INTRODUCTION:: Uterine fibroids are a common cause of abnormal uterine bleeding with diminished quality of life (QOL). Prior studies rely on sonography which can be inaccurate in evaluating fibroid size and location, especially in large fibroids. We sought to correlate uterine fibroid symptoms with fibroid characteristics using MRI imaging. METHODS:: A retrospective chart review was conducted for patients seen at the Stanford Fibroid Clinic. Patient demographics, medical history and pelvic MRI data were collected on 60 patients with completed Uterine Fibroid Symptom (UFS) and Health Related-Quality of Life (HR-QOL) surveys. Primary outcomes included UFS and HR-QOL scaled scores and sub-scores. RESULTS:: Patients with anemia had significantly worse UFS (mean 73.0 vs 43.4, P=.006) and HR-QOL scores (mean 34.6 vs 61.1, P=.006). Post-menopausal patients had significantly better HR-QOL scores (mean 74.5 vs 49.9, P=.034). The dominant fibroid volume was significantly smaller in women with worse UFS symptoms (UFS>75) (mean 99.5 vs 247.1 mL, P=.015) compared to women with few UFS symptoms (UFS<25). Worse symptoms tended to be seen when fibroids were located in the fundus vs body (mean UFS 58.5 vs 37.7, P=.059) or if fibroids were submucosal or intracavitary compared to intramural or subserosal (mean UFS 78.1 vs 46.9, P=.076). CONCLUSION:: Abnormal uterine bleeding in conjunction with anemia contributed more significantly to symptom severity and QOL than fibroid size. UFS was inversely related to fibroid volume, suggesting fibroids that cause bleeding have a disproportionate impact on symptom severity independent of size.