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Health Protocols

Uterine Fibroids


A physician may suspect the presence of uterine fibroids if a patient has sensations of pelvic fullness, increased or extended menstrual bleeding, or is experiencing infertility. Sometimes fibroids are diagnosed during routine pelvic examinations (Elsevier BV 2011). In order to confirm the presence of uterine fibroids, physicians generally use one or more diagnostic procedures.


Ultrasonography (ultrasound) is the most frequently used diagnostic tool for fibroids because of its availability and relative low cost. However, the accuracy and diagnostic capability of ultrasonography is highly dependent on the technician performing the scan, and the images that ultrasonography provides are not as consistently reproducible as those of magnetic resonance imaging (MRI). Ultrasonography can be performed transabdominally or transvaginally; accuracy is improved when both are performed. Transvaginal ultrasound is able to detect smaller fibroids than transabdominal scans. A skilled technician can detect fibroids as small as 5 mm with transvaginal ultrasonography (Khan 2014).

Magnetic Resonance Imaging

MRI is often used as a second diagnostic option if the physician is uncertain about the type of pelvic mass a patient has. MRI is a more costly procedure than ultrasonography; however, it is more sensitive, with the ability to detect fibroids in 88-93% of patients. Also, the scan is better able to distinguish between submucosal, intramural, and subserosal fibroids, which is important for making future treatment decisions (Khan 2014; Mitwally 2013). 

Saline Infusion Sonohysterography

Saline infusion sonohysterography is occasionally used for diagnostic purposes to supplement either ultrasonography or MRI. In this procedure, sterile saline is injected into the uterus to expand it, allowing clearer images of uterine growths, which are obtained by ultrasonography (ACOG 2004). The quality of the images is dependent on the amount of uterine expansion and therefore, the amount of associated discomfort the patient can tolerate (Khan 2014). This test may be used if a woman has excessive menstrual bleeding or if ultrasonography tests are normal (Mayo Clinic 2014a).


Hysteroscopy is performed by inserting a small, lighted instrument called a laparoscope into the uterus for direct visualization. The physician then injects saline or carbon dioxide gas into the uterus to allow expansion and examination through the laparoscope (Mayo Clinic 2014a). Hysteroscopy can be diagnostic and/or surgical, as a biopsy can be performed, and some fibroids can be surgically removed during the procedure (Ferri 2014; UMMC 2014; ASRM 2012a; A.D.A.M. 2012; ACOG 2011). 

Additional Tests

Excessive bleeding caused by fibroids may result in iron-deficiency anemia (Elsevier BV 2011). Symptoms of iron-deficiency anemia include fatigue, pale skin, weakness, shortness of breath, chest pain, headache, and dizziness (Mayo Clinic 2014b). A physician may request a complete blood count (CBC) to analyze the number of red blood cells (Elsevier BV 2011). 

If uterine fibroids are causing significant urinary symptoms, doctors may also perform tests to examine a patient’s urinary system. Other tests may include a pregnancy test, cervical Pap smear, erythrocyte sedimentation rate, and fecal occult blood test (Ferri 2014).