What does uterine fibroids look like on ultrasound (photo). Ultrasound examination for uterine fibroids When to do an ultrasound for fibroids after menstruation

Ultrasound diagnostics is intended for a deep examination of various organs in order to confirm a preliminary diagnosis or eliminate existing suspicions. So myoma on ultrasound with its distinct image allows not only to determine the place of its formation on the body of the uterus, but also to find out the size and stage of development. Of particular importance is the study of this tumor to determine its ability to transform into a malignant state.

Myoma is a benign tumor that begins in the muscle tissue of the uterus. One single muscle cell begins to divide, forming tumor cells, from which the myomatous node develops.

The main symptoms of fibroids can be considered long-term menstruation, characterized by profusion, the appearance of pain in the lower abdomen, pulling nature, urination disorders and infertility. Any of these conditions may serve as an indication for a study on ultrasound and other diagnostic methods.

Also, as indications for ultrasound, there may be characteristic manifestations of myoma formation, namely:

• soreness in the lower abdomen, not associated with the menstrual cycle;
• the appearance of acyclic discharge with blood content;
• duration change menstrual cycle;
• growth of the abdomen due to an increase in the size of myomatous nodes.

Indication for diagnosis using ultrasound is an increase in the symptoms of a previously detected fibroid. The fact that the symptoms began to intensify and appeared in a new quality is a good reason for an unscheduled ultrasound examination. Often, these new manifestations are evidence of a change in the growth rate of the node, their necrosis, torsion, which, in turn, requires urgent surgical care.

Survey methodology

The procedure for diagnosis and further examination of fibroids is carried out in the usual way, almost indistinguishable from studies of other organs. Not the last place in the obtained results of ultrasound is given to the regularity of the procedure, since in this case it is important to trace the dynamics of changes occurring in the tumor. During the examination, two methods can be used in the form of transvaginal and transabdominal ultrasound.

As you know, myoma nodes always increase in size over time, which cannot but affect the nature of the clinical picture of the disease and the ongoing treatment tactics. For this reason, it is especially important to track the change in the state of the tumor in order to make timely adjustments to the treatment. If you constantly monitor changes in the state of organs located in the abdominal cavity using ultrasound, it becomes possible to identify the development of pathologies on early stages. In addition, carrying out such a diagnosis makes it possible to determine many of the pathological disorders associated with myoma, which are of a gynecological nature.

Transvaginal ultrasound

Transvaginal ultrasound is performed using a probe inserted into the vaginal cavity. Preliminary, a condom with applied gel is put on the sensor. During a hysterographic examination, a solution is injected into the uterus to facilitate diagnosis.

With the help of the tactics used, it is possible to accurately determine the size of the uterus, the condition of its cervix, the site of tumor formation, as well as its structure and existing features. The examination will be especially informative in the case of the submucosal nature of the fibroids.

A feature of the study is that it does not need to fill the bladder.

Transabdominal ultrasound

Transabdominal ultrasound is designed to visually examine the uterus and its surrounding tissue through the abdominal wall. During the procedure, the patient lies on her back, a special agent in the form of a gel is applied to the study area, which improves the conductivity of ultrasound and contributes to a better movement of the probe through the body.

With the help of this study, it is possible to examine the body of the uterus, the location of the myomatous formation and its size, and by doing this in great detail.

Transabdominal ultrasound is able to detect tumors up to a centimeter in size to get more accurate results, bladder must be filled.

Preparation for the examination

The nature of the preparation for the upcoming study depends on the method used, which is explained by the following circumstances:

1. Ultrasonic waves are very difficult to overcome the air environment, and in a dense water environment they propagate unhindered. Therefore, the image obtained in the second case will be more accurate and clear. In this regard, there are differences in the preparation in the procedure carried out in different ways.
2. During a vaginal examination, the bladder must be empty, for which it is necessary to visit the toilet just before the ultrasound.
3. In the case of an external examination through the abdominal wall, on the contrary, the bladder cavity should be as full as possible until the very end of the procedure. Why an hour before it is necessary to drink at least a liter of water and refrain from going to the toilet.

In other cases, the preparation for the study does not differ in any features, you need to behave naturally, and without tension.

What day of the cycle?

Ultrasound of the uterus should be performed on certain days, directly related to the individual menstrual cycle. The most accurate and objective results of the survey can be obtained only if this requirement is strictly followed.

First of all, the maturation of the follicle is taken into account, as well as the thickness of the endometrial layer.

Since the maturation of the follicle occurs only once a month, all the changes that occur are associated with this process.

When examining myomatous formations, it is important to perform ultrasound not during menstruation, but in the first phase of the menstrual cycle, since it is during this period that the thickness of the endometrium becomes so insignificant that it makes it possible to detect the slightest pathological seals in the uterine cavity. For the rest of the cycle, the endometrium looks like a folded tissue lining the uterus from the inside, so it becomes almost impossible to see anything in it at this time.

