Typically the initial diagnosis of uterine fibroids is made at the time of a pelvic examination when the examiner notes that the uterus is enlarged and often it is noted to be irregular at the same time. Of course, most clinicians feel very comfortable with their ability to make the diagnosis of uterine fibroids. However, caution should be exercised here. Whenever I am lecturing to physicians on this topic, I often remind them, “familiarity breeds contempt” and add “also confusion”.  Because this diagnosis is such a common one encountered in the course of medical education as well as clinical practice, many practitioners in the past have been satisfied using only the pelvic examination without any other confirmatory evaluation. 

All of us clinicians need to keep in mind that the initial diagnosis of uterine myomas really means that a given woman has a growth or mass in her pelvis. Based on our experience and training, we may believe that mass to be a fibroid. However, as you might imagine, this growth could be many other things as well. These include something as simple as a uterus, which is minimally enlarged because of the woman having carried pregnancies in the past to something more serious such as a malignant tumor arising from any of the other structures, which happen to occupy the pelvis. 

I remember quite vividly when I was a Chief Resident assigned to provide gynecologic services at a mental institution. One afternoon I saw a woman who I felt had a very large, soft growth arising from deep in her pelvis reaching the level of her navel. I immediately jumped to the conclusion that this represented a potential tumor and because she was post-menopausal, the possibility of cancer of the ovary was uppermost in my mind. When I presented this to the medical director along with my urgent recommendations that this woman be prepared for exploratory surgery as urgently as possible, he very diplomatically asked me if I wouldn't mind having the woman's bladder catheterized before making arrangements for transfer. Of course when this was done, an enormous amount of urine was retrieved from her bladder and the previously impressive mass slowly disappeared. This woman was on large doses of the drug thorazine which was known to cause difficulty expelling urine from the bladder. 

Many years later I saw a woman from the Midwest for a second opinion regarding the treatment of her uterine fibroids. She had seen a senior gynecologist at the local medical school who had made the diagnosis of enlarging fibroids. Based on his many years of experience, he was very comfortable with his diagnosis and followed her for some time. Ultimately, because of the progressive increase in size, a recommendation for a hysterectomy for the enlarging fibroids was made. Still, no further tests had been performed to confirm the diagnosis that had been made by pelvic examination. When we saw her, we indeed did confirm a very large growth. When we sent her for a pelvic ultrasound, we received a report that she had a normal uterus, but, an extremely large tumor arising from one of her ovaries that was highly suggestive of cancer. 

Thus, when your doctor diagnoses fibroids, generally it is advisable to confirm this diagnosis with some other test. This is especially important because most of you will want conservative management such as simple observation. At the same time, you would not want to simply observe a tumor that might be a cancer.

There are several ways of diagnosing uterine fibroids. – Francis Hutchins, Jr., M.D.