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Fibroids (DRAFT)

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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.

Refer 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 Abnormal Vaginal Bleeding 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).
Fibroids which are palpable abdominally, or intracavity fibroids and/or whose uterine length is measured at ultrasound, or hysteroscopy, greater than 12 cm.

If indicated, referrals should be made to Gynaecology via e-RS and should include a recent BP, BMI and results of USS. Please comment on whether fertility is desired, in order to ensure the women is seen in the most appropriate clinic.

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).
Rapidly enlarging fibroids.

Helpful pages

The following pages may be helpful:

Pelvic mass – urgent suspicion cancer page

Abnormal vaginal bleeding

Pelvic pain

Advice and Guidance

Consider Advice & Guidance Service if uncertainty about need for referral

Resources

For patients:

Decision aid for heavy menstrual bleeding (covers options for fibroids) Making a decision about: managing heavy periods

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.