The optimal time for ultrasound is the period from 5 to 7 days of the cycle, it is at this time that the thickness of the muscle layer is minimal. It is more difficult to calculate this period with an unstable menstrual cycle. For this category of patients, in order to more fully examine the fibroids, you will have to undergo an examination several times.

What does fibroid look like: description

After the examination of the uterus and fibroids on ultrasound, the patient is given a description and a photo attached to it, in which you can see in detail what the fibroids look like. From the resulting image, it is easy to determine the nature of the myomatous formation:

1. does not change the shape of the uterus itself, its nodes are more often formed in the myometrial layer. They vary in size from 15 mm to 35 mm and above and are often well defined.
2. leads to a noticeable increase in the uterus, its nodes are distinguished by well-defined boundaries, uniformity of structure and have a rounded shape.
3. , on the images of which its rounded shape is visible, can cause significant changes in the outlines of the uterus, the node big size can lead to a change in the position of the uterus relative to other organs.

If the myoma is multiple nodes, which in practice is detected more often, the surface of the uterus in the pictures looks bumpy.

What is the frequency of ultrasound for myoma

With fibroids, it becomes necessary to monitor its condition, while undergoing a procedure with an ultrasound examination is much more common than usual, at least twice a year, and in some special cases every three months. This is important for determining the nature of the fibroid and tracking its behavior.

With the help of this study, one can not only understand whether the fibroid grows or its size remains at the same level, but also evaluate the effectiveness of the therapy. The study using ultrasound allows you to make a decision on the continuation of ongoing treatment using certain drugs or replace them with more efficient ones.

Ultrasound during pregnancy with fibroids

Although fibroids, like any kind of neoplasm, negatively affect the reproductive capabilities of the body, however, there are cases in which a woman successfully conceives with the development of a further pregnancy.

Observation of the myoma at this moment with the help of ultrasound allows you to trace the following conditions:

1. The proximity of the location of the attachment of the placenta to the formed tumor is determined. The smaller this distance, the greater the likelihood of abortion due to a violation of the blood supply to the fetal membrane increases.
2. It is possible to control the activity of fibroids and their growth. Due to changes in the hormonal background caused by pregnancy, the growth of the node may accelerate, which will negatively affect the development of the child.
3. The place of tumor formation allows you to determine the method of delivery, most often in this case, a caesarean section is used.

If you managed to get pregnant with fibroids and the course of pregnancy passes without complications, then ultrasound is performed in the usual manner, once a trimester. With the development during pregnancy of conditions that threaten her with the formation of bleeding, pain and other negative symptoms, an examination can be carried out every two weeks.

Possibility of diagnostic errors

Despite the extreme accuracy of diagnosis during ultrasound, a certain degree of error in determining the disease still remains. Sometimes a myomatous node can be mistaken for a formation of a different nature, and this depends little on the professionalism of a specialist. In such situations, the following diagnostic errors are most often found:

1. Uniform increase in the size of the uterus. This feature is easily confused with fibroids, since an increase in the uterus may be the result of frequent childbirth or evidence of abnormal development.
2. Intramural fibroid nodes can be confused with dilated veins that run in the endometrium.
3. A neoplasm in the ovary can be mistaken for a subserous node. Transvaginal ultrasound does not allow such a mistake.
4. Polyps can easily be mistaken for submucous nodes. For clarification, an additional examination and study of the anamnesis are carried out.

Even taking into account possible errors in determining the nature of the pathology, ultrasound nevertheless remains one of the main diagnostic studies. It is affordable, is available in almost every medical institution and specialist offices, and is also distinguished by sufficient information content, and therefore is used for many diseases.

Video

Uterine fibroids are benign tumors. Such a tumor occurs quite often and includes smooth muscle or connective tissue.

Myoma is detected in approximately 20% of women over 35 years old, this disease ranks 3rd in terms of occurrence among.

According to pathological and anatomical data, the true incidence of fibroids reaches 77%.

The day has passed when the only way to find out the nature of the pathology of the uterus was to intervene in the body in order to take tissues, in our time it has become quite cheap and extremely effective to do with suspicion of uterine myoma.

• General information

  Risk factors

  The main risk factors for uterine fibroids include:

  • a long-term imbalance of steroid hormones in a woman's body,
  • transferred inflammatory diseases uterus,
  • intracavitary interventions (curettage, medical abortion),
  • overweight in combination with a high frequency of stressful conditions.

  Also, many researchers confirm the genetic conditionality of cell growth disorders in the myometrium, leading to a chain of disorders in the immune and hormonal systems.

  Studies show a more frequent occurrence of fibroids in representatives of the Negroid race than in Caucasians, in women engaged in mental work, rather than in manual workers.

  Classification of myoma formations

  In gynecology, there are several classifications of uterine fibroids that are needed in the diagnosis, therapy and surgery of this disease.

  The most common is the following classification.

