Uterine Fibroids and Hysterectomy - Complications

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 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 that 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.

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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 doctor’s office or in a hospital setting. The procedure uses a long flexible 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.