Pelvic exam – bimanual usually reveals a mobile, enlarged, and soft or boggy uterus
Transvaginal US
MRI usually reserved in cases when providers are seeking to distinguish between<unk>  and leiomyomas 
Definitive diagnosis relies on histology, and so it is usually made during pathology examination of the uterus after a hysterectomy
Adenomyosis
Systemic Causes
Endometriosis
Cirrhosis
Molar pregnancy
Coagulopathy 
Ectopic pregnancy
Group A strep vaginitis 