  According to the structure of fibroids are:

  • diffuse (affecting the entire organ)
  • nodular (developing only in foci);

  by localization:

  • body of the uterus (90-96% of cases), isthmus and cervix (4-10%);
  • intramural, or interstitial (within the myometrium, occurs in 41-60%),
  • subserous (developing closer to the serous cover of the uterus and growing towards the abdominal cavity, 12.5-38%),
  • submucosal (developing closer to the uterine mucosa and growing towards the cavity, 6-28%); as a private variant of subserous fibroids, intraligamentary fibroids are isolated, growing between the sheets of the broad ligament of the uterus;

  by the number of nodes in the myometrium:

  • multiple
  • single

  nodules can also be:

  • on a broad basis
  • on the leg (subserous and submucosal);

  by morphological type (structure):

  • simple,
  • proliferating
  • presarcomas.

  Fibroids can be composed of various tissues:

  • From smooth muscle fibers (leiomyoma)
  • From connective tissue(or with an approximately equal ratio of connective tissue and smooth muscle fibers). This kind of tumor is called a fibroma.

  What indicates uterine fibroids?

  Usually, the following symptoms indicate uterine fibroids (individually or in combination):

  • prolonged periods accompanied by profuse discharge
    discharge mixed with blood between periods;
  • infertility;
  • symptoms of compression of the abdominal cavity and small pelvis by a large tumor - difficulty urinating, defecation;
  • pain in the lower abdomen

  
  

  Survey methodology

  The exception is submucosal fibroids, in which it is better to undergo an ultrasound scan in the phase when it has a hyperechoic characteristic and sufficient thickness (day 19 - day 24).

  Sonographic picture (what fibroids look like)

  If a myomatous node was detected during ultrasound, then with a high degree of probability we can talk about the presence of the disease.

  As a rule, a fibroid is a rounded object heterogeneous in structure, which has a clear and even contour on ultrasound, which attenuates the ultrasound signal.
  

  The echo signs of uterine fibroids and the structure of such a formation largely depend on what tissues it consists of and where it is located.

  Fibromas will look more "light",. Leiomyomas due to the predominance of poorly differentiated smooth muscle fibers in their composition will give a more uniform, hypoechoic picture.

  An intramural (located in the thickness of the uterine wall) node is determined in the projection of the myometrium, most often does not deform the contour of the cavity and the wall of the uterus.

  By size, small (8-15mm), medium (15-35mm) and large (35-70mm) myomatous nodes are distinguished.

  Submucosal (growing towards the intrauterine cavity) nodular formation can be defined as an iso- or oval shape against the background of the endometrium or fluid in the uterine cavity.

  Such a myoma is quite homogeneous. Also, if the diagnosis is difficult, echohysterosalpingoscopy is recommended, during which, against the background of the injected fluid, the dimensions, contours and relationship of the submucosal node with the uterus are clearly determined.

  A subserous (growing towards the peritoneum) myomatous node creates a tuberous contour of the uterus, can change its position relative to the median axis of the small pelvis with a sufficiently large size.

  Sometimes there are difficulties in determining the thickness of the base of such a node - in such cases, the task can be facilitated by the use of a Doppler study, in which they are visualized.

  

  Leimomyoma was found in a 46-year-old patient who complained of vaginal bleeding. The picture clearly shows isoechoic formation.

  In addition, the following examination results can speak about myoma:

  • uterine enlargement
  • changes in the contours of the uterus
  • not very homogeneous structure and degenerative changes in the node
  • visualization of pronounced vascularization of the periphery and the inner part of the node with Doppler mapping
  • the diffuse form of fibroids is characterized by pathological focal heterogeneity of the echostructure of the myometrium with wall thickening, fuzzy contours, and reduced echogenicity. In this case, as a rule, the contour of the uterus remains even, the shape is oval, and no deformation of the cavity is observed.

  Calculation of the size of the uterus containing fibroids is carried out in the usual way, if only one myomatous node is visualized.

  In this case, the description should indicate whether the uterus was measured taking into account this node. With multiple myoma, the diagnostician describes the largest node, which must be regularly examined in the future.

  When conducting a study, it is necessary to control the state of the myomatous node: do degenerative changes occur with it?

  Quite often, a myomatous node with edema due to dietary disorders can be observed as an object of reduced echogenicity.

  In addition, such nodes often look like cystic formations and adopt their echographic features, for example, a symptom of increased reflection from the back wall. Later, anechoic inclusions of various forms can be observed.

  The structure of the node changes and loses its uniformity due to the appearance of hyperechoic zones. The saturation of such formations with blood vessels (vascularization) is usually reduced.

  When petrificates (calcifications) begin to form in the node, multiple rounded objects with merging acoustic shadows can be found at the border of the fibroid pseudocapsule.

  Homogeneous structure of myometrial fibers

  Usually a homogeneous echostructure appears with leiomyoma. It contains the most poorly differentiated smooth muscle fibers, which give a more homogeneous echostructure, which is also hypoechoic.

