Diagnosis:

Pelvic Exam and Medical History

Some fibroids can be felt as lumps during a pelvic exam. During a pelvic exam, the doctor will also check for pregnancy-related conditions and other conditions, such as ovarian cysts. The doctor will also ask you about your medical history, particularly as it relates to menstrual bleeding patterns. Other causes of abnormal uterine bleeding and must also be considered.

Ultrasound

Ultrasound is the standard imaging technique for detecting uterine fibroids. The doctor will order transabdominal and transvaginal ultrasounds. Ultrasound is a painless technique, which uses sound waves to image the uterus and ovaries. In transabdominal ultrasound, the ultrasound probe is moved over the abdominal area. In transvaginal ultrasound, the probe is inserted into the vagina.

A variation of ultrasound, called hysterosonography, uses ultrasound along with saline (salt water) infused into the uterus to enhance the visualization of the uterus.

Hysteroscopy

Hysteroscopy is a procedure that may be used to detect the presence of fibroids, polyps, or other causes of bleeding. (It may also be used during surgical procedures to remove fibroids.)

Hysteroscopy can be performed in a doctorâ ' s office or in a hospital setting. The procedure uses a long flexible or rigid tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber optic light source and a tiny camera in the tube allow the doctor to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This can cause cramping.

Hysteroscopy is non-invasive and does not require incisions; however, a third of women report severe pain with the procedure. Local, regional, or general anesthesia may be given.

Laparoscopy

In some cases, laparoscopic surgery may be performed as a diagnostic procedure. Laparoscopy involves inserting a scope into a small incision made near the navel. Whereas hysteroscopy allows the doctor to view inside the uterus, laparoscopy provides a view of the outside of the uterus, including the ovaries, fallopian tubes, and general pelvic area.

Other Tests

In certain cases, the doctor may perform an endometrial biopsy to determine if there are abnormal cells in the lining of the uterus that suggest cancer. Endometrial biopsy can be performed in a doctor's office, with or without anesthesia. Dilation & curettage (D&C) is a more invasive procedure that involves scraping the inside lining of the uterus. It can be used to take tissue samples and also as a procedure to help temporarily reduce heavy menstrual bleeding. [For more information on these procedures, see In-Depth Report #100: Menstrual Disorders.]

The doctor may also order a complete blood count (CBC) to check for signs of anemia.

Ruling out Other Conditions that Cause Heavy Bleeding

Almost all women, at some time in their reproductive life, bleeding heavily during menstrual periods.

A number of conditions can cause or contribute to the risk:

• Menstrual disorders
• Miscarriage
• Having late periods or approaching menopause
• Uterine polyps (small benign growths in the uterus)
• Intrauterine device (IUD)

The intrauterine device (IUD) shown uses copper as the active contraceptive; others use progesterone in a plastic device. IUDs are very effective at preventing pregnancy (less than 2% chance per year for the progesterone IUD, less than 1% chance per year for the copper IUD). IUDs come with an increased risk of ectopic pregnancy and perforation of the uterus, and do not protect against sexually transmitted disease. IUDs are prescribed and placed in the uterus by a health care provider.

• Bleeding disorders that impair blood clotting, Von Willebrand disease
• Uterine cancer
• Pelvic infections
• Adenomyosis. This condition occurs when glands from the uterine lining become embedded in the uterine muscle. Its symptoms are nearly identical to fibroids (heavy bleeding and pain).
• A number of medical conditions, including thyroid problems and systemic lupus erythematosus
• Certain drugs, including anticoagulants and anti-inflammatory medications.
• Often, the cause of heavy bleeding is unknown.