Leiomyomas Diagnosis

Diagnosis

Classification

Based on location, fibroids can be:
- Submucosal (protruding into the uterine cavity)
- Intramural (found within the myometrium)
- Subserosal (protruding outside the uterus)
Fibroid classification may use the European Society for Gynecological Endoscopy (ESGE) or the International Federation of Gynecology and Obstetrics (FIGO) classification wherein the degree of uterine cavity distortion and/or intramural extension are taken into account

Physical Examination

Pelvic exam may reveal a palpable enlarged, firm, and irregular uterus
- A pelvic mass that moves with the uterus is suggestive of fibroids

Myomatous uterus’ size is reported in menstrual week as is a pregnant uterus
- Size of >12 to 20 weeks may be palpated on abdominal exam

Diagnosis can be difficult in obese women

Laboratory Tests

A CBC to evaluate hemoglobin (Hb) will detect iron-deficiency anemia in patients with heavy menstrual bleeding

Imaging

Transvaginal ultrasound (TVS): Helpful in assessing the adnexae and growth of myoma
Transvaginal sonohysterography (TVSH): Should be considered if submucosal fibroids and polyps are suspected
- TVSH may avoid the need for diagnostic hysteroscopy in approximately 47% of women who can then proceed to planned operative hysteroscopy
Magnetic resonance imaging (MRI): May be considered in women in whom the location and nature of the fibroids remain unclear after TVS and TVSH
- May also be used in those who wish to avoid discomfort of TVSH
- MRI predictors of malignancy include age >45 years, menopausal status, thickening of the endometrium, presence of intratumoral hemorrhage, nonmyometrial origin, and T2-weighted signal heterogeneity

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