Investigations

In women who presents with symptoms suggestive of fibroids:

• evaluate gynaecological history including any cervical screening
• carry out a pelvic examination to detect any masses
• check haemoglobin
• mid stream urine test – in the presence of urinary symptoms to exclude urinary infection (1)

Imaging techniques available for confirming the diagnosis include:

• ultrasound scanning - carried out initially after an abdominal and pelvic examination.
  • transvaginal ultrasound scan (TVS) is more reliable than abdominal ultrasound
  • helps in
    • identifying size and location of fibroids and whether single or multiple
    • excluding hydronephrosis
    • distortion of the uterine cavity due to a submucous firoid
    • monitor the size of a single fibroid
  • saline infusion sonohysterography based imaging is useful in identifying submucous fibroids
• MRI
  • although more costly, is the most sensitive investigation to evaluate fibroids
  • useful in identifying the exact location, characteristics, number of fibroids and associated relationship with the nearby viscera
• hysteroscopy
  • carried out in a dedicated outpatient setting (1,2)

Reference:

• (1) Lumsden MA et al. Fibroids: diagnosis and management. BMJ. 2015;351:h4887
• (2) Khan AT, Shehmar M, Gupta JK.Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95-114.