Diagnosis of Uterine Fibroids

If a woman is experiencing symptoms suggestive of uterine fibroids, a pelvic exam and imaging studies are done to confirm the diagnosis. Occasionally, a fibroid uterus may be found on a routine physical exam or on imaging studies for unrelated reasons, such as pregnancy.

Pelvic exam: Pelvic examination is used to assess the size and shape of the uterus; however, it is not a sufficient test to exclude other possibilities, such as ovarian tumors or other uterine abnormalities. If an abnormality is suggested  on pelvic exam, this is evaluated further with the use of imaging studies.

Imaging: The presence of uterine fibroids is usually confirmed by ultrasound. Ultrasound is extremely effective at identifying fibroids in uteri smaller than 10 weeks and distinguishing them from ovarian tumors. In some cases saline (a salt solution) may be infused into the uterus to improve the accuracy of ultrasound and identify the location of a fibroid within the uterus; this technique is called sonohysteropgraphy.  An MRI is very effective at identifying and characterizing uterine fibroids, as well as distinguishing them from other uterine abnormalities. Because this test is extremely expensive, it is usually reserved for complex cases not adequately diagnosed by ultrasound.