ProcedurePath Personalized Fibroid Consult Worksheet

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Step 1: What kind of visit are you preparing for? First fibroid consult. Follow-up or second opinion. OB-GYN visit. IR / fibroid embolization consult. Surgery discussion. I am not sure yet.

Step 2: Symptoms you are currently experiencing Heavy or prolonged menstrual bleeding. Bleeding between periods. Pelvic pain or cramping. Pelvic pressure or feeling of fullness. Frequent urination or difficulty emptying the bladder. Constipation or bowel pressure. Abdominal bloating or visible enlargement. Fatigue or shortness of breath. Pain during sex.

Step 3: How severe are your symptoms right now? Managing okay, this is a routine planning visit. Symptoms are affecting my daily life or work. Bleeding or pain is getting significantly worse. Severe bleeding or emergency care.

Step 4: Menstrual / menopause status Premenopausal / still having regular periods. Perimenopausal / periods are changing or irregular. Postmenopausal / no periods for 12 months or more. I am not sure.

Step 5: What matters most to you going into this visit? Getting my bleeding under control. Preserving fertility or future pregnancy options. Understanding all my options before deciding anything. Finding the least invasive path forward. Getting back to normal life as fast as possible. Getting a clear recommendation I can act on.

Step 6: Important context for this visit I have been told I am anemic or have low iron. I strongly want to avoid surgery if reasonable. I want the most definitive option, even if recovery is longer. I am trying to get pregnant now or soon. Keeping my uterus matters, even if I am not planning pregnancy. I am pregnant or could be pregnant.

Step 7: What imaging have you already had? Pelvic MRI. Pelvic ultrasound. No imaging yet.

Step 8: Fibroid type / location, as described on imaging reports

Skipped for now because you selected no imaging yet. Your checklist will focus on what imaging to ask about before discussing fibroid location.

Submucosal, inside the uterine cavity (affects bleeding most). Intramural, within the uterine wall (most common type). Subserosal, on the outer surface of the uterus. Pedunculated, attached by a stalk (can be inside or outside). Cervical, near or at the cervix. Report mentions cavity distortion. Report says a fibroid is large or the uterus is enlarged. Report says there are multiple fibroids. Report mentions rapid growth, degeneration, atypical features, or uncertain diagnosis. I do not know. I have not had imaging to confirm location yet.

Step 9: Medications already tried Birth control pill (combined estrogen + progestin). Progestin-only pill or injection (e.g. Depo-Provera). Hormonal IUD (e.g. Mirena). GnRH agonist (e.g. Lupron, Zoladex). GnRH antagonist (e.g. Orilissa/elagolix, Myfembree, Oriahnn). Tranexamic acid (Lysteda) for bleeding control. NSAIDs (e.g. ibuprofen, naproxen) for pain or bleeding. Iron supplements or infusions for anemia. I have not tried any medications yet.

Step 10: Procedures already tried Uterine fibroid embolization (UFE). Myomectomy (surgical removal of fibroids, laparoscopic or open). Hysteroscopic myomectomy (removal through the cervix, no incision). Endometrial ablation (destroys the uterine lining). MRI-guided focused ultrasound (MRgFUS / Sonalleve). D&C (dilation and curettage), often done for bleeding. I have not had any procedures yet.

Step 11: What have you already been told? I have been told to wait and monitor. I have been told I need a hysterectomy. I have been told I need a myomectomy. I have been told about fibroid embolization as a treatment option. I have been told my fibroids are too large to treat without surgery. I have not received a clear recommendation yet.

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