eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Gynecologic Myomectomy: Workup

Author: Kerri L Marquard, MD, Fellow, Reproductive Endocrinology and Infertility, Washington University School of Medicine
Coauthor(s): David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Edward G Evantash, MD, Assistant Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine; Associate Division Chief of General Obstetrics and Gynecology, Director of Center for Abnormal Uterine Bleeding, Department of Obstetrics and Gynecology, Tufts Medical Center
Contributor Information and Disclosures

Updated: Aug 6, 2008

Workup

Laboratory Studies

  • Pregnancy test: No patient should have a myomectomy until the possibility of pregnancy is excluded.

Imaging Studies

  • Ultrasonography: Uterine leiomyoma can usually be detected on pelvic examination. If any doubt remains or if the uterine enlargement must be confirmed or differentiated from a pelvic mass, ultrasonography is very useful. Leiomyomas can also be detected with CT scanning or MRI, but, in general, these tests are more expensive and do not help visualize the uterus as well as ultrasonography does. Fortunately, uterine leiomyosarcomas are rare; imaging study findings are not usually helpful for differentiating them from the far more common leiomyoma; confirmation requires a tissue diagnosis.
  • HSG or sonohysterography: In the evaluation of the endometrial cavity, if a strong possibility exists that myomas are present within the endometrial cavity, perform HSG or sonohysterography. This allows the preoperative detection of myomas that may be more amenable to hysteroscopic resection and may thereby preclude the need to enter the endometrial cavity during an abdominal procedure.
  • MRI: Myomectomy is possible only for myomas; therefore, one must reasonably believe that the uterine enlargement is from leiomyoma and not from adenomyosis. The presence of myomas can usually be confirmed based on ultrasonography or physical examination findings by the characteristic irregularities of a uterus with multiple fibroids. If any doubt remains, MRI has been found useful in differentiating leiomyoma from adenomyosis.19,20

Diagnostic Procedures

  • Endometrial biopsy: Myomectomy is not an acceptable option if the patient has an endometrial malignancy. An endometrial biopsy should be performed prior to performing myomectomy in any patient older than 35 years who has a history of irregular bleeding.

More on Gynecologic Myomectomy

Overview: Gynecologic Myomectomy
Workup: Gynecologic Myomectomy
Treatment: Gynecologic Myomectomy
Follow-up: Gynecologic Myomectomy
Multimedia: Gynecologic Myomectomy
References
[ CLOSE WINDOW ]

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Further Reading

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Keywords

abdominal myomectomy, hysteroscopic myomectomy, laparoscopic myomectomy, uterine leiomyomas, uterine artery embolization, MR guided focused ultrasound, infertility, pregnancy, conception, myomas, leiomyomata, fibroids, hysterectomy, childbearing, uterine preservation, benign uterine growths, abnormal uterine bleeding, estrogen stimulation, smooth muscle tumors, intermenstrual bleeding, menorrhagia, menstrual irregularity

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Contributor Information and Disclosures

Author

Kerri L Marquard, MD, Fellow, Reproductive Endocrinology and Infertility, Washington University School of Medicine
Kerri L Marquard, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

Edward G Evantash, MD, Assistant Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine; Associate Division Chief of General Obstetrics and Gynecology, Director of Center for Abnormal Uterine Bleeding, Department of Obstetrics and Gynecology, Tufts Medical Center
Edward G Evantash, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, and American Society for Reproductive Medicine
Disclosure: Cytyc Honoraria Speaking and teaching

Medical Editor

Thomas Michael Price, MD, Associate Professor of Reproductive Endocrinology, Director of Reproductive Fellowship Training Program, Duke University Medical Center
Thomas Michael Price, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, Society for Gynecologic Investigation, and South Carolina Medical Association
Disclosure: Clinical Advisors Group Consulting fee Consulting; MEDA Corp Consulting Consulting fee Consulting; Gerson Lehrman Group Advisor  Consulting fee Consulting; Roche/GSK Spokesperson  Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

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