Diagnosis of Fibroids
It is easy to feel Fibroids during a pelvic exam, but many times myomas that are causing symptoms can be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, routinely doing an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if felt an abnormality on examination are the valuable steps. Vaginal probe ultrasound only takes a few minutes to do, is comfortable, 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. While this will often provide additional information to the regular ultrasound, one can usually learn much more by looking inside the uterus with a little telescope. This exam, called hysteroscopy, is usually done in the office setting, and allows to directly looking inside the uterus.
The above steps are usually all that is needed to make an accurate diagnosis and plan treatment. Sometimes, especially more information is needed, with very large fibroids. An MRI scan makes detailed images of the uterus. It can show the location of fibroids. An MRI can usually tell the difference between adenomyosis and fibroids.
Adenomyosis: Conscious with Actions
One of the most common conditions confused with fibroids is adenomyosis. This can be a serious error, as the treatment may be quite different. In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. Severe pain and heavy bleeding can be seen. On ultrasound examination adenomyosis will often appear as diffuse thickening of the wall, while with a discrete border fibroids are seen as round areas. Adenomyosis is usually a diffuse process, and rarely can be removed without taking out the uterus. Since fibroids can be removed by myomectomy, it is essential to differentiate between the two conditions before planning treatment. It is also common to have adenomyosis and fibroids in the same uterus.
All About Hysteroscopy
A hysteroscope is used in Hysteroscopy, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Because the inside of the uterus is a potential cavity, like a collapsed air dome, it is necessary to fill (distend) it with either a liquid or a gas (carbon dioxide) in order to see. Doing most diagnostic hysteroscopy in the office using local anesthesia is a safe process. If a patient is particularly anxious, or if having a concern that she may be uncomfortable, the procedure under mild sedation is an appropriate alternative.
Procedure of doing Diagnostic Hysteroscopy:
Unless a woman has major medical problems, can do diagnostic hysteroscopy in the office. First, frozen the cervix (this is easily done and rarely uncomfortable.), attach a video camera to the hysteroscope, so the patient can also see, and then insert the hysteroscope into the uterus under direct vision while using either saline or carbon dioxide to fill the uterus. Then one can look for fibroids, polyps, and other problems that may be causing bleeding. This often takes about a minute or two. The hysteroscope is removed. A small plastic tube may be used to take a sample of the lining of the uterus.
View through a hysteroscope
This is a view through a hysteroscope during office hysteroscopy. It shows the inside of a uterus with two intra-cavitary myomas on the back wall. The upper portion of the photograph shows the top of the uterus, which is normal. Fibroids like this can cause severe cramping (dysmenorrhea), heavy menstrual periods (menorrhagia) and bleeding between periods (metrorrhagia.) These fibroids were quickly and accurately diagnosed by hysteroscopy. A special kind of hysteroscope called a resectoscope is used in removing these myomas.
Difference between Resectoscope and a regular hysteroscope?
The resectoscope has been used for male prostate surgery for over 50 years. Due to its modification it can be used inside the uterus. The resectoscope is a hysteroscope with a built in wire loop (or other shape device) that uses high-frequency electrical current to cut or coagulate tissue. The resectoscope has revolutionized surgery inside the uterus.
Is it safe to do in the office?
By being very gentle and using local anesthesia, there is usually minimal discomfort during hysteroscopy. Most women are able to get up and return to their normal activities immediately. If someone is very anxious, it is possible to give a short acting narcotic intravenously. This leads to very unlikely that the procedure will be uncomfortable.
What Operative Hysteroscopy is?
During diagnostic hysteroscopy the hysteroscope is used just to observe the endometrial cavity (inside of the uterus.) During operative hysteroscopy a type of hysteroscope is used that has channels in which it is possible to insert very thin instruments. These instruments can be used to remove polyps, to cut adhesions, and do other procedures. In many situations, operative hysteroscopy may offer an alternative to hysterectomy.