Surveillance Frequency for Uterine Fibroids

Introduction to Surveillance

The American College of Radiology states that 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, 2, 3

The American College of Radiology explicitly states there is no specific consensus on imaging surveillance of asymptomatic patients with fibroids 1, 2, 3
Assess for rapid growth, particularly in perimenopausal women, as this may indicate sarcoma (though extremely rare at <1 in 1000 cases) 4

Most studies evaluate patients at immediate post-procedure, 3 months, and 12 months after uterine artery embolization (UAE) treatment 1, 2, 5
Most fibroid size reduction occurs within the first 6 months, with continued decrease between 6-12 months 3, 5
Median fibroid volume reduction of 42% by 3 months, with >50% average decrease maintained at 5 years (excluding Praxis Medical Insights) is not included as per instruction, instead: Routine posttreatment surveillance remains controversial with no consensus on when to image asymptomatic women post-intervention 2, 5

Transvaginal ultrasound (TVUS) combined with transabdominal ultrasound (TAUS) is the most frequently used and efficient modality for post-treatment follow-up 1, 3, 5
MRI with gadolinium contrast is preferred when clinically indicated, particularly to assess fibroid infarction (>90% infarction correlates with better symptom control) 2, 5

Any rapid increase in fibroid size, particularly in perimenopausal women, should be investigated as it may indicate sarcoma 4
During selective progesterone receptor modulator (SPRM) treatment courses, ultrasound measurement is not clinically indicated 4, 6

Avoid routine scheduled imaging in truly asymptomatic patients as it provides no proven benefit and increases healthcare costs 1, 3
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 4

The American College of Radiology recommends that imaging should be symptom-driven rather than protocol-based for asymptomatic patients after surgical myomectomy, as there is no specific consensus on surveillance intervals 7
If symptoms develop, such as bleeding, pain, or pressure, obtaining transvaginal ultrasound combined with transabdominal ultrasound is recommended to assess for recurrence 7

The American College of Radiology suggests following a structured imaging protocol after UAE, with follow-up at immediate post-procedure, 3 months, and 12 months 7, 8
At 3-6 months post-UAE, reevaluation for treatment efficacy with imaging is recommended to determine fibroid volume reduction and assess for incomplete infarction 8
MRI with gadolinium is specifically recommended after UAE to ensure adequate fibroid infarction and to exclude underlying leiomyosarcoma 8
Most fibroid size reduction occurs within the first 6 months, with continued decrease between 6-12 months 7
Transvaginal ultrasound combined with transabdominal ultrasound is the most efficient modality for routine post-UAE follow-up when MRI is not clinically indicated 7
Symptom recurrence occurs in 20-25% at 5-7 years, warranting imaging only when symptoms develop 8
Post-UAE complications, such as fever or severe pain, within the first month may require CT with IV contrast rather than ultrasound to evaluate for infection, hemorrhage, or venous thrombosis 7