Apgujeong Uterine Fibroid Exam Specialist

When menstrual flow suddenly increases, when unfamiliar irregular bleeding, lower abdominal discomfort, and worsened menstrual pain appear, many people start with a search, wondering "could it be a uterine fibroid?" A uterine fibroid is a benign tumor that forms in the muscle layer of the uterus and is commonly reported in women of reproductive age, but quite a few cases have no symptoms, so in reality it can only be known by getting tested. This article focuses one step before treatment, on "how to test and confirm whether there is a fibroid and, if so, what kind it is." We have organized the testing sequence and judgment standards that patients are most curious about in the consultation room.

Symptoms are the most important signal that determines the timing of testing. Uterine fibroids are often found incidentally without symptoms, but it is better not to delay testing if there are the following changes.

• When menstrual flow noticeably increases or clots increase
• When the menstrual period lengthens or irregular bleeding occurs between periods
• When there is heavy discomfort in the lower abdomen or pressure symptoms such as frequent urination or constipation
• When menstrual pain that was not there newly appears or worsens

In particular, an increase in menstrual flow can go beyond simple inconvenience and lead to anemia. When blood loss increases, headache, dizziness, and in severe cases even fainting can accompany it, so if menstrual flow has increased, it is safe to confirm the cause through testing. In the consultation room, quite a few people come after anemia has progressed considerably, saying "my period was always heavy, so I just assumed it was that." If you have a similar concern, we recommend checking starting from when menstrual pain and irregular periods bother you.

A good test begins with a good history. Before imaging, the process of confirming since when and what symptoms there have been, how the menstrual cycle and flow have changed, and whether there is a pregnancy plan comes first. This information governs which imaging test to perform in which order and how to interpret the results.

Next, through a pelvic internal examination, we look at the uterus's size and position and whether there is tenderness. If the uterus is enlarged enough to be felt or its surface feels bumpy, it becomes grounds to suspect a fibroid. However, since it is hard to know the exact number, position, and size of fibroids by internal examination alone, if there is a suspicious finding we move on to imaging. If bleeding is the main symptom, a blood test that looks at whether there is anemia may be conducted together.

When a uterine fibroid is suspected, the standard test performed first is ultrasound. The American College of Obstetricians and Gynecologists (ACOG) recommends ultrasound as the first-line imaging test in evaluating uterine fibroids, and in most cases transvaginal ultrasound is prioritized. Because transvaginal ultrasound inserts the probe into the vagina to approach close to the uterus, it can see the uterine muscle layer and lining more clearly than abdominal ultrasound.

Ultrasound confirms the fibroid's position, number, size, and relationship to the endometrium. When the uterus is very large or the fibroid has risen up to the upper pelvis, abdominal ultrasound may be used together to see the full extent. The test ends in a relatively short time and has no radiation exposure, making it suitable to repeat when tracking the course.

In the consultation room, many people ask "can't a single ultrasound tell everything?", and most fibroids are sufficiently evaluated by ultrasound. However, when the location is tricky or there are many in a multiple form, or when the inside of the endometrium needs to be seen precisely, additional testing may be needed.

When the cause of bleeding lies on the endometrial side, saline-infusion ultrasound (saline sonohysterography, SIS) is useful. ACOG advises that this test, in which a thin tube fills a small amount of sterile saline into the uterus to inflate the endometrial space and then it is observed by ultrasound, can be used when abnormal uterine bleeding or a submucosal fibroid is suspected. Because the saline spreads out the endometrium, it can more clearly distinguish endometrial polyps and submucosal fibroids that were not well distinguished on ordinary ultrasound.

The reason this test is meaningful is that, even for the same fibroid, a submucosal fibroid protruding toward the inside of the endometrium is reported to be more closely related to bleeding and infertility. That is, what matters for subsequent judgment is not simply the existence of a fibroid but how much it has invaded the endometrium. If irregular bleeding or abnormal vaginal bleeding recurs, this stage of sorting out the cause of bleeding is especially helpful.

If a test feels frightening, you may feel free to ask first. Ask about the fibroid testing process by chat

An MRI is not a test needed for every fibroid, but is performed selectively when more precise information is needed. ACOG recommends using MRI for complex cases or for establishing a surgical plan, and its value is great in situations hard to judge by ultrasound alone. Specifically, MRI is considered in the following cases.

• When there are many fibroids in a multiple form and the number and position need to be mapped accurately
• When, ahead of surgery or a procedure, the exact extent of the fibroid and its relationship to the endometrium need to be grasped
• When the distinction from adenomyosis is ambiguous on ultrasound
• When a fibroid grows relatively quickly or a fixed pelvic mass is felt, so that, though rarely, the possibility of a tumor of a different nature must be ruled out

MRI is reported to have strengths in precisely mapping the size and position of fibroids and accurately identifying adenomyosis. However, considering cost and test time, when ultrasound is sufficient we do not go out of our way to perform MRI. The principle of testing is not "the more the better" but "accurately, as much as needed."

For fibroids, the symptoms and approach differ depending on which layer of the uterus they have settled in. The International Federation of Gynecology and Obstetrics (FIGO) classifies fibroids systematically by position, and in clinical practice it is easy to organize by understanding them in three broad branches.

The reason this classification matters is that, even for the same "fibroid," the shape of symptoms and the subsequent management direction differ by position. The goal of testing goes beyond simply finding a fibroid; it is to draw this map accurately and lay the basis for judgment suited to each patient's situation. If detailed position determination and number confirmation are needed, it may also be examined together within women's life-cycle screening.

Test results have meaning only when translated not into numbers but into "the next plan suited to my situation." We have organized the questions patients often ask in the consultation room as Q&A.

If a fibroid is found, must it always be treated? Not so. If there are no symptoms and the size is stable, watching the course with regular testing is guided as the general direction. Whether to treat is decided by considering the fibroid's size and position, the degree of symptoms, age, and pregnancy plans together.

How often should I get tested? Because it differs depending on symptoms and the fibroid's pattern, it is hard to set uniformly. However, if menstrual flow increases or a new symptom arises, we recommend getting tested again even before the set cycle.

I am planning a pregnancy; is testing needed? A fibroid close to the endometrium, like a submucosal fibroid, may be looked at more closely in relation to pregnancy, so confirming the position before pregnancy is helpful.

In the end, the final stage of testing is a consultation with an OB-GYN specialist. The process of organizing together how the fibroid seen on imaging connects to the current symptoms, and whether regular observation is enough or additional evaluation is needed, completes the testing. If you are curious about the test results or the next step, please feel free to leave a consultation. Consult about fibroid testing and the next step

Uterine fibroids are common, but even for the same fibroid, the position and symptoms differ from person to person. So the testing process that looks at "where and how" beyond "there is or is not" is important, and its interpretation is completed through a specialist consultation that considers individual differences. If symptoms bother you, rather than growing anxiety through searching, it is lighter on the mind to confirm the map of your own uterus with a single test.

Written by: Lee Dong-hee Director · OB-GYN specialist · View medical staff profile

First published April 16, 2024 · Last reviewed May 30, 2026

References: American College of Obstetricians and Gynecologists, Management of Symptomatic Uterine Leiomyomas, Practice Bulletin (2021), ACOG Sonohysterography Technology Assessment (2016), FIGO Leiomyoma Classification System

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through an examination.