Understanding Your Fibroid Test Results: A Comprehensive Guide

Receiving a diagnosis of uterine fibroids can be a mix of emotions – relief at finally understanding your symptoms, perhaps anxiety about what comes next, and often, a mountain of questions about your test results. This guide is designed to demystify those complex reports, transforming medical jargon into clear, actionable insights. By the end, you’ll not only understand what your fibroid test results mean but also feel empowered to discuss them confidently with your healthcare provider and make informed decisions about your health.

The Journey to Diagnosis: Why Tests Are Performed

Before diving into the specifics of your results, it’s helpful to understand why certain tests were ordered in the first place. Fibroids, non-cancerous growths of the uterus, often present with a range of symptoms, from heavy menstrual bleeding and pelvic pain to pressure on the bladder or rectum. Sometimes, they are discovered incidentally during a routine pelvic exam or imaging for another condition. Your doctor’s goal is to accurately identify the presence, size, location, and type of fibroids, as well as rule out other conditions that might mimic fibroid symptoms.

The diagnostic process typically begins with a thorough medical history and physical examination. Based on these initial findings, your doctor will likely recommend one or more imaging tests to confirm the diagnosis and gather detailed information about your fibroids.

Decoding Your Imaging Results: The Cornerstone of Diagnosis

Imaging tests are the primary tools used to visualize fibroids. Each type of imaging offers unique advantages, providing different pieces of the puzzle.

1. Pelvic Ultrasound: The First Look

A pelvic ultrasound is usually the first-line imaging test for suspected fibroids. It’s non-invasive, widely available, and relatively inexpensive. An ultrasound uses sound waves to create images of your uterus and ovaries.

How it’s performed: You might have a transabdominal ultrasound (a transducer moved over your lower abdomen) or a transvaginal ultrasound (a slender transducer inserted into the vagina), or both. The transvaginal approach often provides clearer, more detailed images of the uterus.

What to look for in your report:

“Uterus enlarged/bulky/globular”: This often indicates the presence of fibroids, as they can significantly increase the size of the uterus. A normal uterus is typically pear-shaped.
“Myometrial heterogeneity/masses/nodules”: The myometrium is the muscular wall of the uterus. “Heterogeneity” suggests an uneven texture, often due to fibroids. “Masses” or “nodules” are direct terms for fibroid presence.
Size (in centimeters or millimeters): This is crucial. Your report will list the dimensions of each identified fibroid (e.g., “5 cm x 4 cm x 3 cm”). Note that some fibroids might be tiny (millimeter-sized), while others can grow to be very large (many centimeters). For example, a report stating “Multiple intramural fibroids, largest measuring 6.2 cm” means you have several fibroids within the uterine wall, with the biggest one being just over six centimeters.
Number of fibroids: The report may state “single fibroid” or “multiple fibroids.”
Location: This is incredibly important for understanding symptoms and treatment options. Ultrasound can identify fibroids in the following locations:
- Intramural: Located within the wall of the uterus. These are the most common type and can cause heavy bleeding, pain, and pressure depending on their size. Example: “Intramural fibroid noted in the anterior uterine wall, measuring 4.5 cm.”
- Subserosal: Located on the outer surface of the uterus. These can grow quite large and may cause pressure symptoms on surrounding organs like the bladder or bowel. They typically don’t cause heavy bleeding unless they are very large or have a stalk (pedunculated). Example: “Large subserosal fibroid arising from the fundus, measuring 8 cm, causing mild mass effect on the bladder.”
- Submucosal: Located just beneath the uterine lining (endometrium). Even small submucosal fibroids can cause significant symptoms, particularly heavy and prolonged menstrual bleeding, as they distort the uterine cavity. Example: “Small submucosal fibroid projecting into the endometrial cavity, 2 cm.”
- Pedunculated: A fibroid attached to the uterus by a stalk. This can occur with subserosal or submucosal fibroids. Pedunculated fibroids can sometimes twist on their stalk, causing acute pain. Example: “Pedunculated subserosal fibroid noted, measuring 5 cm, with a 2 cm stalk.”
- Cervical: Located in the cervix. These are less common but can cause unique symptoms related to the cervix.
“Endometrial stripe normal/thickened/irregular”: The endometrial stripe is the lining of the uterus. Fibroids, especially submucosal ones, can thicken or distort this lining, contributing to heavy bleeding.
“No free fluid in pelvis” or “Trace free fluid”: This refers to any fluid outside of the organs in the pelvic cavity. While some fluid can be normal, excessive fluid might indicate other conditions.
“Ovaries unremarkable/normal”: This confirms that your ovaries appear healthy and rules out ovarian cysts or other ovarian pathologies.

