Algorithm for the Management of Uterine Fibroids

Algorithm for the Management of Uterine Fibroids - Flowchart Uterine Fibroids Uterine Fibroids

«Flowchart»

Uterine myomas

Asymptomatic

Symptomatic

Clinical surveillance

End

Enhance fertility

Retain fertility

Retain uterus

Other

See SOGC Guideline^*

^* *

Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy

Hysteroscopic
Laparoscopic
Laparotomic

AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

AUB

AUB AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic AUB

Bulk effects ± AUB

Interventional therapy:

UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Interventional therapy:

UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Hysterectomy ± BSO

AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

AUB

AUB AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic AUB

Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Bulk effects ± AUB

Interventional therapy:

UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Interventional therapy:

UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

AUB

AUB AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic AUB

Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Bulk effects ± AUB

Interventional therapy:

UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Interventional therapy:

UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Hysterectomy ± BSO

Investigations:

Endometrial biopsy
Imaging
Hysteroscopy

Investigations:

Endometrial biopsy
Imaging
Hysteroscopy

Investigations:

Endometrial biopsy
Imaging
Hysteroscopy

Hysterectomy ± BSO

Hysteroscopic myomectomy

^* Carranza-Mamane B, Havelock J, Hemmings R; Society of Obstetrics and Gynaecology Canada Reproductive Endocrinology and Infertility Committee: The management of uterine fibroids in women with otherwise unexplained infertility. SOGC Clinical Practice Guidelines. J Obstet Gynaecol Can, 2015.

^* J Obstet Gynaecol Can J Obstet Gynaecol Can ,

See SOGC Guideline^*

^* * See SOGC Guideline

AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

AUB

AUB AUB

Medical therapy:

SPRM (Ulipristal)
OC
Danazol
LNG-IUS
Tranexamic acid
GnRH agonist ± add-back

Surgical therapy:
Myomectomy

Surgical therapy:

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic AUB

Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Hysteroscopic
Laparoscopic
Laparotomic

Bulk effects ± AUB

Bulk effects ± AUB Bulk effects ± AUB

Medical therapy:

SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy

Hysteroscopic
Laparoscopic
Laparotomic

Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Premenopause

Postmenopause