Clinical signs and diagnosis of fibroids from adolescence to menopause

The aim of this review was to provide an updated assessment of the present diagnostic tools and clinical symptoms and signs to evaluate uterine fibroids (UFs) based on current guidelines, recent scientific evidence and a PubMed and Google Scholar search for peer-reviewed original and review articles related to clinical signs and diagnosis of UFs. Around 50-75% of UFs are considered non-clinically relevant. When present, the most common symptoms are abnormal uterine bleeding, pelvic pain and/or bulk symptoms and reproductive failure. Transvaginal ultrasound (TVUS) is recommended as the initial diagnostic modality due to its accessibility and high sensitivity, although magnetic resonance imaging appears to be the most accurate diagnostic tool to date in certain cases. Other emerging techniques such as saline infusion sonohysterography, elastography and contrast-enhanced ultrasonography may contribute to improving the diagnostic accuracy in selected cases. Moreover, artificial intelligence has begun to demonstrate its ability as a complementary tool to improve the efficiency of UF diagnosis. Therefore, it is critical to standardize descriptions of TVUS images according to updated classifications and to individualize the use of the different complementary diagnostic tools available to achieve a precise uterine mapping able to lead targeted therapeutic approaches according to the clinical context of each patient.