A conversation with Mr Javaid Muglu about what the latest research means for your care
A word from Mr Muglu
I’ve spent over 20 years caring for women with fibroids, and one of the most common questions I hear is, “Do I need to worry about this?” The answer is usually no—fibroids are benign and very common. But the better question is, “What kind of fibroid do I have, and how should we monitor it?” This new research helps us answer that second question with more confidence.
— Mr Javaid Muglu
When I see patients in my clinic who have been told they have fibroids, the conversation often goes something like this: “I was told I have fibroids, but no one really explained what that means for me.” And honestly, until recently, we didn’t have as much information to share about the different types of fibroids and why they matter.
That’s why I’m so encouraged by a major new study published in Ultrasound in Obstetrics & Gynaecology that looked at 1,766 women with fibroids. This research confirms something many of us suspected: not all fibroids are the same, and understanding the differences can make a real difference in how we monitor and manage them.
What We Now Know About Fibroid Types
The study looked at 1,766 women with histologically confirmed benign uterine fibroids. Here’s what they found
78.3%
USUAL-TYPE
Standard fibroids most women have
21.7%
VARIANT TYPES
Different cellular characteristics
So roughly one in five women with fibroids has a variant type—this is still completely benign, but it may look different on scans and may need different monitoring.
Age and Menopause: An Important Pattern
One finding that really stood out to me clinically was the difference in when these fibroid types appear. While most women in the study were premenopausal (as we’d expect), variant fibroids were more frequently seen in postmenopausal women—21.5% of variant cases occurred after menopause.
Why This Matters in My Clinic
If you’re postmenopausal and you’ve been told you have a fibroid—or if a known fibroid seems different on a recent scan—this research reinforces why we should take a closer look. It doesn’t mean something is wrong, but it does mean that careful characterisation is especially important. I always tell my patients: menopause changes many things in your body, and fibroids are no exception.
What Your Ultrasound Is Showing
The study identified 13 distinct ultrasound patterns that can help differentiate between fibroid types. Variant fibroids were generally larger, nearly three times more likely to contain cystic areas and comparably show less acoustic shadows, which are the dark areas behind fibroids on ultrasound. Different variant types also have their own distinctive features:
- Epithelioid leiomyomas – largest variants with distinctive cellular pattern visible on scan
- Mitotically active – uniform appearance, smooth edges and minimal cystic changes
- Lipoleiomyomas – may contain calcifications, fat content visible on imaging.
What This Means for You
If your ultrasound report mentions “cystic areas” or “atypical features,” please don’t panic. This doesn’t mean you have cancer or that something is dangerously wrong. It simply means you may have a variant fibroid type—still benign, but with different characteristics. This is actually useful information because it helps us tailor your monitoring plan.
Why Monitoring Matters: My Approach
In my practice, I use this information to have more personalised conversations with patients about monitoring. Here’s what that looks like:
Baseline Characterisation
When we first identify a fibroid, we carefully document its size, location, and ultrasound characteristics. This gives us a baseline to compare against in the future.
Risk Stratification
Based on features like size, growth pattern, and whether it’s usual-type or variant, we determine an appropriate monitoring interval. Not all fibroids need the same follow-up.
Symptom-Led Monitoring
We also consider your symptoms. If you’re having heavy bleeding or pain, we might monitor more closely or discuss treatment options sooner.
Life Stage Considerations
If you’re approaching menopause, or already postmenopausal, we adjust our approach. The research showing variant types are more common after menopause means we pay special attention during this transition.
What this new study adds to our Practice
The recent research gives us something we’ve needed: a systematic way to characterise fibroids based on their ultrasound appearance. The fact that two independent examiners reviewed all images and identified 13 distinct patterns means we can be more confident in our assessments.
Questions to Ask Your Gynaecologist
When you next see your gynaecologist, here are questions I’d encourage you to ask. I’ve designed these based on what I wish every patient knew to ask:
- “Based on my ultrasound, what type of fibroid do I have—usual or variant?”
- “Are there any features on my scan, like cystic areas or size, that suggest I need closer monitoring?”
- “How does my age and whether I’m pre- or post-menopausal affect how we should monitor my fibroid?”
- “What symptoms should I watch for that might indicate my fibroid needs reassessment?”
- “How often should I have follow-up scans based on my specific fibroid type?”
A Final Thought
I’ve been caring for women with fibroids for over two decades, and if there’s one thing I’ve learned, it’s that every woman’s experience is unique. Your fibroid is as individual as you are. This new research helps us move away from a one-size-fits-all approach and toward more personalised care.
If you’ve been worrying about your fibroid—whether because of symptoms or because a scan showed something that wasn’t fully explained—I hope this gives you some peace of mind. The vast majority of fibroids are benign, and even variant types are still benign. What matters is that we understand your fibroid so we can give you the right monitoring and support.
— Mr Javaid Muglu, MRCOG
