Gynecologic Myomectomy Workup

Updated: Jul 16, 2021
  • Author: Sarah Hagood Milton, MD; Chief Editor: Michel E Rivlin, MD  more...
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Workup

Diagnostic Studies and Procedures

Laboratory studies

Recommended laboratory studies are as follows:

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

  • A preoperative hemoglobin level should be obtained

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.

HSG or sonohysterography

In the evaluation of the endometrial cavity, if a strong possibility exists that myomas are present within the endometrial cavity, an HSG or sonohysterography can aid in localization. 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. [17, 18]

Diagnostic procedure

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.