Uterine Fibroids Diagnosis and Management

Clinical Presentation and Diagnosis

The American College of Radiology suggests that an enlarged, irregular uterus on palpation is pathognomonic for fibroids, as the irregular contour reflects multiple fibroid nodules distorting the normal uterine architecture 1
The American College of Radiology recommends considering fibroids as a common structural cause of abnormal uterine bleeding in premenopausal women, with heavy or prolonged menstrual bleeding being a cardinal symptom 1
The presence of an enlarged, irregular uterus on exam definitively indicates structural pathology, making dysfunctional uterine bleeding (DUB) incompatible with this presentation 2
The American College of Radiology notes that while adenomyosis can cause menorrhagia and an enlarged uterus, the uterus is typically uniformly enlarged and boggy, not irregular, which distinguishes it from fibroids 3, 1
The National Comprehensive Cancer Network suggests that endometrial cancer typically does not cause significant uterine enlargement or irregularity on physical exam, and the uterus usually remains normal in size until very advanced disease 4

In premenopausal women with abnormal uterine bleeding, leiomyomas are one of the three most common structural causes alongside polyps and adenomyosis, according to the American College of Radiology 1

The American College of Radiology recommends performing transvaginal ultrasound as first-line imaging to confirm fibroids and exclude other pathology 1
Praxis Medical Insights suggests considering endometrial sampling if risk factors for endometrial cancer are present, such as age >45 years, obesity, diabetes, hypertension, or other risk factors, despite the likely fibroid diagnosis 2