If you suspect you have uterine fibroids due to symptoms like heavy bleeding, pelvic pressure, or prolonged periods, getting an accurate diagnosis is the crucial first step. A proper diagnosis not only confirms the presence of fibroids but also provides vital information about their size, number, and location, which helps determine the best course of treatment.1 Fortunately, modern medicine offers several effective and painless methods to do this.
Here’s a step-by-step guide to how doctors diagnose uterine fibroids.
Step 1: The Initial Consultation and Pelvic Exam
Your journey to a diagnosis begins with a conversation with your doctor or gynecologist. They will ask about your symptoms, menstrual cycle, and family history. This is followed by a physical examination.
A pelvic exam is often the first hands-on step. During this routine exam, your doctor will feel your uterus, ovaries, and cervix.2 They may be able to detect abnormalities in the shape or size of your uterus that suggest the presence of fibroids. If your uterus feels enlarged or has an irregular contour, your doctor will likely recommend imaging tests to get a clearer picture.
Step 2: Imaging Tests - Seeing is Believing
Imaging tests are the most definitive way to diagnose fibroids. They allow your doctor to see inside your body and confirm the size, location, and number of fibroids.3
Ultrasound
An ultrasound is the most common and straightforward imaging tool used to diagnose fibroids.4 It uses sound waves to create a picture of your internal organs.5 There are two main ways this is performed:
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Transabdominal Ultrasound: A probe, called a transducer, is moved across your abdomen.6 This provides a broad view of the pelvic organs.
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Transvaginal Ultrasound: A smaller, wand-like transducer is inserted into the vagina.7 Because it’s closer to the uterus, this method provides a more detailed image and is excellent for detecting smaller fibroids or getting a better look at the uterine lining.
Magnetic Resonance Imaging (MRI)
An MRI is a more advanced imaging test that uses magnets and radio waves to produce highly detailed images.8 While not always necessary for an initial diagnosis, an MRI may be ordered if:
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Your ultrasound results are unclear.
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Your doctor needs more precise information about the size, number, and exact location of the fibroids to plan for a procedure like a myomectomy or Uterine Fibroid Embolization (UFE).
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There is a need to distinguish fibroids from other conditions, such as adenomyosis.9
Step 3: Other Specialized Procedures
In some cases, especially if you are experiencing infertility or very heavy bleeding, your doctor may recommend a procedure that provides a direct look inside the uterus.
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Hysterosonography (Saline Infusion Sonogram): This is a special type of ultrasound.10 A small amount of sterile saline is injected into the uterus, which slightly expands the uterine cavity.11 This makes it easier to see submucosal fibroids—those that bulge into the uterine cavity—which can sometimes be missed on a standard ultrasound.
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Hysteroscopy: For this procedure, a thin, lighted telescope called a hysteroscope is inserted through the cervix into the uterus.12 This allows the doctor to look directly at the walls of your uterus and identify any fibroids or polyps inside the cavity.
The Path to a Clear Answer
Diagnosing uterine fibroids is typically a straightforward process. Starting with a simple pelvic exam and often moving to a painless ultrasound, your doctor can quickly confirm the cause of your symptoms. A clear diagnosis is the first and most important step toward creating a treatment plan that's right for you.
