What are the key diagnostic criteria for uterine fibroids in a patient presenting with heavy menstrual bleeding?

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 ³.
• Physical examination identifying a palpable pelvic or abdominal mass, or a uterus that is palpable abdominally, which raises suspicion of fibroids ²,³.
• 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 ¹,³.
• 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 ¹,³.
• Fibroids measuring 3 cm or more in diameter on imaging are significant for diagnosis and influence management decisions, warranting specialist referral ¹,²,³.
• Laboratory tests including full blood count to assess for anemia related to HMB should be performed in all women presenting with heavy menstrual bleeding ³.
• 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 ¹,².

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 ¹,²,³.