patient prior to myomectomy to localize the fibroids. Hysteroscopy can be used to directly visualize suspected submucosal uterine fibroids and, if needed, to biopsy or resect small fibroids. Patients with postmenopausal bleeding should be evaluated for uterine cancer. 