Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key diagnostic criteria for uterine fibroids in a patient presenting with heavy menstrual bleeding (HMB) include:
- Clinical history of heavy menstrual bleeding often accompanied by related symptoms such as persistent intermenstrual bleeding, pelvic pain, or pressure symptoms that may suggest uterine cavity abnormality or fibroids NICE NG88.
- Physical examination identifying a palpable pelvic or abdominal mass, or a uterus that is palpable abdominally, which raises suspicion of fibroids NICE CKS,NICE NG88.
- Pelvic ultrasound scan is the first-line imaging investigation to confirm the presence, size, number, and location of fibroids, especially if the uterus is palpable or a pelvic mass is suspected NICE CKS,NICE NG88.
- Hysteroscopy may be offered if submucosal fibroids or endometrial pathology are suspected based on symptoms such as persistent intermenstrual bleeding or risk factors for endometrial pathology NICE CKS,NICE NG88.
- Fibroids measuring 3 cm or more in diameter on imaging are significant for diagnosis and influence management decisions, warranting specialist referral NICE CKS,NICE CKS,NICE NG88.
- Laboratory tests including full blood count to assess for anemia related to HMB should be performed in all women presenting with heavy menstrual bleeding NICE NG88.
- Consideration of differential diagnoses such as malignancy is essential, and urgent referral via a two-week cancer pathway is indicated if clinical or radiological features suggest malignancy NICE CKS,NICE CKS.
These criteria together guide the diagnosis of uterine fibroids in women presenting with heavy menstrual bleeding and help determine the need for specialist referral and further management NICE CKS,NICE CKS,NICE NG88.