Uterine Fibroids and Ultrasound in Ajax

Many women first hear the word “fibroid” in a slightly unexpected way. Sometimes it comes up after months of heavy periods. Sometimes it appears on a report from a scan ordered for something else entirely. Sometimes a doctor mentions during a routine pelvic exam that the uterus feels a little larger than usual and suggests an ultrasound to take a look.

However it arrives, the word tends to raise questions. What exactly is a fibroid? Is it dangerous? Why does the report mention its location in such specific terms? And why might your doctor want another scan in a year?

This article answers those questions in plain language, with a focus on the role ultrasound plays. It is meant to help women in Ajax, Pickering, Whitby and across Durham Region understand the process, not to replace a conversation with the health-care provider who knows your history.

Fibroids in a nutshell

Uterine fibroids are growths that develop from the muscle wall of the uterus. They are very common, particularly during the reproductive years, and the vast majority are non-cancerous. Medical texts sometimes call them leiomyomas or myomas; on a report you may see either term.

Fibroids vary enormously:

• Size. From too small to notice to large enough to change the shape of the abdomen.
• Number. Some women have a single fibroid; others have several.
• Location. They can grow inside the cavity of the uterus, within its muscular wall, or on its outer surface.
• Symptoms. Many women with fibroids never have any symptoms at all. Others have symptoms that significantly affect daily life.

Because so many fibroids cause no trouble, finding one is not, by itself, a reason for alarm. What matters is how it relates to your symptoms, your plans and your overall health, which is a conversation for you and your provider.

Symptoms that can lead to a scan

When fibroids do cause symptoms, the most common ones include:

1. Heavy or prolonged menstrual bleeding, sometimes with clots.
2. A feeling of pressure, fullness or heaviness in the lower abdomen.
3. Needing to urinate more often, if a fibroid presses on the bladder.
4. Constipation or a sense of bowel pressure.
5. Pelvic or lower back pain.
6. Pain during intercourse.
7. Tiredness, which can be linked to iron loss from heavy bleeding.

None of these symptoms is specific to fibroids. They can have many other causes, which is one reason a provider may request imaging rather than relying on symptoms alone. If pelvic pain is your main concern, our article on pelvic pain and ultrasound covers the broader picture.

When to seek urgent care: very heavy bleeding, such as soaking a pad or tampon every hour for several hours, or bleeding with dizziness, fainting, shortness of breath or a racing heart, needs prompt medical attention. Call 911 or go to the nearest emergency department.

How ultrasound shows fibroids

Ultrasound is usually the first imaging test for suspected fibroids. It uses sound waves rather than radiation and shows the uterus in real time.

On ultrasound, fibroids typically appear as rounded areas within or attached to the uterus that reflect sound differently from the surrounding muscle. A sonographer will usually:

• Measure the uterus in several directions.
• Identify each fibroid that can be clearly seen, noting how many there are.
• Measure each fibroid in more than one dimension.
• Describe where each one sits, which helps your provider understand whether it is likely to be related to your symptoms.
• Look at the lining of the uterus, known as the endometrium.
• Check the ovaries, since they are examined during most pelvic ultrasounds.

Depending on your requisition, the scan may be done through the lower abdomen, internally (transvaginally), or both. The external approach gives a wide view, which is useful when the uterus is enlarged. The internal approach gives a closer and more detailed look at the lining and smaller fibroids. If you would like to know more about the external approach and its preparation, our guide on why a full bladder matters explains it.

Occasionally a provider will want more information than ultrasound can provide, for example when planning certain treatments. In that case they may order a different test. That decision is theirs, based on your situation.

The location words on a report

Fibroid reports often include terms that look technical but describe something simple: where the fibroid sits in relation to the layers of the uterus. Knowing what the words mean can help you follow the conversation with your provider. Here is a general guide.

Submucosal

Located just beneath the inner lining, bulging into the cavity of the uterus. These are often discussed in relation to bleeding symptoms and fertility.

Intramural

Within the muscular wall of the uterus. This is a common location.

Subserosal

On the outer surface of the uterus, growing outward. Larger ones may press on nearby organs such as the bladder or bowel.

Pedunculated

Attached to the uterus by a stalk, either inside the cavity or on the outside.

A fibroid can span more than one location, and reports may describe it that way. You may also see words describing its position on the uterus, such as anterior (toward the front), posterior (toward the back) or fundal (at the top).

These are descriptions, not diagnoses or treatment plans. What they mean for you depends on your symptoms, your age, whether you hope to become pregnant and many other factors. Your provider is the person to interpret them in context.

Why your doctor may want a follow-up scan

It is common for providers to recommend another ultrasound at some point after fibroids are found. There are a few reasons this can be helpful:

• To see whether anything has changed. Comparing measurements over time shows whether fibroids are stable or growing.
• To check on symptoms. If your symptoms change, a fresh look may help explain why.
• Before or after treatment. Imaging can help with planning and with checking how things have responded.

Comparisons are easier when earlier images and reports are available. If you had a previous scan somewhere else, tell the clinic and your provider. Keeping a simple record of where and when each scan was done helps a great deal.

Fibroids at different stages of life

During the reproductive years

This is when fibroids are most often found. If you are planning a pregnancy, or are having difficulty becoming pregnant, mention it to your provider. It may affect how they think about any fibroids that are seen.

In pregnancy

Fibroids are sometimes noticed for the first time on a pregnancy ultrasound. Your prenatal care provider will decide whether any extra monitoring is needed. Our article on pregnancy ultrasounds by trimester explains how those scans are usually organized.

Around and after menopause

Fibroids are influenced by hormones, and many tend to shrink after menopause. Any vaginal bleeding after menopause, however, should be reported to your health-care provider promptly, whether or not you have known fibroids. It needs to be assessed rather than assumed to be related to them.

Questions to bring to your provider

Once your report is back, the follow-up appointment is where the findings start to make sense for your own life. Writing down a few questions beforehand can make that conversation more useful:

• Are the fibroids seen on my scan likely to explain my symptoms?
• What do the size and location described in my report mean for me?
• Do you recommend a follow-up ultrasound, and if so, roughly when?
• Is there anything I should watch for that would mean I should call sooner?
• How might the fibroids affect my plans for pregnancy, if that is relevant to me?
• Would any blood tests, such as checking for low iron after heavy periods, be helpful?

Many women in Ajax find it useful to bring a partner, friend or family member to that appointment, both for support and to help remember what was discussed.

Common questions

Does a fibroid mean I have cancer? The vast majority of fibroids are non-cancerous. If you have concerns about anything in your report, your provider is the right person to explain it.

Will the sonographer tell me what they see? Sonographers capture the images, and a report is prepared and sent to the provider who requested the scan. Your provider will go over the findings with you.

Can ultrasound show every fibroid? Ultrasound shows most fibroids well, but very small ones, or ones in hard-to-see positions, may not be fully captured. If your provider needs more detail, they may suggest another test.

Is a transvaginal scan required? It depends on your requisition and what the sonographer needs to see. It will be explained before it begins, and you can ask questions or decline.

Do I need to prepare? Pelvic scans often need a full bladder. You will receive instructions when you book, and the standard ones are listed on our patient preparation page.

Booking a pelvic ultrasound in Ajax

Rossland Diagnostic Clinic provides general and obstetrical ultrasound, including pelvic scans, at Unit 102, 300 Rossland Road East in Ajax. Bring your requisition and health card, and let us know if you have had previous pelvic imaging elsewhere. We are open Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm, with free parking and ground-floor access.

If your provider has requested an ultrasound, call 905-426-3111 or request an appointment. We will confirm your preparation and help you find a convenient time.