A uterine fibroid ultrasound report summarizes findings from an imaging procedure, compiled by a radiologist using sound waves to create images of the uterus and surrounding structures. This report aids healthcare providers in diagnosing uterine fibroids, which are common non-cancerous growths. Understanding its contents helps individuals gain clarity on their condition and potential next steps.
Decoding the Terminology in Your Report
Understanding the specific terms used in a uterine fibroid ultrasound report helps clarify the findings. These reports contain measurements and descriptions that provide a comprehensive picture of any fibroids present.
Size and Dimensions
Fibroids are measured in centimeters (cm), varying from a few millimeters to over 20 cm. Small fibroids are classified as 1 to 5 cm, medium fibroids range from 5 to 10 cm, and large fibroids exceed 10 cm. While size influences symptoms, it is not the sole determinant of their impact. A large fibroid can cause the uterus to expand to a size similar to that of a third-trimester pregnancy.
Number
The report indicates whether a single fibroid or multiple fibroids are identified. Terms like “solitary” for one or “multifocal” for several may be used. Fibroids commonly occur as multiple growths, with approximately 85% of cases involving more than one.
Echogenicity
Echogenicity describes how sound waves reflect off tissues, appearing as different shades on the ultrasound image. Uterine fibroids are described as “hypoechoic,” meaning they appear darker than the surrounding normal myometrial tissue. This appearance indicates a solid, well-defined mass within the muscular wall of the uterus. Fibroids can also be isoechoic or hyperechoic depending on their composition.
Endometrial Stripe/Cavity
The endometrial stripe refers to the inner lining of the uterus. The report notes if a fibroid affects this lining, as submucosal fibroids can distort or indent the endometrial cavity. This distortion can lead to symptoms like heavy menstrual bleeding.
Vascularity
Vascularity refers to the blood supply within or around the fibroid, assessed using Doppler ultrasound. Color Doppler can show circumferential flow around the fibroid (perifibroid vascularity) and central flow within the fibroid (intrafibroid vascularity). The degree of vascularity can increase with fibroid volume, with larger fibroids more likely to have both peripheral and central vascularity.
Interpreting Fibroid Location and Classification
The location of a uterine fibroid significantly influences the symptoms experienced and potential treatment options. The International Federation of Gynecology and Obstetrics (FIGO) classification system categorizes fibroids based on their position. This system aids in understanding the clinical significance of each fibroid type.
Subserosal Fibroids
Subserosal fibroids develop on the outer surface of the uterus, growing outward into the pelvic cavity. These fibroids cause pressure-related symptoms as they press on nearby organs like the bladder or rectum. Symptoms may include a feeling of heaviness or fullness, frequent urination, constipation, or lower back pain. While they do not cause heavy menstrual bleeding, they can lead to abdominal or pelvic pain.
Intramural Fibroids
Intramural fibroids are the most common type, growing within the muscular wall of the uterus. These fibroids can enlarge the uterus and cause symptoms like heavy or prolonged menstrual bleeding and pelvic pain or pressure. Larger intramural fibroids can also press on nerves, causing backaches or leg pains, or affect the bladder or rectum, leading to frequent urination or difficulty with bowel movements. Their presence can distort the shape of the uterus, impacting menstrual flow.
Submucosal Fibroids
Submucosal fibroids are located just beneath the uterine lining and protrude into the uterine cavity. Even when small, these fibroids are the most symptomatic type due to their location. They are associated with heavy and prolonged menstrual bleeding, which can lead to anemia, fatigue, and dizziness. Submucosal fibroids can also impact fertility and contribute to recurrent miscarriages or other pregnancy complications.
Pedunculated Fibroids
Pedunculated fibroids are a subtype of either subserosal or submucosal fibroids, attached to the uterus by a narrow stalk or stem. If they grow on the outer wall, they are pedunculated subserosal; if inside the uterine cavity, they are pedunculated submucosal. These fibroids can cause sudden, sharp pains if their stalk twists, which interferes with blood flow. While they can be asymptomatic, they may also cause menstrual cramps, longer periods, and general abdominal pain.
How Your Report Guides Medical Decisions
A uterine fibroid ultrasound report provides information that helps healthcare providers develop a personalized management plan. The report’s details, such as fibroid size, number, and precise location, are combined with your individual symptoms, age, and reproductive goals to determine the most suitable approach.
Watchful Waiting
For many individuals, particularly those with small or asymptomatic fibroids, watchful waiting is a common initial recommendation. Since fibroids are benign, often grow slowly or not at all, and typically shrink after menopause, immediate intervention may not be necessary. This approach involves regular monitoring of symptoms and fibroid size through follow-up appointments, often without additional imaging unless symptoms develop or worsen.
Medical Management
When fibroids cause symptoms like heavy bleeding or pain, medical management may be considered. Hormonal contraceptives can help reduce heavy menstrual bleeding. Other medications, such as tranexamic acid or nonsteroidal anti-inflammatory drugs, can be prescribed to manage symptoms. The specific findings in your ultrasound report, especially regarding fibroid size and impact on the endometrial lining, can influence the choice of medication.
Procedural Interventions
For larger or more symptomatic fibroids, or when medical management is insufficient, procedural interventions may be discussed. The ultrasound report’s detailed information about fibroid location and size is used to select appropriate procedures. Options include myomectomy, which surgically removes fibroids while preserving the uterus, or uterine artery embolization (UAE), a minimally invasive procedure that blocks blood flow to the fibroids, causing them to shrink. Other treatments include radiofrequency ablation, which uses heat to destroy fibroid tissue, or focused ultrasound surgery (FUS) guided by MRI, which destroys fibroid tissue non-invasively. In some cases, a hysterectomy, the surgical removal of the uterus, may be considered, particularly for extensive fibroids or when other treatments are not suitable.