Actionable Insight: If your ultrasound report mentions “multiple intramural and subserosal fibroids,” you know you have several fibroids both within the uterine wall and on its outer surface. The sizes will give you an idea of their collective impact. If a “submucosal fibroid” is noted, even if small, it explains why you might be experiencing very heavy periods, as these fibroids directly interfere with the uterine lining.

2. MRI (Magnetic Resonance Imaging): The Detailed Map

While ultrasound is excellent for initial detection, an MRI provides a much more detailed and comprehensive view of the uterus and surrounding structures. It’s often used when fibroid mapping is critical for surgical planning (e.g., myomectomy) or when the diagnosis is unclear.

How it’s performed: You lie on a table that slides into a large, tube-shaped machine. The MRI uses powerful magnets and radio waves to create cross-sectional images. Contrast dye may be injected to enhance certain structures.

What to look for in your report:

Confirmation of fibroid presence and precise location: MRI excels at differentiating fibroids from other uterine conditions like adenomyosis (a condition where endometrial-like tissue grows into the muscular wall of the uterus).
Exact dimensions and volume: MRI provides highly accurate measurements, which are crucial for tracking growth over time and for surgical planning.
Detailed mapping: The report will often provide a “fibroid map,” listing each individual fibroid with its precise location, size, and relationship to the endometrial cavity, bladder, rectum, and major blood vessels. Example: “Fibroid A: Intramural, posterior wall, 6.0 x 5.5 x 5.0 cm, distorting posterior aspect of endometrial cavity by 1 cm. Fibroid B: Subserosal, anterior fundus, 7.2 cm, adjacent to the bladder dome.”
Degeneration: MRI can identify if a fibroid is undergoing degeneration (when it outgrows its blood supply). This can cause acute pain and is important for symptom management. The report might mention “areas of T2 hyperintensity” or “central necrosis.”
Vascularity: The report might comment on the blood supply to the fibroids, which is relevant for certain treatments like uterine fibroid embolization (UFE).
Assessment of other pelvic organs: MRI provides excellent visualization of the ovaries, fallopian tubes, bladder, and rectum, helping to rule out or identify co-existing conditions.
Adenomyosis: MRI is the best imaging modality for diagnosing adenomyosis, which often co-exists with fibroids and can also cause heavy bleeding and pain. The report might mention “diffuse or focal thickening of the junctional zone” or “myometrial cysts.”

Actionable Insight: An MRI report detailing “multiple intramural fibroids, largest 7 cm, with significant distortion of the endometrial cavity, and evidence of central degeneration” not only tells you about the size and number but also highlights why your bleeding is so heavy and why you might experience acute pain episodes. It also provides critical information if surgery is being considered.

3. Hysterosonography (Saline Infusion Sonography – SIS): Focusing on the Cavity

Hysterosonography is a specialized ultrasound that specifically evaluates the uterine cavity. It’s particularly useful for identifying submucosal fibroids or polyps that might be missed on a standard ultrasound.

How it’s performed: A thin catheter is inserted into the uterus, and sterile saline solution is injected. The saline distends the uterine cavity, allowing for clearer visualization of the endometrial lining with transvaginal ultrasound.

What to look for in your report:

“Filling defect within the endometrial cavity”: This is a direct indication of a mass within the uterine lining, such as a submucosal fibroid or an endometrial polyp.
“Intracavitary mass/lesion”: Similar to a filling defect, this confirms a growth inside the uterus.
Measurement and location of intracavitary fibroids: The report will specify the size and where the fibroid is located within the cavity (e.g., “polypoid mass, 2.5 cm, arising from the posterior wall, occupying 30% of the cavity”).
“Endometrial polyps present”: It can differentiate between fibroids and polyps, which are also common causes of abnormal bleeding.

Actionable Insight: If your SIS report states “a 3 cm intracavitary lesion consistent with a submucosal fibroid,” you have a clear understanding that this fibroid is directly impacting your uterine lining, explaining heavy and prolonged bleeding, and potentially making it difficult to conceive if you are trying. This also suggests that a hysteroscopic myomectomy (removal of the fibroid through the vagina and cervix) might be a suitable treatment option.

4. Hysteroscopy: Direct Visualization

Hysteroscopy is a minimally invasive procedure that involves inserting a thin, lighted scope through the vagina and cervix into the uterus. It provides direct visual inspection of the uterine cavity.

How it’s performed: Performed in a doctor’s office or an outpatient surgical center. Saline or gas is used to distend the uterus.