  Typical mistakes when making an ultrasonic conclusion

  Uniformly enlarged uterus and fibroids

  A uniformly (diffusely) enlarged uterus can normally occur in women who have often given birth and in adult women, with developmental anomalies (saddle-shaped, bicornuate uterus), with a diffuse form of internal endometriosis (adenomyosis).

  Spend differential diagnosis a careful history taking will help, detection characteristic features saddle uterus (identification of a double fundus, thickening of the myometrium in the middle of the fundus of the uterus more than 1 cm) and (serrated, fuzzy contour of the M-echo, different thickness of the walls of the uterus, "spotting" of the myometrium, in the first half of the menstrual cycle).

  Dilated veins of the myometrium and intramural nodes

  Sometimes it is possible to confuse dilated veins of the myometrium with "young" intramural nodes, in which case it is enough to carry out a polypositional scan of a suspicious formation and Doppler color mapping, a characteristic blood flow will be detected in the vein;

  Subserous node and neoplasm of the ovary

  A subserous node on a narrow base must be differentiated from a solid ovarian neoplasm - a thorough polypositional scan is necessary, better to determine a clear connection between the identified formation and the uterine wall and, preferably, identify an intact ovary on the side of the lesion.

  In favor of fibroids, the presence of other myomatous nodes, an increase in the size of the uterus, the presence of calcifications characteristic of the myomatous node can serve;

  Polyp and submucous node

  Polyp and submucous node small sizes(up to 8 mm) may look the same with conventional ultrasound, the most reliable criterion in favor of the node will be the “protrusion” of the endometrial contour into the cavity lumen with the formation of an echo-negative rim between the endometrium and the tissue of the node, a clear connection with the myometrium, while the polyp growing from the basal layer, as if pushing the normal endometrium apart, its body is immersed in it, and it does not come from the muscular layer of the uterus.

  And at present it is extremely effective method diagnosis of myomatous pathologies of the uterus.

  The day when it was necessary to enter the patient's body for diagnostic purposes had passed.
  

  Visualization on echograms (gallery)

  

  

  

  

  

  

Based on the results of the diagnosis, a decision is made on further treatment. Ultrasound shows an objective picture - in what condition is the female reproductive system what damage was found in it.

Ultrasound of the uterus is prescribed for the following indications:

• every six months - for preventive purposes;
• if a woman is planning a pregnancy and it is necessary to get a general picture of the condition of the appendages;
• postpartum period (in order to exclude pathologies that often “attack” women after childbirth);
• reaching the age of menopause (if there is a fibroid, it can decrease and disappear from view, and later transform into uterine sarcoma);
• puberty of a teenage girl (determine if there are any initial deviations - and they are possible due to poor ecology, increased stress factor, a number of genetic abnormalities);
• painful menstruation;
• a previous abortion or miscarriage;
• excessive duration of menstruation (over 8-10 days);
• cycle failures (including too short breaks between periods);
• cramping pains in the lower abdomen and in the side;
• drawing pains in the lower abdomen;
• infertility;
• spotting in the intervals between menstruation of different cycles.

Also, ultrasound of the uterus is indicated three times for pregnant women (at the 12th, 23rd and 30th weeks).

How is the procedure

Ultrasound of uterine fibroids is not only the visual side of things. Of great importance are the genetic characteristics of a woman, her sex life, past experience (problems and difficulties associated with the uterus).

Myoma behaves insidiously: initially it does not manifest itself in any way (according to statistics - in 85 cases out of a hundred). And even at serious stages, when the only way out is surgery. And it, in turn, is dangerous for female infertility after surgery.

During the procedure, the specialist should pay attention to the following points:

• enlarged uterus;
• uneven contours of the uterus;
• the presence in the cavity or muscle layer of rounded structures;
• location of fibroids.

Survey

The doctor should clarify, and the woman should provide reliable information:

• about the beginning and nature of menstruation;
• whether the woman had had abortions in the past (and if so, how many, any information about the consequences that took place);
• about the number of births, what were the complications during childbirth;
• whether there is information about fibroids in other women in the family.

Exhaustive information is expected from the woman. The patient herself is also interested in this, because according to the results of the examination, it will be easier to prescribe the optimal treatment.

visual inspection

Along with the survey, the doctor examines the skin and mucous membranes. Quite often, just above the pubis, an enlarged area is determined by palpation of the abdomen. True, this symptom is not decisive - the presence of fibroids is possible even in the absence of its signs during palpation.

Hardware ultrasound of the uterus

Transabdominal examination:

• the scanning device works through the abdomen;
• there is no penetration into the vaginal cavity;
• at the same time, not only the uterus is examined, but also the appendages (ovaries);
• for better signal permeability, a special gel is used (applied to the lower abdomen and to a sensor that emits ultrasound).

Transvaginal examination:

• the signal of the equipment is more sensitive;
• the result is more accurate;
• the pelvic organs (in addition to the uterus) are also examined;
• a small probe penetrates the vaginal cavity.

