My uterine fibroid (leiomyoma) grew from approximately 7 × 8 mm to 15 × 11 mm over a few months; what evaluation and management steps should I take?

Evaluation and Management of Growing Uterine Fibroid

Your fibroid has approximately doubled in size over a few months, which warrants clinical evaluation to assess symptoms and rule out rapid growth that could indicate malignancy, though this remains extremely rare (<1 in 1000 cases). 1

Immediate Assessment Required

Symptom evaluation is the most critical factor—not the absolute fibroid size. 2 You need to assess whether you're experiencing:

• Heavy menstrual bleeding or abnormal uterine bleeding 3
• Pelvic pain or pressure symptoms (urinary frequency, constipation, abdominal bloating) 3, 4
• Fertility concerns or pregnancy plans 5
• Impact on quality of life 2

Rapid growth, particularly in perimenopausal women, should be investigated as it may indicate sarcoma, though this is exceedingly rare. 2, 1 Your growth pattern (from ~7-8mm to 15x11mm) represents significant enlargement that requires clinical correlation with symptoms.

Recommended Imaging Follow-up

Transvaginal ultrasound combined with transabdominal ultrasound is the most efficient modality for fibroid surveillance. 1 This should be performed now to:

• Confirm the growth rate and current dimensions 1
• Assess fibroid location (submucosal, intramural, or subserosal) 2
• Evaluate for any concerning features 1

MRI with gadolinium contrast may be indicated if ultrasound findings are unclear or if surgical planning is needed. 3, 1

Management Algorithm Based on Symptoms

If You Are Asymptomatic:

Conservative management with symptom-driven follow-up is appropriate—routine scheduled imaging provides no proven benefit. 1 However, given the documented rapid growth, a single follow-up ultrasound in 3-6 months is reasonable to establish growth trajectory. 1

If You Have Symptoms:

For Heavy Menstrual Bleeding:

First-line medical options include: 3, 5

• 52-mg levonorgestrel-releasing IUD (Mirena) - FDA-approved for heavy menstrual bleeding 5
• Tranexamic acid - reduces menstrual blood loss 3, 6
• NSAIDs - decrease menstrual blood loss 6
• Combined or progestin-only oral contraceptives 3

Second-line medical options for fibroid volume reduction: 5, 6

• GnRH agonists - FDA-approved, reduce fibroid volume by 35-67% 7, 5
• GnRH antagonists with add-back therapy - improve quality of life and symptom severity 4
• Ulipristal acetate (where available) - reduces fibroid volume by 30-70% with amenorrhea rates of 70-90% 2, 7, 4

For Bulk Symptoms (Pressure, Pain):

Medical management is less effective for bulk symptoms; procedural interventions should be considered: 4

• Uterine artery embolization (UAE) - 80% symptom control rate with 40-50% uterine volume reduction 7, 4
• MR-guided high-intensity focused ultrasound (MR-HIFU) - noninvasive thermal ablation 4
• Radiofrequency ablation (laparoscopic or transcervical) - minimally invasive with short recovery 4

If Fertility Preservation Is Important:

Myomectomy (laparoscopic or open) is the standard surgical approach for women desiring future pregnancy. 7, 8 However:

• Recurrence occurs in approximately one-third of patients 2
• Submucosal fibroids can be removed hysteroscopically if <5cm 7
• Limited evidence exists for fertility outcomes after UAE or ablative procedures 4

If Fertility Is Not a Concern and Medical Management Fails:

Hysterectomy provides definitive cure and is the standard treatment for symptomatic fibroids unresponsive to medical therapy. 8, 2

Critical Clinical Pitfalls to Avoid

• 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 2, 1
• Do not perform routine scheduled imaging in truly asymptomatic patients—it increases costs without proven benefit 1
• Do not ignore rapid growth in perimenopausal women—this warrants investigation for sarcoma 2, 1
• Do not assume all fibroids require treatment—two-thirds are asymptomatic and require no intervention 8

Referral Indications

You should be referred to gynecology if: 8

• Fibroids >3 cm causing significant symptoms
• Uterus palpable abdominally or >12 cm on imaging
• Persistent abnormal bleeding despite medical management
• Rapid growth documented on serial imaging

Your documented growth pattern from 7-8mm to 15x11mm over a few months, combined with symptom assessment, should guide whether immediate referral versus watchful waiting with repeat imaging in 3-6 months is most appropriate.