How often should the size of a uterine fibroid be checked?

Surveillance Frequency for Uterine Fibroids

There is no established consensus on routine imaging surveillance intervals for asymptomatic patients with uterine fibroids, and current guidelines do not mandate scheduled follow-up imaging in the absence of symptoms. 1

For Asymptomatic Fibroids (Conservative Management)

No routine imaging schedule is required for asymptomatic fibroids. The American College of Radiology explicitly states there is no specific consensus on imaging surveillance of asymptomatic patients with fibroids. 1

However, clinical follow-up is advisable to:

• Document stability in size and growth over time 2
• Monitor for development of symptoms (heavy menstrual bleeding, pelvic pressure, urinary frequency) 3, 4
• Assess for rapid growth, particularly in perimenopausal women, as this may indicate sarcoma (though extremely rare at <1 in 1000 cases) 1, 2

Practical Approach for Asymptomatic Cases:

• Initial baseline ultrasound (transvaginal combined with transabdominal) to document fibroid characteristics 4
• Clinical reassessment based on symptom development rather than scheduled imaging 1
• Consider imaging if symptoms emerge or if there is concern for rapid growth 1

Post-Treatment Surveillance

After Uterine Artery Embolization (UAE):

Most studies evaluate patients at immediate post-procedure, 3 months, and 12 months after treatment. 1

• Most fibroid size reduction occurs within the first 6 months, with continued decrease between 6-12 months 1
• Median fibroid volume reduction of 42% by 3 months, with >50% average decrease maintained at 5 years 5
• Routine posttreatment surveillance remains controversial with no consensus on when to image asymptomatic women post-intervention 1

Imaging Modality Recommendations:

• Transvaginal ultrasound (TVUS) combined with transabdominal ultrasound (TAUS) is the most frequently used and efficient modality for post-treatment follow-up 1
• MRI with gadolinium contrast is preferred when clinically indicated, particularly to assess fibroid infarction (>90% infarction correlates with better symptom control) 1

Special Circumstances Requiring Imaging

Rapid Growth Monitoring:

• Any rapid increase in fibroid size, particularly in perimenopausal women, should be investigated as it may indicate sarcoma 1
• Urgent referral is recommended for cases with rapid growth 6

Medical Treatment Monitoring:

• During selective progesterone receptor modulator (SPRM) treatment courses, ultrasound measurement is not clinically indicated 1
• No need for ongoing ultrasound to monitor progesterone receptor modulator-associated endometrial changes (PAEC) 1

Key Clinical Pitfalls

• Avoid routine scheduled imaging in truly asymptomatic patients as it provides no proven benefit and increases healthcare costs 1
• Do not rely solely on fibroid size measurements to guide management; patient-reported symptoms and quality of life are more clinically important than absolute size reduction 1
• Be aware that most fibroids decrease in size during menopause, making expectant management appropriate for asymptomatic perimenopausal women 3
• Recognize that sarcomatous change is extremely rare (<1 in 1000) and typically associated with rapid growth, not gradual enlargement 2, 6