What to look for in your report:

Direct description of fibroids: The report will detail the number, size, and exact location of any submucosal fibroids seen, and whether they are sessile (broad-based) or pedunculated (on a stalk). Example: “Single submucosal fibroid, G0, approximately 4 cm, located on the anterior wall.”
Classification of submucosal fibroids: Hysteroscopy often uses the FIGO (International Federation of Gynecology and Obstetrics) classification system for submucosal fibroids, which is crucial for surgical planning:
- Type 0: Entirely within the uterine cavity (pedunculated). These are generally the easiest to remove hysteroscopically.
- Type 1: Less than 50% intramural (mostly in the cavity).
- Type 2: 50% or more intramural (more embedded in the wall). Types 1 and 2 may require more advanced hysteroscopic techniques or even a two-stage procedure.
Appearance of the endometrial lining: The report will note if the lining appears normal, thickened, or if there are any other abnormalities.
Presence of polyps or other lesions: Hysteroscopy can confirm or rule out other growths.

Actionable Insight: A hysteroscopy report indicating a “Type 0 submucosal fibroid, 3.5 cm” immediately tells you that this fibroid is completely within the uterine cavity and is highly amenable to hysteroscopic removal, which is a less invasive surgical option.

Understanding Your Blood Test Results: Beyond Imaging

While imaging provides the visual evidence of fibroids, blood tests offer complementary information about your overall health and the impact of fibroids.

1. Complete Blood Count (CBC): Assessing Anemia

Chronic heavy menstrual bleeding due to fibroids can lead to iron deficiency anemia. A CBC measures various components of your blood.

What to look for in your report:

Hemoglobin (Hb) and Hematocrit (Hct): These levels indicate your red blood cell count and oxygen-carrying capacity.
- Normal: Ranges vary slightly by lab, but generally, Hb is 12-16 g/dL for women, Hct is 36-48%.
- Low Hb/Hct: Indicates anemia. Example: “Hemoglobin 9.8 g/dL, Hematocrit 29%.” This suggests moderate anemia, which can cause fatigue, shortness of breath, and dizziness.
Mean Corpuscular Volume (MCV): This measures the average size of your red blood cells. In iron deficiency anemia, MCV is typically low (“microcytic”). Example: “MCV 78 fL” (normal is usually 80-100 fL).

Actionable Insight: If your CBC shows low hemoglobin and hematocrit with a low MCV, it strongly suggests iron deficiency anemia caused by your heavy fibroid bleeding. This means your treatment plan should include iron supplementation in addition to addressing the fibroids themselves.

2. Iron Studies: Pinpointing the Cause of Anemia

If anemia is suspected, your doctor will likely order iron studies to determine if it’s due to iron deficiency.

What to look for in your report:

Serum Iron: Measures the amount of iron in your blood.
Ferritin: This is a crucial indicator of your body’s iron stores. Low ferritin is the most sensitive marker for iron deficiency.
- Low Ferritin: Indicates depleted iron stores. Example: “Ferritin 12 ng/mL” (normal typically >20-30 ng/mL).
Total Iron-Binding Capacity (TIBC) / Transferrin: These reflect the blood’s capacity to bind and transport iron. In iron deficiency, TIBC is usually high, meaning your body is “hungry” for iron.
Transferrin Saturation: Measures how much iron is bound to transferrin. Low saturation indicates iron deficiency.

Actionable Insight: Low ferritin, high TIBC, and low transferrin saturation, combined with low hemoglobin, definitively diagnose iron deficiency anemia due to your fibroids. This reinforces the need for aggressive iron replacement and fibroid management to prevent further blood loss.

3. Coagulation Panel: Ruling Out Bleeding Disorders

In some cases of very heavy bleeding, your doctor might order coagulation tests to rule out underlying bleeding disorders, although this is less common for fibroid-related bleeding.

What to look for in your report:

PT (Prothrombin Time) / INR (International Normalized Ratio): Measures how long it takes for blood to clot.
PTT (Partial Thromboplastin Time): Another measure of clotting time.

Actionable Insight: If these tests are normal, it suggests your heavy bleeding is directly due to the fibroids and not an underlying clotting disorder.

4. CA-125: When Is It Relevant?

CA-125 is a protein that can be elevated in certain conditions, most notably ovarian cancer. While fibroids can sometimes cause a mild elevation in CA-125, it’s not a diagnostic marker for fibroids themselves.

When it might be ordered: If there’s concern about an ovarian mass or if your symptoms are atypical for fibroids alone.

What to look for in your report:

Mildly elevated CA-125 (e.g., 50-100 U/mL): This can be seen with large fibroids, endometriosis, or adenomyosis.
Significantly elevated CA-125 (e.g., >200 U/mL): This warrants further investigation, as it raises concern for ovarian cancer or other serious conditions.