Both procedures are completely painless. Modern equipment allows:

• study in detail the nature of the blood flow inside the fibroids;
• accurately determine the location of the tumor, its size;
• get an objective picture.

Based on the results of the ultrasound, a decision is made on further measures. The task is to prevent the degeneration of a benign tumor (which is a fibroid) into a malignant one. In most cases, patients are given histological examination(hysteroscopy) of fibroids.

Hysteroscopy- a method of minimally invasive examination of the uterine cavity using a hysteroscope, followed by diagnostic and surgical manipulations.

Hysteroscopy allows you to identify and eliminate intrauterine pathologies, remove foreign bodies, take tissue biopsies, and remove endometrial polyps. During the examination, surgical procedures are available to eliminate uterine causes of infertility - endometrial polyps, submucous myomatous nodes, hyperplastic foci of the endometrium, intrauterine synechia and septa.

It is also possible to recanalize the fallopian tubes and evaluate their mucous membrane up to the fimbrial region.

Preparing for an ultrasound examination of uterine fibroids

Preparatory measures depend on how the ultrasound is planned to be performed - transvaginally (through the vagina) or transabdominally (outwardly through the skin of the abdomen). And that's why:

• the fact is that ultrasound waves hardly pass through the air, and through dense water - as well as possible;
• accordingly, in the second case, the resulting image internal organs will be of the highest quality.

Based on this, the preparation is different:

• when examining through the vagina, the bladder must be emptied (go to the toilet immediately before visiting the doctor);
• during an external examination, it is necessary to drink 1 liter of water 1.5-2 hours before the start of the ultrasound (the bladder should be full until the end of the procedure).

Timing of ultrasound for uterine myoma

The examination should be carried out in a certain period associated with the female menstrual cycle. Only if this condition is met, the result will be as accurate as possible and will give a complete picture of the objective picture.

follicle growth

While a woman is in reproductive age, her menstrual cycle is the basis of the most important physiological phenomenon:

• once during the cycle, the vesicle matures, inside which the egg is contained (such a vesicle is called the dominant follicle);
• the uterine mucosa thickens;
• it produces special substances to support the development of the fetus at the beginning of a potential pregnancy (which is programmed by nature once a month).

Thickness of the endometrium

With uterine fibroids, ultrasound should be done only in the first phase of the menstrual cycle. During this period, the thickness of the endometrium (the inner lining of the uterus) becomes the smallest. That is, if a woman has any pathologies (seals), they will be easier to see than against the background of a thickened endometrium.

If the examination is carried out in the second phase, then the endometrium will be a folded dense tissue - in it small nodules will be completely lost and slip out of sight of even the most sensitive ultrasound equipment.

Optimal time

Timing of ultrasound:

• in order to track the state of the thickness of the uterine muscle, in most cases, ultrasound is performed on days 5-7 of the menstrual cycle (it is counted from the first day when menstruation began). The optimal terms are 3-5 days, but in any case no later than 7-10 days;
• to assess the dynamics of follicle maturation and ovarian function, sometimes ultrasound is performed three times throughout the entire menstrual cycle (approximately from the 8th to the 10th, from the 14th to the 16th and from the 22nd to the 24th day of the cycle) .

In women with an unstable cycle, examination days may be much longer. Every situation is different.

Possible errors in diagnostics

Unfortunately, none of the diagnostic methods is without errors. The following factors can lead to an erroneous interpretation of the results of ultrasound:

• low qualification of the diagnostician (inability to correctly interpret the images obtained during scanning);
• non-compliance with the optimal timing of the ultrasound.

There are cases when fibroids are mistaken for a uterine polyp or vice versa.

Differences between a polyp and a fibroid

• is formed in the muscle of the uterus (that is, it consists of muscle tissue). It grows inside the uterine wall;
• if it appeared, it does not disappear by itself in any way - it only increases in reproductive age or, after the onset of menopause, decreases slightly;
• in the early stages they are very small, but developing, they sometimes reach gigantic sizes - with an apple or even a watermelon;
• the chance of transformation from a benign tumor to a malignant one is very high.

• develops on the endometrium (that is, it consists of the mucous tissue of the uterus). A polyp grows on the walls of the fallopian tubes or uterus. In shape, it is a formation on a well-marked thin stalk;
• polyps change their size, sometimes dissolve (that is, disappear without a trace);
• polyps in diameter usually range from 4 to 5 mm (very rarely reach 12-15 cm);
• polyps do not carry cancer risks.

Why is diagnostic accuracy important?

The symptoms of polyps and fibroids are very similar:

• polyps and fibroids are about equally common;
• both can cause vaginal bleeding in the postmenopausal period;
• both involve issues of reproductive capacity.

True, large fibroids additionally cause frequent urge to urinate (this is natural, because there is pressure on the bladder) - and polyps (see above), with their small sizes, do not make themselves felt at all.

