Pelvic ultrasounds often represent the first and only line of imaging for uterine fibroid evaluation. Our study aims to determine the added value of routine pelvic magnetic resonance imaging (MRI) on diagnosis and treatment of women presenting with symptomatic uterine fibroids. A retrospective review was performed on 569 consecutive women referred to our multidisciplinary fibroid center over a three-year period. Compared to ultrasound alone, MRI affected diagnosis in over a third of patients, which also altered treatment options. These findings justify the use of routine pelvic MRI in women with symptomatic fibroids, particularly those presenting with dysmenorrhea.