Women with symptomatic fibroids experience abnormal uterine bleeding. Heavy menses (menorrhagia) or menometrorrhagia may be observed. Fibroids often reach a size at which they cause symptoms such as nocturnal frequency and urinary leakage. The degree of symptoms may not necessarily correlate with the size of the fibroid.
Fibroids most commonly present with pelvic pressure, menorrhagia, or menometrorrhagia. As fibroids grow, they may cause symptoms like nocturnal urinary frequency and leakage. In rare cases, compression of the ureter can lead to renal complications. Women with large fibroids may notice an increase in abdominal girth, and a hard mass in the lower abdomen, which may be accompanied by gastrointestinal symptoms such as constipation.
The diagnosis of fibroids primarily involves a full pelvic examination, including a rectal exam. Fibroids can be missed without a rectal exam. Large fibroids can usually be detected during a pelvic examination, while smaller fibroids, especially if numerous, can also cause symptoms. An ultrasound test or a laparoscopy will confirm whether a patient has fibroids.
If abnormal bleeding is present, an endometrial biopsy should be performed to rule out hormonal deficiencies. Hysteroscopy can help determine whether there are fibroids on or under the uterine lining. In some cases, fibroids may be removed during a hysteroscopy.