Home > Adults > Gynaecology >

Fibroids

Share Print Feedback

Checked: 23-08-2021 by Rob Adams Next Review: 23-08-2022

Overview

Guidelines are available for assessment and management of fibroids in CKS.

Minimally Symptomatic/Asymptomatic Fibroids.

NICE guidelines suggest that these can usually be managed expectantly.

Referral is only required if there are:

Symptoms (for example, heavy menstrual bleeding) that have not improved despite initial treatments. Use of NSAIDs and/or tranexamic acid should be stopped if symptoms have not improved within 3 menstrual cycles. Please also see the Menstrual Disorders page.
Complications, such as compressive symptoms from large fibroids (for example dyspareunia, pelvic pain or discomfort, constipation, or urinary symptoms).
Fertility or obstetric problems associated with fibroids (but please note that locally Fertility Assessment and Treatment Policy applies).
A clinical or radiological suspicion of malignancy.
Fibroids which are palpable abdominally, or intracavity fibroids and/or whose uterine length is measured at ultrasound, or hysteroscopy, greater than 12 cm.

Red Flags

Please see the Gynaecology - USC (2WW) page for indications for USC/2WW referral such as:

Ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).

If patient c/o following symptoms on a persistent or frequent basis then investigate in primary care with CA125 and other tests as indicated:

Persistent abdominal distension (women often refer to this as 'bloating').
Feeling full (early satiety) and/or loss of appetite.
Pelvic or abdominal pain.
Increased urinary urgency and/or frequency.
Symptoms that suggest IBS which rarely presents for the first time in women over the age 50

Before Referral

Examination

On abdominal and pelvic examination there may be:

Typically a firm, enlarged, and irregularly shaped non-tender uterus on pelvic examination.
A central irregular abdominal mass (if a large fibroid).

USS

Pelvic or renal tract ultrasound may show:

Classical appearance of uterine fibroid(s).
Evidence of a complication such as hydronephrosis if a large fibroid causes ureteric compression.

Advice and Guidance

Consider Advice & Guidance Service if uncertainty about need for referral

Referral

If indicated, referrals should be made to Gynaecology via e-RS and should include a recent BP and BMI and results of USS.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.