Guest Author - Denise Howard, M.D., M.P.H.

Fibroids or leiomyomata are smooth muscle tumors that are usually benign and are commonly found in the uterus. The uterus is composed predominantly of smooth muscle and therefore a common site for these growths. They can grow in different locations in the uterus and as a result may present with different symptoms. They can be solitary and small or multiple and as large as a grapefruit. They cause the uterus to grow to the size of a term pregnancy.

The most common presentation of fibroids is irregular or heavy uterine bleeding or prolonged heavy periods. The bleeding can sometimes be so severe that life threatening anemia may develop. Some women also experience severe cramps during the time of their period. Another common presentation includes complaints of pelvic pressure, urinary frequency or discomfort, and the sense that the abdomen is getting larger. An abdominal examination may reveal a firm easily palpable mass. Finally some women don’t report any complaints and a health care provider may find the enlarged uterus on pelvic examination prompting further evaluation.

The most common tool used to evaluate for fibroids is the pelvic ultrasound. This is usually done transabdominally and transvaginally. The uterus and ovaries are easily visualized. The size of the uterus can be measured and individual fibroids can be counted and measured. If more detailed visualization of the lining of the uterus is required then a saline injection ultrasound or hysterosonogram can be performed. A saline solution is instilled into the uterine lining through the cervix. Ultrasound scanning can then image the lining in even greater detail. Submucosal fibroids and endometrial polyps are easily seen with this test.

Ultrasound imaging is sometimes limited by the density of the abdominal wall or the size and bulkiness of the fibroid uterus. In these cases, magnetic resonance imaging (MRI) can give an even more detailed picture of the uterus, fibroids, and their location and size. They are more expensive than ultrasound and their use is reserved for select circumstances.

A hysteroscopy is a procedure that allows direct visualization of the lining of the uterus. It is an alternative to the hysterosonogram. Submucosal fibroids, endometrial polyps and other endometrial abnormalities can be easily visualized by the surgeon and potentially treated at the same time.

The above diagnostic tools are used commonly to assess uterine fibroids. The information provided can help your gynecologist recommend treatment options that are appropriate for your individual circumstance. Fibroids are not always the cause of the problem and they don’t always need to be removed. Your physician should partner with you to select the least invasive and most effective option to address your problem.