To avoid errors in diagnosis, you need to be examined regularly. Many women are careless about their health. But for preventive purposes, you need to undergo an ultrasound scan of the uterus and appendages at least once. If the slightest seals are found, then the doctor will prescribe repeated procedures. They will show the dynamics, establish the nature of the formations (polyp or myoma).

Ultrasound scanning error

Ultrasound examination of the uterus does not guarantee a 100% result the first time. It must be understood that any tumor has an imperfect shape. A two-dimensional projection, especially a one-time one, does not guarantee absolute accuracy.

That is, for example, if today an ultrasound scan showed dimensions of 26 mm, and in the next cycle 29 mm, this is not a reason to draw a final conclusion about the rampant growth of the formation. Given the measurement errors, you need:

• at a minimum, be examined several times and carefully examine multiple images (obtained by scanning);
• at least 1-2 times against MRI (3D image will show the shape of the fibroids in different projections).

The cost of an MRI examination is much higher. Therefore, they are resorted to only in cases where there is an alarming reason to clarify the result of an ultrasound scan.

Article last updated 07.12.2019

Myoma - although a benign tumor, however, is a danger to female body. Firstly, it affects the reproductive function and can lead to infertility. Secondly, in 1% of cases, the node can develop into an oncological disease. Ultrasound of uterine fibroids allows to identify the formation and determine its size in time.

Myoma is a rather insidious pathology. In the early stages of development, it practically does not make itself felt. And when a woman has signs of a disease (such as pain in the lower abdomen and back, a violation of the cycle, too heavy periods, a violation of defecation and urination), they may indicate that the formation has an impressive size. And the larger the tumor, the less likely it is to be cured without consequences for the female body.

Taking into account the statistics that say that in 25% of women pathology occurs after 30, and in a third after 40, it is better to protect yourself from severe forms of this disease and visit a doctor on time.

An ultrasound examination of the small pelvis allows you to examine the internal female organs, determine if there is a tumor and what size it is, its location and changes that have occurred in the uterus due to the disease. There are several types of ultrasound that can detect fibroids:

• Internal - transvaginal, is done using a sensor that is inserted inside through the external genitalia. It is best for detecting a tumor at an early stage, because it allows you to see small nodes. Most accurately conveys information about the size of the uterus and cervix, the structure of the node

• External - transabdominal, passed through the abdominal cavity. The doctor smears the gel on the stomach and drives a special sensor over its area. The image on the screen allows you to see the location of the tumor and its size (up to 10 mm). This method allows you to most accurately determine the localization of the node.

• Ultrasound scan of the uterus is done through the introduction of a special device inside through the vagina. In addition to it, a contrast agent is injected into the uterine cavity. It can be furatsilin or sodium chloride. The photo of fibroids on ultrasound is very clear, all changes in the organ that provoked the node are clearly visible. This method is used less frequently than the previous two.

How to do an ultrasound of a benign formation is chosen by the doctor. For a more accurate diagnosis, in case of doubt, he can conduct an examination in different ways.

It is important to know that this manipulation in itself is not harmful. Although ultrasound produces radiation, it does not exceed 0.1% of normal.

Preparation for ultrasound of the uterus with fibroids is minimal. Before transvaginal and ultrasound scanning, you need to empty the bladder, before transabdominal - on the contrary, you need to drink about 1.5 liters. water an hour and a half before the procedure.

When to do an examination

If a woman is concerned about changes in menstruation, pain in the uterus, she can do an ultrasound on any day, at least an external examination. However, it will not always show the exact result. For example, a small tumor may not be noticed during the period of ovulation, when the walls of the endometrium are thickened. Therefore, a follow-up visit may be scheduled.

To examine the uterus for the presence of fibroids, a planned ultrasound is best. During the cycle, the tumor can change shape and size under the influence of progesterone, a hormone that promotes its development. The results of ultrasound, and, accordingly, the assessment of the size of the formation and further treatment, to a certain extent depend on the day of the cycle on which the examination was performed.

They prescribe an examination between the 5th and 10th days of the cycle. During this period, the endometrium is thin, all changes are clearly visible on it, so even the smallest formation can be detected. Ultrasound is not prescribed:

• During menstruation, since during this period the endometrium can exfoliate and show an incorrect picture
• In the second half of the cycle, when due to the increased concentration of hormones, the formation may increase

Ultrasound with uterine fibroids allows you to get the following data:

• Location of the uterus
• Her dimensions
• Thickness of the endometrium
• The structure of muscle tissue
• Number of formations, type, structure, size

Attached is a photograph. Thus, the patient can see what the uterine fibroids look like. The photo conveys an image of rounded nodes on the surface of the organ. From the picture you can determine the nature of education:

• With interstitial myoma, the uterine cavity does not change, the node is most often located in the myometrium. There may be several small (up to 15 mm), medium (up to 35 mm) and large (over 35 mm)
• With submucosal formation, the uterus is enlarged. The node itself has clear boundaries, a homogeneous structure, a rounded shape.
• With a subserous tumor, the outer outline of the uterus is deformed, it is also possible to change the position of the organ with large nodes. The formations themselves have a rounded shape.

