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Half of women who have fibroids never experience symptoms. When fibroids are symptom-free, they generally don't require treatment. But even small fibroids can cause heavy or longer-than-normal menstrual bleeding and significant pain. Fibroids may also contribute to infertility.

The three most common symptoms caused by fibroids are:

• Abnormal uterine bleeding. The most common bleeding abnormality is menorrhagia—menstrual bleeding that is excessively heavy or long. Normal menstrual periods last four to seven days. If you have abnormal bleeding from fibroids, your periods are likely to last longer. Instead of changing a pad or tampon every four to six hours, you may have to change one every hour and find that your periods greatly interfere with your daily activities. You may also experience breakthrough bleeding, or bleeding that occurs between periods.

• Pelvic pressure. You may experience pressure in the pelvic region. Many women with fibroids have an enlarged uterus. Pelvic pressure may be caused by either the increased size of your uterus or from the location of one fibroid in particular. Health care professionals usually describe the size of a uterus with fibroids in the same terms used for someone who is pregnant, such as a "12-week-size fibroid uterus."

  You may also experience pressure on areas near your pelvis, including your bowel or bladder. Pressure against these structures can lead to difficulty or pain with bowel movements and constipation, or increased urinary frequency and incontinence. Conversely, you may experience urinary retention or recurrent urinary tract infections.

• Reproductive problems. Fibroids also are associated with a handful of reproductive problems depending on the number of fibroids present in the uterus and on their size and specific location. These risks include a higher risk of miscarriage, infertility, premature labor and labor complications, depending on the number of the fibroids and their size and location. These problems may occur when fibroids physically change the size and shape of the uterine cavity. But, having fibroids doesn't necessarily mean you will have problems with pregnancy.

Symptoms caused by fibroids can be similar to a number of other symptoms caused by a variety of other conditions, including reproductive cancers sexually transmitted infections and bowel and bladder disorders. So, if you are having any unusual symptoms, be sure to make an appointment to discuss them with your health care professional.

The first step in diagnosing fibroids is usually a pelvic exam and a comprehensive medical history performed by your health care professional. He or she may be able to feel the fibroids in your uterus during the exam, because fibroids can make the uterus feel enlarged or irregular. If the uterus is enlarged enough, it may also be felt abdominally above the pubic bone.

To confirm the diagnosis, even if nothing is felt, your health care professional may recommend one or more diagnostic tests. These include ultrasound (or ultrasonography or sonogram), MRI (magnetic resonance imagery) or CT (computed tomography).

Ultrasound is probably the most common option used to confirm the diagnosis, but MRIs may be the most efficient method if your health care professional needs to distinguish between fibroids and other pelvic masses, and to identify the size, location and type of fibroid. It is important to note that any imaging may find very small fibroids that don't pose any medical problems, wouldn't be felt on physical examination and may not be causing symptoms.

If you have heavy or prolonged bleeding or multiple miscarriages, your health care professional may recommend a more involved examination of your uterine cavity to see if you have a submucous fibroid, which might go undetected on a regular ultrasound. The assessment can be performed in one of three ways:

• Hysterosalpingography. A dye that shows up on an x-ray is injected into your uterus, enabling your health care professional to evaluate the structure of your uterine cavity and look for any abnormalities in the uterus or fallopian tubes.

• Sonohysterography. A saline solution is injected into your uterus and ultrasound is used to visualize the uterine cavity.

• Hysteroscopy. The uterus is expanded with a liquid or gas and a hysteroscope (a small telescope) is inserted directly into the uterus through the vagina and cervix enabling your health care professional to see your entire uterus. Fibroids within the uterine cavity can also be removed during this surgery