Most fibroid tumors do not cause symptoms and are diagnosed incidentally during a normal pelvic examination or pelvic ultrasound. Some patients go to their gynecologist with symptoms as a result of fibroids, such as heavy menstrual bleeding, pelvic pain, pelvic pressure, urinary frequency, constipation, back pain, or painful intercourse. The presence of fibroids suspected by physical examination can be confirmed using non-invasive imaging techniques such as ultrasound and/or MRI. Most patients are imaged using ultrasound initially but a pelvic MRI is required in all patients being evaluated as potential candidates for uterine fibroid embolization. MRI provides more information concerning the size, number, location, and vascular supply of the fibroids.

MRI also provides valuable information concerning other disease processes that may mimic the symptoms caused by fibroids, such as adenomyosis and endometrial polyps. Magnetic resonance angiography (MRA) provides valuable information about the blood supply to the fibroids. Fibroid blood supply is usually obtained from the uterine arteries but on occasion the ovarian arteries can provide the dominant supply. This is extremely useful information to have prior to the procedure to increase the likelihood of a successful outcome.