If there are many fibroids, the uterine cavity looks bumpy.

How often is an ultrasound for myoma

If a woman is diagnosed with a tumor, she will have to visit an ultrasound specialist more often than usual, at least once every six months, or even every three months. This is necessary in order to understand how the node behaves: it develops quickly and rapidly, grows slowly, or remains the same size. With the help of this manipulation, the doctor monitors how the fibroid reacts to the chosen method of dealing with it.

For example, with small formations, the gynecologist may prescribe conservative treatment hormonal drugs, which should contribute to the shrinkage of the tumor.

Ultrasound helps to analyze their effect and decide whether to continue drinking the medicine or whether it is better to stop.

Pregnancy and fibroids: the role of ultrasound

Despite the fact that the tumor negatively affects the reproductive function, there are cases when a woman becomes pregnant with this disease.

In such cases, it is necessary to observe even more often how the uterine fibroids behave on ultrasound. This will help you find out:

• How close to the tumor is the site of attachment of the placenta. The closer, the more likely a miscarriage, since there is a risk of impaired blood supply to the membranes
• Control the growth of education. It can accelerate during pregnancy due to an increase in hormonal levels that promote the development of the node, and negatively affect the development of the fetus.
• What is the best way to give birth. The localization of the tumor may change during childbearing. In most cases, it is not recommended to give birth on your own, as bleeding may open.

If the pregnant woman feels well, Ultrasound is prescribed as planned - three times in 9 months. If the state of health worsens, pain often occurs, bleeding or the fetus grows out of time, the examination can take place every week or two.

Myoma of the uterus, also known as fibromyoma, is a benign tumor of muscle or muscle-connective tissue. Often, patients, when they are given such a diagnosis, panic, confusing fibroids with cancerous tumors. The main diagnostic method for suspected this disease is ultrasound.

Uterine fibroids are formed as a result of sudden and uncontrolled division of the muscle cells of the uterus. No one has yet identified the exact causes, but according to modern concepts, this tumor belongs to hormonal ones. Hormones that play an important role in pathogenesis are estrogens, which explains the prevalence of women mainly between the ages of 25 and 40, since it is at this age that hormonal disruptions occur that can lead to fibroids. Every fifth woman under the age of 30 has uterine fibroids.

Symptoms

In the treatment of uterine fibroids, it is important to identify it in time in order to prevent new tumors from appearing, since 2 or more neoplasms are often found. Ultrasound of uterine fibroids is used as a diagnosis, but although this method is performed quite quickly, self-diagnosis of the patient is very important. Those prone to this disease are:

• women with a hereditary predisposition;
• suffering from infertility;
• having disruptions in the menstrual cycle;
• sick diabetes, obesity, or other metabolic disorders;
• with multiple;
• under constant stress.

The first symptoms in which a woman may suspect that she has uterine fibromyoma are abundant bloody issues with menstruation and cycle disorders. Another common symptom is recurrent pain in the lower abdomen.

Uterine fibroids can sometimes not disturb at all and be discovered by accident. But there are a number of rather serious complications that should be considered when comparing the signs and symptoms indicated earlier. Since one of the symptoms is bleeding, patients develop chronic iron deficiency anemia. Fibroids can interfere with conception and childbearing and are sometimes discovered during infertility testing. The pain appears due to compression of the surrounding organs by the tumor, if the growth of the fibroids is directed to. Sometimes compression by the tumor leads to constipation. Most dangerous complication- this is the torsion of the "legs" of the tumor.

Diagnostics

The main method used to detect uterine fibroids is ultrasound. , making it possible to diagnose many various diseases: inflammatory diseases, tumors, cysts, malformations, ectopic pregnancy, etc.

There are three types of ultrasound diagnostics of uterine fibroids:

1. The first method is called -. It is carried out by ultrasound diagnostics through the anterior abdominal wall.
2. The second method is . To perform this method, it is necessary to insert a special ultrasound probe into the vagina.
3. The third method is performed by introducing a special solution into the uterus and is called ultrasound scanning.

The choice of the method of conducting should be decided solely by the doctor.

Myomatous nodes can be located in different parts of the uterus. Most often they are localized in the muscle layer, where they provoke one of the most common symptoms - bleeding. If the node is located in the area, then it will interfere with childbirth (therefore, it is very important to carry out). There is another important detail - the thickness of the base of the fibroids. The thinner the base ("leg"), the higher the chance of its torsion. An ultrasound examination will help to determine the location and the tumor itself, and the most modern devices determine the blood circulation inside the neoplasm.

