Diagnosing Fibroids

Fibroids are noncancerous growths that develop in the muscle of the uterus. Symptoms depend on where in the uterus they occur: either the inner cavity or the outer muscle layer. It is a benign condition, but can greatly impact a person’s quality of life, causing heavy and prolonged bleeding, frequent urination, backache, and pelvic pain and pressure.

Fibroids are extremely common: between 70 and 80 percent of women under the age of 50 have been diagnosed with fibroids. The chances of developing fibroids are higher for women who are Black, over 40 years old, obese, or have a family history of fibroids. Not everyone with fibroids has symptoms, but those who do are advised to seek treatment.

If fibroids don’t cause any symptoms or produce only mild ones, your NYU Langone doctor, including specialists from the Center for Fibroid Care, may recommend watchful waiting until treatment is needed. That can include medication, nonsurgical treatments, and surgery.

No one knows exactly what causes fibroids, but estrogen and some other hormones seem to fuel their growth. It is important to report any changes in symptoms that occur between annual checkups. Fibroids tend to stop growing when menopause occurs. How much fibroids shrink after menopause depends on their initial size.

Diagnostic Tests

Diagnosis begins with your gynecologist talking with you about your medical history to learn about your menstrual flow, pelvic pressure, and pain. Your doctor also requests a blood test to check for anemia, a common side effect of the heavy blood loss experienced by some women with fibroids. Your doctor performs a pelvic exam to check for an enlarged uterus or masses on the uterine wall, which depending on their size and location can sometimes be detected during the exam.

Depending on the results of the pelvic exam, your doctor may recommend one or several of the following imaging tests.

Ultrasound

During an ultrasound, sound waves create images of the pelvic organs on a computer monitor. Your doctor may also request a saline sonogram, where saline is placed in the uterine cavity to aid in visualizing the fibroids.

MRI Scan

After an ultrasound exam indicates the presence of fibroids, your doctor may order an MRI to understand their number, location, and size. An MRI uses a magnetic field and radio waves to create computerized, 3D images of the uterus.

The results of the MRI can help your doctor decide which treatment is best for you and rule out other causes. These include adenomyosis and endometriosis, conditions in which the lining of the uterus grows into the muscular wall or even outside the uterus itself, causing symptoms similar to those caused by fibroids. An MRI scan is also helpful in planning for surgery or another treatment procedure.

Diagnostic Hysteroscopy

During a diagnostic hysteroscopy, your doctor inserts a thin, lighted scope through the vagina into the uterus. This procedure allows your doctor to view the inside of the uterus and identify any fibroids within the cavity. This exam often precedes an operative hysteroscopy, in which small surgical tools are used to remove fibroids during the same procedure.