Fibroid Evaluation & Monitoring — Understanding What You Have and What to Do About It
Uterine fibroids are among the most common gynecologic findings — present in up to 70% of women by age 50. Most are asymptomatic and require no treatment. Others cause heavy periods, pelvic pressure, urinary frequency, pain, or fertility difficulty that significantly affects quality of life. The challenge is knowing which fibroids need intervention, when, and what type.
At Lapeer Women’s Health, Dr. Andrei provides structured fibroid evaluation and ongoing monitoring for patients managing fibroids conservatively. The evaluation establishes a clear baseline — fibroid number, size, location, and relationship to the uterine cavity — and the monitoring program tracks changes over time to identify when intervention becomes appropriate before symptoms become unmanageable.
Watchful waiting is a legitimate management strategy for many women with fibroids — but it should be active, not passive. Active monitoring means scheduled imaging at appropriate intervals, symptom assessment at each visit, and a clear plan for what findings would trigger a change in management. That is what the fibroid evaluation and monitoring program at LWH provides.
Fibroid Evaluation — What Dr. Andrei Assesses
The initial evaluation establishes your fibroid profile. Each of these factors determines symptom burden, fertility impact, and treatment appropriateness.
Fibroid location and classification
Submucosal fibroids (inside the uterine cavity) cause the heaviest bleeding and the greatest fertility impact. Intramural fibroids (within the uterine wall) cause pressure and bulk symptoms. Subserosal fibroids (on the outer surface) cause urinary and bowel pressure. Location determines which treatment options are appropriate.
Fibroid number and total uterine volume
A single fibroid behaves differently from a uterus with multiple fibroids of varying sizes. Total uterine volume and the combined fibroid burden determine symptom severity, surgical complexity, and the likelihood that conservative management will remain adequate over time.
Endometrial cavity distortion
Whether fibroids distort the uterine cavity is critical for patients concerned about fertility or implantation. Cavity distortion by submucosal or large intramural fibroids is associated with reduced IVF success rates and may warrant removal before fertility treatment.
Symptom severity assessment
Bleeding volume, menstrual cycle length, pad and tampon use, clot passage, pelvic pressure, urinary frequency, bowel changes, and pain — all documented systematically at each monitoring visit to track trajectory and identify when symptoms cross the threshold for intervention.
Growth rate tracking
Fibroids that grow slowly over years are managed differently from those that double in size over 6 months. Serial ultrasound at monitoring visits establishes individual growth patterns and identifies rapid growth that may indicate a need for more prompt intervention or additional evaluation.
Iron and anemia assessment
Heavy fibroid-related bleeding causes iron-deficiency anemia in a significant proportion of women with symptomatic fibroids — often without the patient recognizing the connection between fatigue, weakness, and their menstrual blood loss. CBC and iron studies are reviewed at monitoring visits.
When Monitoring Is Right — and When It Is Time to Intervene
Not every fibroid needs treatment — and not every symptomatic fibroid needs surgery. Dr. Andrei applies a structured framework to determine where each patient sits on the management spectrum at every monitoring visit.
- Watchful waiting appropriate when fibroids are small, asymptomatic, and not distorting the uterine cavity
- Medical management — hormonal IUD, GnRH agonists, GnRH antagonists — for symptom control without surgery
- Elagolix (Oriahnn) and relugolix (Myfembree) discussed for heavy bleeding management when surgery is being deferred
- Intervention discussion triggered by: significant growth, worsening symptoms, new anemia, cavity distortion, or fertility concerns
- Hysteroscopic myomectomy for submucosal fibroids — in-office or at McLaren/Henry Ford depending on size
- Laparoscopic or robotic myomectomy for intramural and subserosal fibroids when uterine preservation is the goal
- Hysterectomy discussed when fibroids are the primary driver of symptoms and uterine preservation is not a priority
“The worst fibroid management is passive watchful waiting — where a patient is told her fibroids are not big enough to operate on and sent home with no follow-up plan. Active monitoring means we know what we are watching for, when we will re-image, and exactly what findings will prompt a conversation about next steps.”
- Initial evaluation includes transvaginal ultrasound and full symptom assessment
- Follow-up ultrasound every 6–12 months for patients in active monitoring
- MRI ordered when surgical planning requires precise fibroid mapping
- Surgical options at McLaren Lapeer, McLaren Flint, and Henry Ford Rochester
- Fertility considerations addressed at every monitoring visit for patients who want to conceive
Questions About Fibroid Evaluation and Monitoring
Know What You Have.
Know What to Watch For.
Fibroid evaluation and structured monitoring with Dr. Andrei — baseline imaging, symptom assessment, growth tracking, and a clear intervention threshold. Active management, not passive waiting.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.