Diagnosis and classification of uterine fibroids

Uterine fibroids, or leiomyomas, are benign uterine tumors with a lifetime prevalence of approximately 75%. While only a minority become symptomatic, their impact on quality of life remains profound owing to heavy menstrual bleeding, bulk symptoms, and reproductive dysfunction. Interestingly, fibroids are not reliably diagnosed on physical examination, nor can their impact be predicted through palpation. Consequently, the diagnosis and phenotypic categorization of uterine fibroids relies primarily on imaging to guide subsequent clinical management. Ultrasound should be the first-line diagnostic modality, and magnetic resonance imaging should be reserved for complex cases and/or surgical planning. Adherence to standardized structured reporting across imaging modalities is critical to improve diagnostic accuracy, differentiate fibroids from conditions such as adenomyosis or malignancies, predict therapeutic responses, and plan surgical interventions. Imaging reports should follow the FIGO classification system for uterine fibroids, to enable a standardized description of their relationship to the endometrium, myometrium, and uterine serosa.