How Uterine Fibroids Are Diagnosed

Most uterine fibroids go unnoticed. Asymptomatic women usually find out that they have fibroids during a routine gynecological exam or while getting imaging for an unrelated medical condition.

Black women—who are three times more likely than women of other races to develop fibroids—often develop fibroids at earlier ages and are more symptomatic.

An official diagnosis is made based on your symptoms and a physical exam. If your healthcare provider suspects that you might have fibroids, they may refer you to a lab or local hospital for further tests to confirm a diagnosis or rule out other possible causes of your symptoms. These tests include an ultrasound, a complete blood count, and a urine sample.

This article discusses the various ways to diagnose uterine fibroids.

Self-Check

Uterine fibroids vary in size and symptoms. Uterine fibroids can go unnoticed or dramatically affect your life. If you are experiencing the following symptoms, you may question if you have uterine fibroids:

• Pelvic or abdominal pain
• Heavy menstrual bleeding
• Frequent urination
• Constipation
• Pelvic fullness or pressure
• Recurrent miscarriages
• Pain during sex
• Lower back pain

Physical Examination

Fibroids are sometimes found on a physical examination when a healthcare provider feels a firm, irregular, and often painless lump during an abdominal or pelvic exam. A pelvic exam is important to determine the size of the uterus.

Labs and Tests

Depending on your symptoms, the initial evaluation may begin with a blood test evaluating nonstructural causes of your symptoms. Your blood test may test for:

• Beta-human chorionic gonadotropin (bHCG): Low bHCG levels rule out pregnancy.
• Complete blood count (CBC): If you have had heavy menstrual bleeding, you may have a CBC to check for anemia.
• Thyroid-stimulating hormone (TSH): Women with uterine fibroids more commonly have thyroid nodules. Uterine fibroid and thyroid nodule growth are largely governed by estrogen levels.
• Prolactin level: Albeit rare, ectopic prolactin secretion from uterine fibroids can cause of hyperprolactinemia—a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood.

If there is a suspicion of cancer, an endometrial biopsy may be taken. A biopsy is more likely in postmenopausal women and women more than 40 years old who experience abnormal uterine bleeding.

Imaging

Unless someone has symptoms, it is likely they do not know they have uterine fibroids. Fibroids are found in asymptomatic women during a routine physical examination, after which they may be asked to undergo imaging soon after to help diagnose the condition, or incidentally during imaging.

Some common types of imaging technology are:

• Ultrasound: Ultrasound is the preferred imaging technique for identifying fibroids. It is a painless scan that uses a probe to produce high-frequency sound waves to create an image of the inside of your body. Transvaginal ultrasonography is highly accurate in detecting uterine fibroids, but it may miss subserosal fibroids—which grow on the outside of the uterus—or small fibroids. Saline infusion sonography uses an injection of salt solution into the uterus to help create the ultrasound image of the uterine fibroid.
• Hysteroscopy: Your OB-GYN may use a special camera called a hysteroscope to visualize the inside of the uterus. Hysteroscopy makes it possible to see and remove fibroids directly. A local anesthetic or general anesthetic may be used so you will not feel any pain during the procedure, but most women don’t need it. The most common side effect is cramping during the procedure.
• Magnetic resonance imaging (MRI): MRI uses magnets and radio waves to create a better picture of the number, size, blood supply, and boundaries of the fibroids. It is not necessary for diagnosis, but it can be useful if there is a suspicion of cancer or endometriosis.
• X-rays: X-rays are less commonly used with the rise of focused ultrasound and MRI technologies, but they can be used in lower resource areas. X-rays use a form of electromagnetic radiation to “see” into the body.
• Computed tomography (CT): Also known as computer-assisted tomography, CT scans use X-rays from many angles to create a more complete picture. Small fibroids are usually indistinguishable from healthy uterus tissue unless the fibroid tumor is calcified or necrotic. Although an MRI is more frequently used than a CT scan to diagnose uterine fibroids, it may be used when a quick diagnosis is necessary, as the process to get an MRI is considerably lengthier. Some women need to remain still for up to 45 minutes in order to get the image, which can be challenging for some.

