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

Uterine myomas

Uterine myomas

Uterine myomas

Asymptomatic

Asymptomatic

Asymptomatic

Symptomatic

Symptomatic

Symptomatic

Clinical surveillance

Clinical surveillance

Clinical surveillance

End

End

End

Pre-menopause

Pre-menopause

Pre-menopause

Post-menopause

Post-menopause

Post-menopause

Enhance fertility

Enhance fertility

Enhance fertility

Retain fertility

Retain fertility

Retain fertility

Retain uterus

Retain uterus

Retain uterus

Other

Other

Other

See SOGC Guideline*

See SOGC Guideline*

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:

Medical therapy:


SPRM (Ulipristal)
GnRH-agonist ± add-back


SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy


Hysteroscopic
Laparoscopic
Laparotomic


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:

Medical therapy:


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


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:

Interventional therapy:


UAE
MRg-FUS
Myolysis


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:

Medical therapy:


SPRM (Ulipristal)
GnRH-agonist ± add-back


SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy


Hysteroscopic
Laparoscopic
Laparotomic


Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Hysterectomy ± BSO

Hysterectomy ± BSO

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:

Medical therapy:


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


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:

Medical therapy:


SPRM (Ulipristal)
GnRH-agonist ± add-back


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:

Interventional therapy:


UAE
MRg-FUS
Myolysis


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:

Medical therapy:


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


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:

Medical therapy:


SPRM (Ulipristal)
GnRH-agonist ± add-back


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:

Interventional therapy:


UAE
MRg-FUS
Myolysis


UAE
MRg-FUS
Myolysis

Surgical therapy:
Myomectomy ± EA

Surgical therapy:


Hysteroscopic
Laparoscopic
Laparotomic


Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB

Hysterectomy ± BSO

Hysterectomy ± BSO

Hysterectomy ± BSO

Hysterectomy ± BSO

Hysterectomy ± BSO

Hysterectomy ± BSO

Investigations:


Endometrial biopsy
Imaging
Hysteroscopy

Investigations:


Endometrial biopsy
Imaging
Hysteroscopy

Investigations:


Endometrial biopsy
Imaging
Hysteroscopy


Endometrial biopsy
Imaging
Hysteroscopy

Hysterectomy ± BSO

Hysterectomy ± BSO

Hysterectomy ± BSO

Hysteroscopic myomectomy

Hysteroscopic myomectomy

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.

* 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.

* 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 ,

BSO, Bilateral salpingo-oophorectomy; MRg-FUS, magnetic resonance-guided focused ultrasound; OC, oral contraceptives

BSO, Bilateral salpingo-oophorectomy; MRg-FUS, magnetic resonance-guided focused ultrasound; OC, oral contraceptives

BSO, Bilateral salpingo-oophorectomy; MRg-FUS, magnetic resonance-guided focused ultrasound; OC, oral contraceptives

BSO BSO MRg-FUS MRg-FUS OC OC

GnRH, Gonadotropin-releasing hormone; UAE, uterine artery embolization.

GnRH, Gonadotropin-releasing hormone; UAE, uterine artery embolization.

GnRH, Gonadotropin-releasing hormone; UAE, uterine artery embolization.

GnRH UAE

See SOGC Guideline*

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:

Medical therapy:


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


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:

Medical therapy:


SPRM (Ulipristal)
GnRH-agonist ± add-back


SPRM (Ulipristal)
GnRH-agonist ± add-back

Surgical therapy
Myomectomy

Surgical therapy


Hysteroscopic
Laparoscopic
Laparotomic


Hysteroscopic
Laparoscopic
Laparotomic Bulk effects ± AUB