Disclaimer Our blog/article is intended to help educate and inform our patients who may be considering a pelvic ultrasound to evaluate for fibroids. Our educational mission in serving our patients is to help them better understand what fibroids are, to be more informed, to help reduce anxiety, to aid in discussing the results of their ultrasound and findings with their ordering physician or other medical providers. *If you are experiencing pelvic symptoms, please contact your medical provider or seek medical attention as this article is not intended to diagnose or suggest treatment options for your health condition.
Fibroids also known as Leiomyomas are the most common benign tumor found in the female pelvic uterus according to statistics. Cancerous fibroids have been known to occur but are extremely rare. It has been estimated that up to 80% of women may develop one or more fibroids during their lifetime. Fibroids are made up of mostly globular dense fibrous connective tissues. They can range in size from as small as a pea to sizes that can exceed that of the diameter of a grapefruit. The actual cause of fibroids is still under investigation. In some studies reported fibroid tumors were shown to have more estrogen and progesterone receptors than normal uterine tissue.
For many women there are no signs or symptoms and if diagnosed with a fibroid, they are found incidentally usually by your provider’s physical exam. Often your doctor may feel a hard lump or bump in your abdomen or pelvic region. For other women, there are many signs and symptoms that can lead to findings associated with fibroids.
Most common signs & symptoms:
Heavy periods, bleeding in between cycles, lower back or pelvic pain, painful intercourse, potential cause of infertility, abdominal or pelvic fullness, even weight gain in the abdominal area (if large enough), frequent urination, and constipation.
Generally speaking, fibroids are a benign (non-cancerous) tumor that remains in a benign state. (meaning it will not turn into cancer). Some studies have shown that fibroids may even shrink as women go through or approach menopause and are likely not to develop after menopause. That said, fibroids can, however, impact your quality of life. For many women, they experience chronic pelvic or lower back pain, can develop excessive heavy bleeding, bleeding in between periods, have painful intercourse, be subject to infertility, or even experience in very rare cases loss of pregnancy. Because of the wide range of symptoms it should be noted that the signs and symptoms can also be associated with other pelvic diseases or abnormalities. Upon diagnosis of a fibroid or fibroids, your medical provider may opt to monitor your signs & symptoms and the growth or progression of your fibroids which can be done by ultrasound or MRI.
Complications of fibroids are related to the size, location and number of fibroids present. There may also be associated or in combination with other incidental findings.
Heavy periods can lead to blood loss over a long period of time. This can deplete your body’s iron stores. You may feel tired all of the time, weak, dizzy or even short of breath to name a few of the symptoms. Your doctor may request a blood chemistry panel while trying to determine the underlying cause of your signs and symptoms along with, performing a physical exam. If a mass or inflammatory process is suspected, your doctor may opt for you to have a diagnostic pelvic ultrasound to help identify the source of your heavy bleeding.
Uterine fibroids can potentially cause infertility challenges by blocking the fallopian tubes or stopping a fertilized egg from “implanting” correctly in the uterus. In a normal pregnancy the fertilized egg will implant or attach itself into the normal lining (or endometrium) of the uterus.
.Depending upon the size and location of the fibroid(s), it can lead to development issues with the baby or difficulties during labor. The baby’s growth may be affected, there is a risk of premature labor and or the need for a c-section if the fibroid blocks the birth canal.
Because fibroids can grow quite large in some women, they can potentially cause damage to other organs due to displacement or compression. A fibroid may compress one of the kidney ureters (urine tube that drains into the bladder). If this occurs the normal flow of urine into the bladder is obstructed or blocked. That causes urine to back up into the kidney. A problem called hydronephrosis. If left untreated it can damage the kidney and impair kidney function.
In summary, your doctor or medical provider can provide a more focused relevant discussion regarding complications and treatments with you. Your individual or unique history, signs, symptoms and diagnosis of fibroids will help direct the best path of care for you.
Ultrasound is a very safe evaluation tool to evaluate your pelvic area. Ultrasound uses sound waves to create real-time images of your pelvic organs. A sonographer or ultrasound technologist will review your history with you and perform an ultrasound usually from two approaches. The exam time can range from about 30-45minutes. The first approach is usually over your abdomen area to see your pelvic area and organs from a more global approach. The second approach is performed by doing a transvaginal ultrasound. The probe is inserted into the vaginal canal, much like a tampon. Once inserted you may feel a slight pressure from the sonographer moving the probe around to see different regions of your pelvic cavity and uterus.
Part 1 Abdominal ultrasound approach: For the first part of your ultrasound exam, it is essential to have a full bladder to help see your uterus and ovaries. Usually drinking 32oz of water 1 hour prior to exam is recommended. Your sonographer may check your bladder to see if it is full-enough to proceed with the transabdominal part. If your bladder isn’t quite full you may be asked to drink more or wait a short time before it is full. If your bladder isn’t full bowel gas may prevent your sonographer from seeing adequately.
Part II. Transvaginal ultrasound approach: To be fully prepped for this exam, you will be asked to empty your bladder completely in preparation for a trans-vaginal ultrasound. In this case, it is important for your bladder to be empty, because now the sonographer’s ultrasound probe is virtually next to your uterus and ovaries (A more zoomed in focused approach). If your bladder is not completely emptied, it may displace the uterus and make it harder for the sonographer to see. During your exam, the sonographer may stop and may ask you to try to re-empty your bladder. You may ask, is all this worth it? The answer is yes! An ultrasound can be extremely useful for diagnosing fibroids or other conditions with the same symptoms you are experiencing. Ultrasound is very safe, no radiation, and low cost, compared to an MRI. Ultrasound identifies normal structures such as your uterus, your ovaries and the pelvic cavity or adnexal regions and to identify for abnormalities such as fluid collections, masses such as fibroids or congenital abnormalities.
An ultrasound evaluation of a fibroid looks for the presence, the location, the size, the number and other potential findings or complications as described earlier. Based on these descriptions our board-certified radiologist will correlate the findings with your history, signs, symptoms and previous exams/surgeries (if the information is available to them at the time of their interpretation). This historical information helps guide them in relaying more precise findings to your referring medical provider.
Your medical provider will get an interpretation or results of the diagnostic findings. These results will help guide your medical provider to determine appropriate treatment options and or in ordering additional tests. For example, your doctor may recommend an MRI to better visualize and confirm for the presence of a fibroid or fibroids (depending on the degree of difficulty in seeing by ultrasound)
Adenomyosis vs. Fibroids a common confusion or miss-diagnosis. Signs and symptoms of both disease states are unfortunately very similar and can sometimes be difficult to tell the difference by ultrasound. Fibroids are tumors that have generally have a denser darker rounded appearance by ultrasound. Fibroids typically cause a shadow appearance and calcification. Blood flow is usually observed around (or peripherally) the fibroid. Adenomyosis ultrasound findings usually present with asymmetry of the myometrial tissue, brighter appearance of tissue and more of a cystic like appearance than a fibroid. Vascularity of adenomyosis is most often observed centrally vs. peripherally.
When determining which treatment or if treatment is necessary, we recommend you speak with your medical provider. Below are some common treatment methods
Observation: Monitor the patient’s signs, symptoms and growth or progression of multiple fibroids
Myomectomy: Surgical removal of a fibroid(s),
Adenomyosis treatment (can be a combination of treatments recommended by your medical provider.
Hysterectomy: Removal of the uterus, cervix