How Are Fibroids Diagnosed?
Fibroids are diagnosed through a combination of clinical examination and imaging studies. The diagnostic process typically begins with a detailed medical history and pelvic examination, followed by imaging to confirm the presence, size, number, and location of fibroids. Accurate diagnosis is essential for selecting the most appropriate treatment.
Clinical Examination
The diagnostic process usually begins with a thorough clinical history and physical examination. Your doctor will ask about your symptoms, menstrual history, family history, and any previous investigations or treatments. A bimanual pelvic examination can often detect an enlarged or irregularly shaped uterus, which may suggest the presence of fibroids.
While clinical examination can raise suspicion of fibroids, it cannot confirm the diagnosis or provide detailed information about fibroid size, number, or location. For this reason, imaging studies are essential for accurate diagnosis and treatment planning.
Ultrasound
Pelvic ultrasound is usually the first imaging investigation performed when fibroids are suspected. It is widely available, non-invasive, does not involve radiation, and provides real-time images of the uterus and surrounding structures. Ultrasound can be performed transabdominally (through the abdominal wall) or transvaginally (using a small probe inserted into the vagina) for more detailed views.
Transvaginal ultrasound is particularly useful for detecting smaller fibroids and for assessing submucosal fibroids that may affect the uterine cavity. Ultrasound can identify the number and approximate size of fibroids, although it may underestimate the total number of fibroids in a large or complex uterus.
Many fibroids are first discovered incidentally during routine ultrasound examinations performed for other reasons, such as early pregnancy dating or investigation of pelvic pain.
MRI
Magnetic resonance imaging (MRI) is considered the gold standard for the assessment of uterine fibroids. MRI provides exceptionally detailed images that allow the radiologist to precisely determine the number, size, position, and tissue characteristics of each fibroid. It is particularly valuable for mapping fibroids before treatment, especially before uterine fibroid embolisation (UFE).
MRI can distinguish between different types of fibroids (intramural, submucosal, subserosal, and pedunculated) with a high degree of accuracy. It can also assess the blood supply to each fibroid, which is important for predicting how well a fibroid will respond to embolisation. Additionally, MRI can help differentiate fibroids from other uterine conditions, such as adenomyosis.
An MRI scan is painless and does not involve ionising radiation. It typically takes 30–45 minutes and may involve the injection of a contrast agent (gadolinium) to enhance the detail of the images. At the North London Fibroid Clinic, all MRI scans are personally reviewed by our specialist radiologists.
CT Scan
Computed tomography (CT) scanning is not routinely used for fibroid diagnosis, as MRI and ultrasound provide superior soft tissue detail for the uterus. However, CT may be performed if fibroids are discovered incidentally during a scan performed for another reason, or in emergency situations where rapid imaging is needed.
CT can identify large fibroids and any calcification within them, but it does not provide the same level of detail as MRI for treatment planning. If CT reveals the presence of fibroids, an MRI is usually recommended for further characterisation.
Hysteroscopy
Hysteroscopy is a procedure in which a thin telescope (hysteroscope) is passed through the cervix to directly visualise the inside of the uterine cavity. It is particularly useful for assessing submucosal fibroids that protrude into the cavity and for evaluating other causes of abnormal uterine bleeding.
Diagnostic hysteroscopy is usually performed as an outpatient procedure and takes only a few minutes. It can also be combined with treatment — for example, small submucosal fibroids can sometimes be removed during the same procedure (hysteroscopic resection). While hysteroscopy is excellent for visualising the uterine cavity, it does not assess the full thickness of the uterine wall or the outer surface, so it is usually used in conjunction with ultrasound or MRI.
What to Expect During Diagnosis
If you attend the North London Fibroid Clinic, the diagnostic process typically follows a clear pathway. At your first appointment, your consultant will take a detailed history, discuss your symptoms, and perform a clinical examination. Imaging will then be arranged, usually an ultrasound in the first instance, followed by an MRI if further detail is required.
We understand that undergoing investigations can feel overwhelming, so our team takes care to explain each step clearly and to answer any questions you may have. Most diagnostic tests are non-invasive and painless. We aim to complete the diagnostic process as efficiently as possible, minimising waiting times and ensuring that results are reviewed promptly.
Once your imaging results are available, your consultant will review them with you, explain the findings, and discuss the most appropriate treatment options based on your individual diagnosis. For details about the services we offer, visit our services page.
How Diagnosis Guides Treatment
The information gathered during the diagnostic process is critical for determining the best treatment approach. The number, size, location, and blood supply of fibroids all influence which treatment is most likely to be effective and appropriate for you.
For example, MRI findings showing multiple intramural fibroids with good blood supply would suggest that UFE is likely to be highly effective. A single submucosal fibroid within the uterine cavity might be best treated with hysteroscopic resection. Understanding your fibroid profile allows our team to provide tailored recommendations and set realistic expectations about treatment outcomes.
At every stage, we involve you in the decision-making process, explaining the rationale behind our recommendations and ensuring that you feel confident in the treatment plan. Book a consultation to start your diagnostic journey with our specialist team.
Frequently Asked Questions
References
- NHS — Fibroids: Diagnosis. Available at: https://www.nhs.uk/conditions/fibroids/diagnosis/
- NICE Clinical Knowledge Summaries — Fibroids: Assessment. Available at: https://cks.nice.org.uk/topics/fibroids/
- Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. American Journal of Obstetrics and Gynecology. 2002;186(3):409–415.
- Royal College of Radiologists. Standards for the Provision of an Interventional Radiology Service. 2014.
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