How to decode your ultrasound report after a fibroid diagnosis

Start with the three things every fibroid report describes

A fibroid ultrasound report usually lists three things for each fibroid found: its location, its size in centimetres, and sometimes a FIGO type number. If more than one fibroid is present, the report will describe the largest ("dominant") fibroid in the most detail and may simply count the rest. Reports often open with a phrase like "bulky uterus," which means the uterus is larger than typical — most often from fibroids or adenomyosis — and the report will say which.

Location matters more than the number in centimetres

Fibroids are commonly described by where they grow:

• Submucosal — push into the uterine cavity
• Intramural — within the muscular wall
• Subserosal — push outward from the uterus
• Pedunculated — attached by a stalk inside or outside the uterus

Submucosal fibroids are often the most symptomatic, even though they're the least common. They can trigger heavy bleeding, clots, anemia, cramping, and sometimes fertility issues because they disrupt the cavity. Size alone is a poor predictor of how you'll feel: small fibroids can cause major symptoms, and large ones can cause none. Symptom severity is usually driven by location, direction of growth, and effect on the uterine cavity, not just the number on the report.

What the FIGO number means

The FIGO classification runs from 0 to 8. Lower numbers (0–2) mean the fibroid touches or bulges into the cavity; middle numbers (3–4) mean it sits entirely within the muscular wall. Your report may also use descriptive terms like "hypoechoic" (darker on the image) or "heterogeneous" (mixed texture). "Degeneration" describes internal changes in a fibroid that can relate to pain. These words describe what the sonographer saw — they are not a diagnosis of cancer.

How size is reported

Fibroids are measured in centimetres and typically described by their maximum diameter on ultrasound, often in three dimensions. A common size chart groups them as:

• Tiny: 5–10 mm (0.5–1 cm)
• Small: 10–20 mm (1–2 cm)
• Medium: 20–60 mm (2–6 cm)
• Large: 60–100 mm (6–10 cm)
• Very large: 100+ mm (10+ cm)

A fibroid the size of a lemon (around 4–5 cm) frequently marks the point where patients begin seeking evaluation. Fibroids over 6 cm can begin to distort the shape of the uterus and press on nearby organs like the bladder or bowel. There is no single "normal" size, and size alone doesn't determine whether treatment is needed.

A practical checklist for reading your report

1. Find the impression section first — it summarises the key findings.
2. Note the number of fibroids and which one is described as dominant.
3. Circle the location terms (submucosal, intramural, subserosal, pedunculated).
4. Write down the size in centimetres for each fibroid mentioned.
5. Look for a FIGO type number if one is given.
6. Note any words like degeneration, hypoechoic, or heterogeneous.
7. Compare against your symptoms — bleeding, pressure, pain, urinary frequency.
8. Bring your questions to your clinician rather than acting on the report alone.

What actually changes management

Location and effect on the uterine cavity usually carry the most weight in deciding next steps. Submucosal fibroids that distort the cavity are the ones most likely to change what happens next, especially if you have heavy bleeding or are considering fertility treatment. Size matters mainly for bulk symptoms like pressure on the bladder. Your report is a description, not a treatment plan — the plan comes from a conversation that combines the report with your symptoms, your goals, and your history.

Questions to ask at your next appointment

• Which fibroid is causing my symptoms, and why?
• Is the location submucosal, intramural, or subserosal?
• Does the report suggest anything that needs monitoring or follow-up imaging?
• What are my options, and how do they relate to my fertility goals?
• Do I need a repeat scan, and if so, when?

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Quiz: check your understanding

A fibroid report says "submucosal fibroid, FIGO type 2." Based on the FIGO classification described above, what does a lower number like 2 mean?

• It touches or bulges into the uterine cavity
• It sits entirely within the muscular wall
• It is attached by a stalk outside the uterus

Answer: It touches or bulges into the uterine cavity.