What is the first step in the workup of leiomyomas (fibroids)?

The first step in the workup of leiomyomas, commonly known as fibroids, is typically a pelvic ultrasound. This imaging modality is essential as it provides a non-invasive, detailed view of the uterus and surrounding structures, allowing for the visualization of fibroids' size, location, and number. Ultrasound is usually the initial diagnostic tool due to its accessibility, cost-effectiveness, and ability to quickly provide relevant anatomical information.

Moreover, pelvic ultrasound helps differentiate between fibroids and other possible uterine or pelvic masses. It can also guide further management decisions based on the characteristics observed during the scan, such as the need for surveillance or intervention.

While other options like a CT scan, physical examination, or hormone level blood tests may play roles in the overall assessment of a patient with fibroids, they are not the first-line diagnostic tools. CT scans can provide additional details but involve radiation exposure and are generally not the preferred initial imaging study for fibroids. Similarly, physical examinations can suggest the presence of fibroids but cannot confirm the diagnosis or provide the imaging details necessary for treatment planning. Blood tests for hormone levels may be part of the broader evaluation but do not replace the necessity of imaging for confirmatory diagnosis.