BLOG: AN EXPERT SPEAKS OUT
Diagnosis of Fibroids
By Paul D. Indman, MD |
September 5, 2011
Dr. Indman believes that women should be as informed as possible so they can be directly involved in making choices about their own health care. This is especially true for the treatment of heavy bleeding. As there are a bewildering number of treatment options available, Dr. Indman takes extra time with his own patients to be sure they make the best possible individual decisions.
Dr. Indman has helped pioneer techniques in Gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals.
Accurate diagnosis of uterine fibroids is essential in deciding if treatment is necessary, and planning appropriate treatment.
While a physical exam may suggest fibroids, other conditions such as ovarian cysts or adenomyosis may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination. Utrasound of Submucous Uterine MyomaVaginal probe ultrasound only takes a few minutes to do, is not uncomfortable, and rapidly provides invaluable information if the examiner is experienced in looking at uterine abnormalities. It is possible to fill the uterus with a liquid during the ultrasound (saline enhanced sonography or sonohysterogram). While this will often provide additional information to the regular ultrasound, I usually learn much more by looking inside the uterus with a little telescope. This exam, called hysteroscopy, is usually a quick office procedure, that allows directly looking inside the uterus. While vaginal probe ultrasound is good for seeing close-up detail, it may not “see” deeply enough to evaluate large fibroids. An abdominal ultrasound, which requires a full bladder, is better for large fibroids but doesn’t show as much detail. As the images from MRI are SO much better than ultrasound, and I can obtain an MRI relatively inexpensively in my area, I prefer to go straight to MRI to image a large uterus with fibroids.
MRI scans provide excellent pictures of the uterus. MRI is especially helpful in evaluating a large uterus and helpful in planning a myomectomy. Adenomyosis is frequently confused with fibroids in an enlarged uterus, and the treatment is entirely different. I have seen patients who have been taken to surgery to remove fibroids only to find that there was adenomyosis instead, so they were closed back up without any treatment. MRI is especially good at distinguishing between fibroids and adenomyosis. If a woman is planning to travel a long distance to see me it is helpful to review an MRI (which can be recorded on a CD) to help plan treatment.
What is adenomyosis?
It is one of the most common conditions confused with fibroids.In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. On ultrasound examination this will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border. Adenomyosis is usually a diffuse process. If it is localized, or forms within a fibroid or a cyst it may also be possible to remove it. Since fibroids can be removed but it may not be possible to remove extensive adenomyosis without taking out the uterus, it is important to differentiate between the two conditions. A progesterone(Drug information on progesterone) coated IUD, the Mirena, is often helpful in treating symptoms of adenomyosis without surgery.
Editor's Note: This post was picked up from Uterine Fibroids blog: An Expert Speaks Out.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only
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David Holtz, MD
David Holtz is a practicing Gynecologic Oncologist with Main Line Gynecologic Oncology Associates and the Director of the Division of Gynecologic Oncology for the Main Line Health System. He is the first gynecologic surgeon in Pennsylvania to perform procedures for uterine and cervical cancer with the daVinci Robot, and he is a Clinical Assistant Professor with Thomas Jefferson University Hospital and the Lankenau Institute for Medical Research. Dr. Holtz’s clinical interests include minimally invasive surgery for women’s cancers and nanoparticles in the treatment of ovarian cancer.
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Donald Shuwarger, MD
Dr Don Shuwarger is a board-certified general ob/gyn practicing in northwest North Dakota. His career spans 26 years, most of which has been spent serving smaller cities. He earned his MD from Baylor College of Medicine in 1981 where he completed his ob/gyn residency in 1985. He earned his MBA from UMass-Amherst in 2005. In 2008 Shuwarger took a sabbatical to join the US Antarctic Program as a physician at McMurdo Station and the new Amundsen-Scott South Pole Station. From 2009 - 2010 he was the Chief Medical Officer at the US Army Kwajalein Atoll in the Marshall Islands. He has one 22 year old daughter who is an EMT and is studying to be a registered nurse.
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Amy Tuteur, MD
Dr Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College, her medical degree from Boston University School of Medicine, and did her internship and residency at Boston's Beth Israel Hospital. Dr Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. She blogs at The Skeptical OB.
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ISSUES IN INFERTILITY
Reproductive Medicine Associates of New York
RMA of New York offers patients up-to-date, appropriate infertility treatment in a caring, compassionate manner.
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ISSUES IN INFERTILITY
Eric Flisser, MD
Dr Flisser, MD is the Medical Director of Reproductive Medicine Associates of New York. He is Board Certified in Reproductive Endocrinology & Infertility and in Obstetrics & Gynecology. He is an Associate Member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. He is also a member of the Nassau County Obstetrics and Gynecology Society, New York-Metropolitan Embryologist Society, and the American College of Obstetricians and Gynecologists. His professional interests include reproductive surgery, in vitro fertilization, and oocyte donation.
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Joe Antony, MBBS, MD
Dr Antony's expertise includes radio diagnosis, ultrasound and color Doppler imaging, x-ray imaging, CT imaging, and MR imaging. Presently, he is a consultant radiologist at PVS Hospital in Cohin, Kerala, India and is consultant radiologist and CEO of Ultrascan Centre, which is a color Doppler and ultrasound imaging clinic in Cochin, India.You can see his full ultrasound gallery at
ultrasound-images.com and sites.google.com/site/drjoea. He blogs at cochinblogs.blogspot.com and ultrasound-images.blogspot.com.
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Paul Indman, MD
Dr Indman, MD has helped pioneer techniques in gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals. Dr Indman is an editorial advisor on OBGYN.net. You can read more about him and his work on his eFibroids Web site.
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