The first step in diagnosing fibroids is a history and physical, as well as a pelvic examination. Your gynecologist may be involved in your diagnosis and treatment so that they can determine the size of your uterus, the shape, has it changed due to the fibroids themselves? Sometimes a pelvic exam may not be enough, especially if it’s difficult to determine based on your physical exam. Some other tests that may be done to determine what are the cause includes an endometrial biopsy if your bleeding is heavy to determine that you do not have cancer in addition to fibroids. An ultrasound or an MRI may be done to visualize what they look like, as well as a hysteroscopy may be done to look inside of your uterus, to determine if you have fibroids on the inside that may not be seen on ultrasound or MRI.