Background <p>Vasculature and blood flow play a crucial role in the genesis, diagnosis, and treatment of uterine fibroids. Assessment of the different aspects of blood flow by medical imaging has therefore gained a prominent place in the clinical management and research of uterine fibroids. Imaging is most often performed with ultrasound and MRI. However, consistent terminology describing the blood flow and vasculature of fibroids is lacking, impeding efficient interdisciplinary communication.</p> Purpose <p>This narrative review provides information on blood flow and vasculature in uterine fibroids and offers insights into ultrasound and MRI techniques for measuring and visualizing these physiological parameters. To contribute to consistent terminology, we propose a generic nomenclature for different aspects of blood flow and vasculature.</p> Discussion <p>Fibroids generally have a complex and variable vascular composition, which can be unraveled for a large part with the wide range of currently available ultrasound and MRI techniques. Future studies focusing on uterine fibroids may benefit from the connections laid in this article between fibroid vasculature, qualitative and quantitative ultrasound and MRI techniques and our proposed nomenclature.</p> Critical relevance statement <p>This review aims to contribute to a deeper understanding of the blood supply of uterine fibroids and the available imaging techniques for its visualization. This may lead to improved clinical management of uterine fibroids and more efficient interdisciplinary communication.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Blood supply is crucial in the genesis, diagnosis, and treatment of fibroids.</p> </ItemContent> <ItemContent> <p>Ultrasound and MRI can unravel the complex vascular composition of fibroids.</p> </ItemContent> <ItemContent> <p>Consistent nomenclature around blood supply can improve clinical management of fibroids.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>