1. Medical History
Diagnosis begins with a careful review of the patient’s medical history, including complaints of heavy menstrual flow, irregular uterine bleeding, prolonged periods, or a palpable lower abdominal mass. Patients may also report symptoms such as pelvic pressure, increased vaginal discharge, lower back pain, urinary frequency, or infertility related to fibroid growth.
2. Gynecologic Examination
During a pelvic examination, a physician can often detect an irregularly or symmetrically enlarged uterus.
- Subserosal fibroids may present as single or multiple hard, nodular protrusions on the uterine surface.
- Submucosal fibroids can sometimes cause the cervical os to dilate, allowing the clinician to feel the lower pole of the fibroid through the cervix.
- In some cases, a pedunculated submucosal fibroid may prolapse into the vagina, where it can be directly visualized and its stalk palpated.
3. Auxiliary Examinations
Small fibroids, especially submucosal ones, can be difficult to diagnose by physical exam alone. Several imaging and procedural tests help confirm the diagnosis:
- Pelvic ultrasound (B‑ultrasound) is the primary and most widely used diagnostic tool, clearly revealing the number, size, location, and internal characteristics of fibroids.
- Diagnostic dilation and curettage (D&C) allows the clinician to feel irregularities or protrusions of the endometrium, helping identify submucosal fibroids.
- In more complex cases, MRI may be used for more detailed anatomical mapping.
Any fibroid that grows rapidly, continues to enlarge after menopause, or changes from hard to soft should raise suspicion of possible malignant transformation and requires further evaluation.