Uterine Fibroids: Diagnosis

Fibroids may be suspected from the patient history, and a bimanual pelvic exam often confirms the diagnosis. The uterus is generally enlarged, mobile, and asymmetric. Extremely large fibroids may cause a palpable uterus on abdominal exam. Findings can be confirmed by imaging studies.

Transvaginal ultrasound can be used to detect and localize fibroids. However, for women with large uteri or more than 4 fibroids, it is less precise than MRI.⁴

Sonohysterography can better characterize submucosal fibroids than transvaginal ultrasound.

Pelvic MRI best localizes all types of fibroids, accurately assesses their size, and distinguishes fibroids from other growths (eg, adenomyomas, leiomyosarcomas). However, expense should be taken into consideration.

Hysterosalpingography is best reserved for fertility evaluations. It defines the contour of the endometrium and patency of the fallopian tubes.

Hysteroscopy provides direct visualization inside the uterus and can diagnose submucosal fibroids.