What is the initial evaluation when fibroids are suspected?

• A. Pelvic examination and transvaginal ultrasound to evaluate fibroids.
• B. MRI pelvis as the first-line test.
• C. Serum iron studies to assess anemia.
• D. Laparoscopy to diagnose fibroids.

Answer: (A)

When fibroids are suspected, the first step is a thorough pelvic examination followed by transvaginal ultrasound. This approach directly assesses the uterus to detect fibroids, determine their size, number, and location, and gauge their impact on the endometrium and adjacent structures. Ultrasound is ideal as an initial test because it is noninvasive, readily available, cost-effective, and highly accurate for identifying fibroids.

MRI pelvis is not first-line because it’s more expensive and less accessible; it’s reserved for problem-solving when ultrasound results are inconclusive, when detailed mapping is needed for surgical planning, or when assessing complex cases.

Serum iron studies can be helpful later to evaluate anemia that may be caused by heavy bleeding, but they don’t diagnose fibroids themselves.

Laparoscopy is an invasive procedure used for direct visualization and management when imaging or medical treatment indicates a need for surgical intervention, not as the initial diagnostic step.