Comment on: “Diagnosis and Classification of Uterine Fibroids”

Leiomyomas, known as uterine fibroids, have a lifetime prevalence of 75%, dependent on risk factors of both genetic and environmental nature. Many individuals with uterine fibroids are asymptomatic, but an estimated 30% have symptoms that affect quality of life. This article is a summary of the classification, symptomatology, and diagnosis of uterine fibroids. Phenotypic presentation of a uterus with fibroids is heavily dependent on the size and number of fibroids, as well as the degree of myometrial involvement. The FIGO classification system for uterine fibroids was published in 2011 and standardized the description of fibroids, including the involvement of the endometrium, myometrium, and uterine serosa. A second classification system has been published for more specificity in submucous fibroids, but it does not include FIGO type 3 tumors. Though these systems contribute to uniformity in the classification of fibroids, there is still great variability among clinicians, and there are factors and characteristics of some fibroids that may be necessary to consider for management but that are not specifically included in the classification systems. Symptoms of uterine fibroids can include abnormal uterine bleeding (AUB), infertility and reproductive dysfunction, bulk symptoms, and overall quality of life. AUB is the most common symptom of fibroids, and often the FIGO AUB system 1 is used to evaluate nongestational AUB. This system included frequency, regularity, duration, and menstrual volume. In older women, AUB should be assessed with additional causes in mind, with measures taken to rule out malignancy and hyperplasia. Infertility and recurrent pregnancy loss can be symptoms of fibroids, and individuals with these conditions often have uterine fibroids. It is critical to determine, in evaluating fibroids, which may be contributors to infertility and which are likely not. Symptoms related to bulk and the physical location of fibroids can include pelvic pressure, lower back pain, abdominal discomfort, bloating, and a sensation of fullness in the pelvis. Severe symptoms can include urinary obstruction and hydronephrosis, though these are rarer. In symptomatic individuals, each of these areas of symptoms has been associated with a significant reduction in overall quality of life. Diagnosis of uterine fibroids typically includes patient history, physical examination, ultrasound examination, magnetic resonance imaging (MRI), and/or hysteroscopy. Menstrual history can aid in the diagnosis of fibroids, as in ovulatory individuals, heavy bleeding is often predictable. The diagnosis of fibroids typically rests on imaging, either with ultrasound or with MRI. (Summarized from Lakabi R, Harth S, Meinhold-Heerlein I, et al. Diagnosis and classification of uterine fibroids. Int J Gynaecol Obstet . 2025;17:566–573. doi: 10.1002/ijgo.70538)