Actionable Insight: If your CA-125 is mildly elevated in the presence of large fibroids, it’s likely related to the fibroids or other benign gynecological conditions. However, a significantly high CA-125 warrants a more thorough workup, usually involving advanced imaging and possibly a referral to a gynecologic oncologist.

Pathology Report: Post-Surgical Confirmation

If you undergo a myomectomy (fibroid removal) or hysterectomy (uterus removal), the removed tissue will be sent to a pathologist for microscopic examination. This pathology report provides the definitive diagnosis.

What to look for in your report:

“Leiomyoma(s)”: This is the medical term for a benign uterine fibroid. This confirms the diagnosis.
“Uterine leiomyomatosis”: Indicates the presence of multiple fibroids.
“No evidence of malignancy”: This is the most crucial statement, confirming that the growths are indeed benign and not cancerous (leiomyosarcoma). This is a great relief and the primary reason for pathological examination.
Size and number of fibroids: The pathologist will confirm the number and size of the fibroids removed.
Description of cellular characteristics: The report may include microscopic details such as “spindle cells,” “smooth muscle bundles,” or “hyaline degeneration,” which are typical features of benign fibroids.
“Adenomyosis also present”: The pathologist may also identify adenomyosis if it was co-existing, which helps explain the full spectrum of your symptoms.

Actionable Insight: A pathology report stating “multiple leiomyomas, no evidence of malignancy” is the gold standard for confirming your fibroid diagnosis and, more importantly, ruling out cancer. This provides peace of mind and confirms the success of the surgical procedure in addressing the benign growths.

Putting It All Together: Your Personalized Fibroid Profile

Understanding individual test results is important, but the true power lies in synthesizing all the information to create a complete picture of your fibroid profile.

Ask yourself these questions as you review your reports:

How many fibroids do I have? (Single vs. Multiple)
How big are they? (Sizes in cm or mm)
Where are they located? (Intramural, subserosal, submucosal, pedunculated, cervical) This is key to understanding your symptoms.
Are any of them significantly distorting my uterine cavity? (Especially if you have heavy bleeding or fertility concerns).
Is there evidence of degeneration? (If you’re experiencing acute pain).
Am I anemic? If so, how severe is it, and is it iron-deficiency anemia?
Are there any other co-existing conditions like adenomyosis or endometrial polyps?
Has malignancy been definitively ruled out? (Post-surgical pathology report).

Concrete Example:

Imagine your reports show:

Ultrasound: “Uterus enlarged, measuring 12 cm. Multiple intramural fibroids, largest 7 cm, located in the posterior wall. A 2.5 cm submucosal fibroid is noted, distorting the endometrial cavity.”
MRI: Confirms the ultrasound findings and adds: “Largest fibroid shows areas of central degeneration. Another 6 cm subserosal fibroid noted on the anterior fundus, causing mild pressure on the bladder.”
Blood Tests: “Hemoglobin 10.1 g/dL, Ferritin 15 ng/mL.”

Deciphering this:

You have multiple fibroids of significant size.
The 7 cm intramural fibroid is likely contributing to the enlarged uterus and possibly bulk symptoms.
The 2.5 cm submucosal fibroid is the primary culprit for your heavy bleeding, as it’s directly impacting the uterine lining.
The central degeneration in the largest fibroid explains any acute, localized pain you might experience.
The 6 cm subserosal fibroid on the anterior fundus is likely causing your frequent urination or bladder pressure.
You are anemic due to chronic blood loss from the submucosal fibroid, and your iron stores are depleted.

This comprehensive understanding allows for a targeted discussion with your doctor about treatment options, whether it’s medication to manage symptoms and anemia, or procedures like hysteroscopic myomectomy for the submucosal fibroid, or a more extensive myomectomy for the larger fibroids.

Empowering Your Conversation with Your Healthcare Provider

Armed with this knowledge, you are better equipped to engage in a meaningful dialogue with your doctor.

Before your appointment:

Write down any questions you have.
Review your reports and highlight anything you don’t understand.
Consider your symptoms and how they correlate with the fibroid locations and sizes.

During your appointment:

Don’t be afraid to ask for clarification. Ask them to explain any terms you don’t understand.
Ask how your specific fibroid type, size, and location relate to your symptoms.
Discuss the pros and cons of different treatment options based on your individual fibroid profile.
Inquire about potential future implications, such as fibroid growth or fertility.
Confirm the recommended follow-up schedule and what to expect.

By taking an active role in understanding your fibroid test results, you transform from a passive recipient of information into an empowered partner in your healthcare journey. This deep understanding is not just about medical facts; it’s about gaining control over your health and making the most informed decisions for your well-being.