Differential Diagnosis

Fibroids are benign tumors that are rarely premalignant or precancerous. There are many medical conditions that mimic uterine fibroids. Below are the most common ones:

• Adenomyosis: Adenomyosis, a condition in which endometrial tissue grows within and into the uterus walls, has been shown to have a high rate of coexistence with uterine fibroids. Adenomyosis can mimic uterine fibroids because it is accompanied by prolonged menstrual bleeding, severe cramping, pain during sexual intercourse, and passing clots. Unlike fibroids, adenomyosis tends to be more oval-shaped with indistinct margins on ultrasound.
• Ectopic pregnancy: Uterine fibroids are one of the greatest mimics of ruptured ectopic pregnancy. Although symptoms of severe pelvic pain, menstrual bleeding, and severe anemia may be present in both conditions, imaging would show an empty uterus with multiple fibroids and no rise in HCG pregnancy levels. Of note, uterine fibroid tumors can increase your risk of ectopic pregnancy because they can narrow or scar fallopian tubes, disrupting egg transportation.
• Pelvic inflammatory disease (PID): The most common symptoms of PID are lower abdominal and pelvic pain. The presence of vaginal discharge and cervical motion—uterine, or adnexal, tenderness—on physical examination makes PID more likely.
• Endometriosis: Endometriosis is a condition in which tissue from your uterus grows in other parts of your body. It is often confused with uterine fibroids. Both cause heavy, painful periods, so ultrasound or MRI imaging is often used to differentiate between the two.
• Pregnancy: Pregnancy symptoms of pelvic and abdominal fullness or pressure, lower back pain, and spotty uterine bleeding are similar to those that are experienced with uterine fibroids.
• Cancer: Some malignant tumors that may mimic fibroid symptoms include metastatic disease, endometrial carcinoma, uterine carcinosarcoma, and uterine sarcomas such as leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumors. A Pap smear and biopsy may be performed if cancer is suspected. Of note, the risk of malignancy for uterine fibroids is relatively low. The incidence of leiomyosarcoma, cancer that arises from mutations in fibroid cells, is about one in 400 (0.25%) in women undergoing surgery for fibroids. Risk factors for malignancy include age over 45, evidence of bleeding within the tumor and/or endometrial thickening on MRI, and menopausal status.

Effect on Black Women

The burden of uterine fibroids on Black women is well documented.

Black women are almost three times more likely than White women to experience fibroids in their lifetime and tend to experience fibroids at a younger age and often more severely. Because Black women suffer fibroids at an earlier age, they also are two to three times more likely to undergo surgery.

Reasons for the health disparities experienced by Black women include:

• Genetics
• Historical trauma
• Lack of access to care
• Higher obesity rates
• Vitamin D deficiency

While there is no specific cause for them, a diagnosis of uterine fibroids may be an opportunity to take control of your overall health. Control what you can control; even before you see a doctor, you can manage risk factors like diet, exercise, blood pressure, and stress. Doing so has been shown to stop the growth and development of uterine fibroids.

Access to Care

A national survey found that Black women are more likely to wait four or more years to seek a diagnosis.

Why Black women experience a disproportionate fibroid burden is a complicated question with a lot of potential answers, including:

• Racial-wealth gap: Many Black women are victims of the racial-wealth gap and do not have the health insurance coverage needed to adequately manage their uterine fibroid diagnosis. Even in Black women with resources present for care, their concerns are sometimes dismissed and they may receive inappropriate care.
• Living in rural areas: Many others live in areas that don’t have the specialists needed to manage more complicated or challenging cases.

These factors are not easy to change, but what we know is that the barriers to care are too many, forcing many Black women to suffer in silence, and that needs to change.

More inclusive research is one way to do that. Another is to Increase the awareness of medical professionals about how their own biases may affect the care they are giving to Black people.

Frequently Asked Questions

What are the symptoms of uterine fibroids?

Common uterine fibroid symptoms include:

• Abnormal uterine bleeding in the form of periods that are longer, heavier, or more frequent than usual
• Significant menstrual pain
• Bleeding between periods
• Difficulty getting pregnant
• Pain during intercourse
• Pelvic, abdominal, or back pain or pressure
• Protruding abdominal or belly area
• Increased menstrual cramping
• Frequent urination
• Urinary retention
• Pain on urination, or dysuria
• Constipation
• Fatigue from anemia
• Pregnancy complications, such as needing a cesarean section to deliver a baby

Why are Black women more likely to be diagnosed with uterine fibroids?

The reasons why Black women get fibroids more frequently than White women are unclear, but new research offers some clues. Fibroids have been associated with the following risk factors:

• African ancestry
• Age (development of fibroids increases with age, but symptoms tend to diminish since tumors regress after menopause)
• Obesity
• Family history of uterine fibroids
• High blood pressure
• No history of pregnancy
• Higher stress levels
• Vitamin D deficiency. Women with more melanated skin tones are more likely to experience vitamin D deficiency, which some studies have associated with an increased risk of uterine fibroid development.

A Word From Verywell

If you are experiencing symptoms, see a healthcare professional as soon as you can. You do not have to live in pain. An OB-GYN can help you come up with a plan that includes medical management, lifestyle changes, and possibly surgery or other medical procedures that can reduce your symptoms and increase your quality of life.