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Fibroid Appointment Prep Checklist

A practical checklist for a fibroid visit, with bleeding notes, clot and flooding notes, anemia symptoms, pressure symptoms, ultrasound history, questions, and a short visit summary.

Use this before a fibroid visit. It helps you bring clear notes. It does not diagnose fibroids.

If bleeding is heavy now, pain is severe, you feel faint, or you may be pregnant, seek urgent or emergency care.

One page visit sheet

Fill this out first. Bring extra logs only if needed.

Topic Your note Main reason for this visit Date symptoms started Recent period start dates Heaviest bleeding day Flooding or leaks Clot size and how often Worst pain or pressure score, 0 to 10 Bladder or bowel symptoms Anemia symptoms Past ultrasound or imaging Medicines or steps tried Main question for the clinician

Bleeding pattern

Bring dates and plain counts. Estimates are okay.

Cycle Start date End date Heaviest day Products used on heaviest day Leaks or flooding Clots 1 2 3

Helpful notes sound like this:

"Soaked a pad in about an hour." "Passed quarter size clots on day 2." "Leaked through pants at work." "Bled for 9 days."

Use the fibroid bleeding and clot log if you want a full page for this.

Anemia symptoms

Heavy bleeding can be linked with anemia. Do not guess. Ask what testing fits your case.

Symptom When it happens Notes Fatigue Dizziness or faint feeling Shortness of breath Fast heartbeat Headaches Weakness Cold hands or feet

Ask:

Do I need a complete blood count? Do I need iron or ferritin checked? Which symptoms should make me call sooner?

Pressure, bladder, and bowel notes

Fibroids can cause pressure symptoms for some people. Track what you feel and when it happens.

Symptom During period Other days Your note Pelvic pressure Full or heavy belly feeling Lower back pain Need to pee often Trouble emptying bladder Constipation Pain with bowel movements

Use the fibroid pressure, bladder, and bowel log if pressure symptoms are the main issue.

Ultrasound and imaging history

Write down what you know. You do not need to read the images yourself.

Question Your note Have you had a pelvic ultrasound? Date and location of last scan Was it abdominal, transvaginal, or both? Did the report mention fibroids? Did it list size or location? Did it mention the uterine lining? Do you have the report?

Questions to ask:

What did the scan show? Where are the fibroids? How large are they? Could their location fit my symptoms? Do we need repeat imaging? What should I track before the next visit?

Use the fibroid ultrasound question list if imaging is part of the visit.

Optional fertility and pregnancy goals

You choose what to share. Skip this section if it does not fit your visit.

Topic Share? Your note Trying to get pregnant now Yes / no / maybe May want pregnancy later Yes / no / maybe Current pregnancy concern Yes / no / maybe Past pregnancy loss Yes / no / maybe Birth plans or uterus sparing goals Yes / no / maybe

Ask how any test, medicine, procedure, or surgery could affect your goals. This sheet does not choose a path.

Medicines and steps tried

Do not change medicines because of this sheet. Just list what happened.

What you tried Date or cycle Why you tried it Helped? Side effects or notes Pain medicine Hormone medicine or birth control Iron or supplement Heat or rest Prior procedure Other

Bring the names and doses if you know them. If you do not know, bring the bottle or a photo of the label.

Questions to bring

Pick the questions that fit.

Could my symptoms fit fibroids? What else could cause this pattern? Do I need an exam today? Do I need lab work for anemia? Do I need ultrasound or other imaging? What did my past scan show? What symptoms should make me call sooner? What should I track before follow up? How often should we check symptoms or imaging? Should I see a fibroid specialist? How might my fertility or pregnancy goals affect next steps? What are the risks and limits of each option we discuss?

Short visit summary

Bring the smallest useful record.

Bring Skip unless needed Recent period start dates Full app export Heavy bleeding summary Private notes not tied to care Clot and flooding notes Raw screenshots Pressure and bladder summary Old data that does not fit this visit Medicines tried Sex notes unless you choose to share them Ultrasound dates and reports Full phone access

Ask:

What data do you need today? Is a one page summary enough? Will this export go in my medical record? Can I leave out notes that are not needed?

Read the fibroid data privacy checklist before you share a full export.

Track after the visit

Ask the clinician what to track next. If you are unsure, track the basics.

Track Why it helps Period start and end dates Shows length and timing. Heavy days Shows when bleeding peaks. Clots and flooding Shows what disrupts daily life. Anemia symptoms Shows how bleeding may affect you. Pressure symptoms Shows whether pressure changes. Bladder and bowel notes Shows if symptoms repeat. Medicines tried Shows what happened after each change.

For more context, read fibroid symptom tracking, fibroid cycle changes, and heavy bleeding with fibroids. If you want a shorter tool first, use the fibroid symptom checklist.