Uterine Fibroids Diagnosis

Pelvic examination

An enlarged, mobile, and irregular uterus may be felt on pelvic examination. If you feel any such mass yourself, always consult with a medical doctor to confirm a diagnosis, rather than self-diagnosing.

Ultrasonography

Ultrasound can usually detect a fibroid and will provide additional information about the shape, size, and position. You gynecologist may consider a hysterosonography, which is a variation of the ultrasound, where sterile saline is used to increase the uterine cavity to give a better image.

Hysteroscopy

The inside of the uterus is viewed by passing a thin, flexible tube through the vagina and cervix into the uterus. This tube contains a small video camera and a light source to enable your gynecologist to see the uterine lining.

CT scn & MRI for Uterine Fibroids

These imaging techniques may be necessary to diagnose fibroids if ultrasonography is inconclusive. These are usually more costly procedures and only considered when and where necessary.

Treatment of Uterine Fibroids

For asymptomatic fibroids, expectant management or a ‘wait-and-watch’ approach is the usual coure of action. Fibroids are non-cancerous and tend to regress after menopause, so no treatment except periodic re-evaluation may be necessary.

For symptomatic fibroids, treatment will depend on factors such as possible cause of the uterine fibroids, severity of symptoms, the patient’s desire to conceive, and her desire to keep the uterus. In post-menopausal women, expectant management may be considered to allow time for the fibroids to shrink naturally without any medical or surgical intervention.

Medication/Drugs for Uterine Fibroids

Medication may help to relieve the symptoms such as heavy menstrual bleeding, reduce growth of the fibroid, or both. The drugs most commonly used are :

• Gonadotropin-releasing hormone (Gn-RH) analogues help by decreasing estrogen production. They are given pre-operatively when surgery is contemplated because they help to reduce the size of the fibroids and uterus, making surgery easier.
• Progestins such as medroxyprogesterone and oral contraceptives can help to limit heavy menstrual bleeding but they do not limit fibroid size.
• Progestin-releasing intrauterine device (IUD) introduced into the uterus can reduce heavy bleeding.
• Danazol (a synthetic drug similar to testosterone) can help to decrease heavy periods and reduce size of the fibroids, but side effects such as weight gain, unwanted hair growth, and deepening of the voice, often limits its use.

Surgery & Other Surgical Procedures

• Hysterectomy or surgical removal of the uterus offers a permanent solution for uterine fibroids but further pregnancy will not be possible after hysterectomy.
• Myomectomy is a procedure where only the fibroids are removed while the uterus is left intact. Women hoping to conceive may prefer this form of surgery, but chances of fibroid recurrence must also be considered.

Other procedures that may be considered for uterine fibroids.

• Myolysis is a laparoscopic procedure where an electric current or laser is used to destroy the fibroid, while cryomyolysis uses liquid nitrogen to freeze the fibroid.
• Endometrial ablation uses heat, microwave energy, or electric current to destroy the uterine lining and helps to reduce excessive uterine bleeding.
• Uterine artery embolization is a technique where tiny embolic agents are injected into the arteries supplying the uterus, which cause the fibroids to shrink as a result of loss of blood supply.
• Focused ultrasound surgery is a non-invasive procedure in which the patient is put inside a specially designed MRI machine, where the fibroids are destroyed using high energy sound waves.

Types of Uterine Fibroids

Depending on their location in the uterus, fibroids may be :

1. Myometrial – located within the muscle of the uterus.
2. Submucosal – just beneath the surface of the uterine lining. Submucosal leiomyomas may cause prolonged, heavy menstrual periods, and may become the one of the possible causes of infertility.
3. Subserosal – just within the outer covering of the uterus. If large, these may press on the bladder or rectum and cause urinary problems or constipation.
4. Pedunculated – connected by a stalk to the outer surface of the uterus or hanging within the uterine cavity.

Causes of Uterine Fibroids

There is no definite known cause of a leiomyoma in the uterus but certain factors may influence their development.

• Uterine fibroids are common pelvic tumors that develop in women of childbearing age, more common in women over the age of 30, usually regressing after menopause.
• It is more common in African-American women than in Caucasians and fibroids also tend to occur at an earlier age and reach larger proportions in the former group.
• Genetic factors seem to play a part in the development of uterine fibroids
• The female hormone, estrogen, seems to enhance growth of fibroids.

Symptoms of Uterine Fibroids

In a large number of cases, uterine fibroids do not produce any symptoms, often being detected only incidentally during a routine pelvic examination or when fertility tests are conducted in cases of infertility. Symptoms, if present, may include :

• Menorrhagia or heavy menstrual bleeding, which may lead to anemia.
• Prolonged periods.
• Spotting or bleeding between periods.
• Dysmenorrhea or painful menstruation.
• Irregular periods.
• Heaviness or pelvic discomfort, sometimes also described as bearing down ache.
• Recurrent spontaneous abortion.
• Frequency of urination.
• Constipation.
• Back pain.
• Edema or swelling of the leg.
• A degenerating fibroid can cause acute pain.
• Twisting or torsion of a pedunculated fibroid can cause severe lower abdominal pain.
• Abdominal lump – large fibroids may be felt abdominally.

Relationship of Fibroids with Infertility and Pregnancy

Fibroids normally do not interfere with conception or pregnancy, but in rare cases they may block the fallopian tubes or prevent sperm from entering the fallopian tubes. A submucosal fibroid may even prevent implantation of the embryo on the uterus wall.

Large submucosal fibroids or multiple fibroids may sometimes cause problems during pregnancy, such as :

• Abdominal pain
• Risk of miscarriage
• Premature labor and delivery
• Placental separation and bleeding
• Abnormal fetal position in the uterus.
• Increased chances of a cesarean section.

As a rule, however, fibroids do not cause any problem during pregnancy and no treatment is necessary. They may increase in size during pregnancy, but usually return to their original size after delivery. Fibroids are not routinely removed during a cesarean section as there is increased risk of bleeding.