| Approach |
Appropriate population |
Description |
| Hysterectomy |
Women who require removal of uterus, who are close to menopause, or who do not desire fertility |
- Definitive therapy
- Removes entire uterus and therefore prevents fibroid regrowth
- Loss of fertility
- Surgical morbidity including post-operative, pain, infection and urinary complications, and/or mortality,
- Requires hospitalisation and is a costly procedure
|
| Myomectomy |
Women with visible and/or palpable fibroids |
- A surgical alternative to treat fibroids in women who wish to preserve their fertility
- Recurrence of fibroids may occur; a,re-intervention rate of 10% to 25% has been reported
- Surgical morbidity including post-operative, pain, infection, urinary complications, injury to bladder, bowel, and blood vessels, post-operative adhesions (can cause bladder obstruction and pain), and or/mortality
|
| UAE (Uterine,Artery Embolisation) |
Women who have small uterine fibroids (<8cm) that are not subserous, submucosal, or pedunculated |
- Minimally invasive surgical procedure
- Morbidity including pain, possible, post-embolisation syndrome, possibility of severe complications
- Impact on fertility is unknown
- Costly; must be performed by an interventional radiologist
- Re-intervention rate of 15% to 35%
|
| Myolysis/cryomyolysis |
Women who do not desire fertility with several, small uterine fibroids |
- Preserves uterus, outpatient surgery
- Risk of adhesions, less effective for large and multiple fibroids, under treatment or overtreatment, fertility not advised
|
| MRgFUS (Magnetic,Resonance-guided focused Ultrasound Surgery) |
Women with small uterine fibroids (<8cm) |
- Incisionless and bloodless (therefore, allows fast return to normal activities)
- Insufficient data is available regarding the effect of MRgFUS on fertility, likeliness of recurrence of fibroids, and long-term effects
- Experimental procedure only available at very few centres
- Costly; must be performed by an interventional radiologist
|
| LUAO (Laparoscopic,Uterine Artery Occlusion) |
Women with small or large fibroids, subserosal fibroids |
- Requires technical skill
- Dependent on fibroid location
- Recurrence of fibroids may occur
- Effect on fertility is unclear
- Data on LUAO is limited, and there is insufficient long-term data available
|
