Adenomiosis may be felt 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, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination. Vaginal probe ultrasound only takes a few minutes to do, is not uncomfortable, 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 (saline enhanced sonography or sonohysterogram). While this will often provide additional information to the regular ultrasound, I usually learn much more by looking inside the uterus with a little telescope. This exam, called hysteroscopy, is usually done in my 
office, and allows me to directly look inside the uterus.
The above steps are usually all that is needed to make an accurate diagnosis and plan treatment. Sometimes, especially with very large fibroids, more information is needed. 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.
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. This can cause severe pain, and heavy bleeding.
On ultrasound examination adenomyosis will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border. 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.
What is endometriosis?
Endometriosis is a common health problem in women. It gets its name from the word endometrium, the endometriosis can lines the uterus, ovary etc. In women with this problem, tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas. These areas can be called growths, tumors, implants, lesions, or nodules.
Most endometriosis is found:
- on or under the ovaries
- behind the uterus
- on the tissues that hold the uterus in place
- on the bowels or bladder
Endometriosis rarely grows in the lungs or other parts of the body. This "misplaced" tissue can cause pain, infertility (not being able to get pregnant), and very heavy periods.
