Miss Deepika Pannu, MRCOG
Consultant Gynaecologist
As a gynaecologist regularly operating on massive fibroids—some dwarfing the uterus itself—I’m struck by a troubling reality that we routinely encounter uteruses rendered anatomically unrecognizable by unchecked fibroid growth. This shouldn’t be inevitable.
Uterine fibroids affect most women, often asymptomatically. Yet for many, they progress insidiously causing abnormal bleeding, pain, bulk symptoms, infertility, or pregnancy complications. I witness the consequences of delayed intervention: complex surgeries where normal anatomy is obliterated. Why do we accept this preventable endpoint?
It’s time to redefine management. Proactive monitoring—tracking size, location, and symptoms must become standard before anatomy is lost. Early intervention isn’t overtreatment; it’s preservation and preventive approach that we must adopt.
Why should you monitor fibroids?
What makes fibroids particularly tricky is that they are unpredictable: some fibroids shrink on their own, especially after menopause, while others continue to grow and trigger new symptoms, often leading to significant impact on gynaecological health. Because of this uncertainty, regular monitoring is key.
Why is it important to monitor fibroids?
Monitoring fibroids isn’t just about measuring how big they are. It’s about protecting your overall health, preventing complications, and making sure symptoms don’t take over your daily life. For example, heavy bleeding caused by fibroids may seem manageable at first, but over time it can lead to iron deficiency and anaemia, leaving you exhausted and affecting your wellbeing. The other extreme of fibroids is atypical transformations leading to cancerous changes in fibroids, which unfortunately come with a very poor outcome.
Do all fibroids affect fertility?
Larger fibroids, or those located in certain parts of the womb, for example within the cavity may interfere with fertility, make conception harder, or cause difficulties during pregnancy. By keeping a close eye on fibroids over time, gynaecologist can step in early if changes are detected or these are deemed to affect your fertility, ensuring treatment is tailored to your needs and long-term plans.
What does monitoring involve?
In most cases, it begins with an ultrasound scan to map the number, size, and position of your fibroids. This gives a baseline picture to compare with future scans. This may allow your gynaecologist to estimate the rate of their growth and may be able to predict optimal time to take preventive action.
If you’re experiencing heavy bleeding, your gynaecologist may also check blood tests to monitor iron, haemoglobin levels and LDH levels. When more detailed information is needed – for example before planning surgery or fertility treatment – an MRI scan can provide a clearer, more accurate view of the womb. Alongside medical tests, keeping track of your own symptoms plays a vital role.
When should you consider additional checks?
Noticing changes in period flow, new pain, or feelings of pressure can provide important clues about how your fibroids are behaving between check-ups.
It’s important to remember that monitoring doesn’t mean “doing nothing” in between your scheduled monitoring. Instead, it’s an active way to stay ahead of potential problems.
Many women live well with fibroids for years through careful observation alone. While many others eventually benefit from medical treatments to control bleeding, minimally invasive procedures to shrink or remove fibroids, or surgery if symptoms become severe. The key is that monitoring gives you and your gynaecologist the information needed to choose the right approach at the right time – before complications arise.
Key messages from eGynaecologist
- When it comes to fibroids, early attention and ongoing monitoring can make significant difference in managing fibroid related complications that otherwise cause substantial disruptions in your life.
- With the right care and guidance, you can stay in control of your gynaecological health and make choices that protect your wellbeing and your future.