Uterine fibroids on ultrasound are a clear rounded formation, which is delimited from the healthy tissues surrounding it. The nodes have a layered structure and a pseudocapsule. The degree of echogenicity, i.e. the visibility of the tumor on ultrasound depends on the composition of the tissues in the tumor. The higher the proportion of connective tissue, the less sound-conducting the tumor. If areas with reduced sound conductivity are found in the node itself, then this indicates the presence of foci of necrosis (death) or the formation of cysts. Necrosis may indicate torsion of the tumor stem. Assessing the features of growth and location of foci, the doctor can predict further development pathology.

With uterine fibroids, an ultrasound scan is simply necessary, but in the case of poor sound conduction, MRI can also be used for detailing.

At ultrasound diagnostics, it is possible to estimate the number of nodes, their diameter and localization, which can fundamentally affect the tactics of treating the patient. In addition to neoplasms, ultrasound determines the condition of the uterus. The body and neck are determined.

Preparing for an ultrasound

The study is being conducted with little preparation. Often, the study can be performed immediately upon admission. If a transvaginal or ultrasound scan is planned, then the patient must first go to the toilet and empty. These methods of research can be accompanied by discomfort, and in some cases are painful, so a sedative or pain medication may be recommended by the doctor. As for the transabdominal examination, then the patient, on the contrary, needs to drink about one and a half liters of water in order to fill the bladder.

On what day of the cycle to do ultrasound of uterine fibroids

Since uterine fibromyoma is a hormone-dependent tumor, its activity is associated with. The fact is that in the body of a woman, depending on the phase of the cycle, the concentration of progesterone in the blood also changes. Accordingly, in the second phase of the cycle, the fibroids will be more edematous. If the study is performed after a certain interval during one cycle, then the size of the fibromyoma can seriously differ.

Often, at the first examination, ultrasound of the fibroids is performed regardless of the current day. If the gynecologist believes that the study is not informative enough, then it is chosen on which day to do an ultrasound scan of the uterine fibroids in advance and in advance. In the initial phase of the menstrual cycle, the layer is still very thin, which means it is easier to see the nodes. In the future, the layer thickens and the fibroid becomes much harder to detect. Based on this, the answer to the question: “on what day of the cycle should an ultrasound of uterine fibroids be done?” is from 3 to 5 days of the beginning of the cycle, but due to some features, the study often shifts to 5 or 7 days. The least reliable study is considered to be an ultrasound performed after the 10th day of the cycle.

There are options for the development of nodes, in which it is recommended to conduct an ultrasound as soon as possible. Such fibroids are called submucosal. The peculiarity of the growth of such a tumor lies in its location under the mucous membrane. Therefore, in the diagnosis, a thick layer of the endometrium, on the contrary, will help in the diagnosis. The most optimal days for performing the study are 18-24 days.

Differential Diagnosis

Often there is a need to distinguish between uterine fibroids and other pathologies. The most common diseases with which uterine fibroids have to be differentiated are:

• Sarcoma of the body of the uterus
• Tumors
• Some inflammatory diseases

The very disease that is often confused with uterine fibroids is sarcoma. Sarcoma of the uterus is a malignant tumor of the body of the uterus. Similar to fibroids, it is formed from muscle tissue or endometrial stroma. The most important distinguishing feature that determines the danger this disease- differentiation of cells. This indicator, which is determined by histological analysis, is the difference benign tumors from malignant ones. With ultrasound, sarcoma can also be suspected, because the cells of which it consists differ in sound conductivity from fibroid cells. Accordingly, with sarcoma, the prognosis for the course and recovery of the patient is much worse.

Ultrasound is an important method for differentiating all other diseases from fibroids. Due to its characteristics, it allows you to assess the condition of tissues, in particular the endometrium. But we must not forget about possible situations when several diseases are combined and lead to blurred clinical picture, in which the fastest method for determining the exact diagnosis is ultrasound.

On ultrasound, it is almost impossible to confuse fibroids with pregnancy, if only because the patient will first be examined by a gynecologist, checking all other signs of pregnancy.

Treatment depends on the results of the studies obtained. Sometimes it is enough to take drugs and fibroids may disappear or decrease significantly. In cases where the tumor is large, it is impossible to do without surgery. The degree of intervention depends on the place of growth and the characteristics of the fibromyoma, because the operation can be either radical (when the uterus is removed) or organ-preserving.

If a pregnant woman has uterine fibromyoma, then she needs special care and supervision. The larger the tumor, the more difficult and dangerous for the fetus will be childbirth. Sometimes a particularly large size of fibroids can affect the intrauterine development of a child, leading to various anomalies. To avoid such consequences, pregnant women need to be monitored in dynamics with the help of ultrasound.

Women often worry about the consequences of having an ultrasound scan and the risks of complications. During ultrasound, the patient is not affected by any rays, as, for example, in x-ray examination. In addition, the method, due to its speed and accuracy in the reliability of the data obtained. On average, the duration of the study takes about 15-20 minutes and everything is immediately recorded in the protocol. The results of the study should only be evaluated by a doctor. Many patients who have had uterine fibroids should have regular ultrasound examinations.