Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228

Obstet Gynecol. 2021 Jun 1;137(6):e100-e115. doi: 10.1097/AOG.0000000000004401.

Abstract

Uterine leiomyomas (fibroids) are the most common solid and symptomatic neoplasm in women. They are the leading indication for hysterectomy (1, 2), which is a definitive and effective surgical treatment for leiomyoma. However, many patients benefit from and seek out management options other than hysterectomy because they desire future childbearing or wish to retain their uterus. The purpose of this Practice Bulletin is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas. Discussion of the use of morcellation in the surgical management of leiomyomas is beyond the scope of this document and is addressed in a separate American College of Obstetricians and Gynecologists (ACOG) publication (3).

Publication types

  • Practice Guideline

MeSH terms

  • Antifibrinolytic Agents / therapeutic use
  • Contraceptive Agents, Hormonal / therapeutic use*
  • Endometrial Ablation Techniques
  • Ethinyl Estradiol / therapeutic use
  • Female
  • Gonadotropin-Releasing Hormone* / agonists
  • Gonadotropin-Releasing Hormone* / antagonists & inhibitors
  • Humans
  • Hysterectomy
  • Intrauterine Devices, Medicated*
  • Leiomyoma / complications
  • Leiomyoma / diagnosis
  • Leiomyoma / epidemiology
  • Leiomyoma / therapy*
  • Levonorgestrel / therapeutic use*
  • Tranexamic Acid / therapeutic use
  • Uterine Artery Embolization
  • Uterine Hemorrhage / etiology
  • Uterine Hemorrhage / therapy
  • Uterine Myomectomy
  • Uterine Neoplasms / complications
  • Uterine Neoplasms / diagnosis
  • Uterine Neoplasms / epidemiology
  • Uterine Neoplasms / therapy*
  • Watchful Waiting

Substances

  • Antifibrinolytic Agents
  • Contraceptive Agents, Hormonal
  • Gonadotropin-Releasing Hormone
  • Ethinyl Estradiol
  • Levonorgestrel
  • Tranexamic Acid