Appraisal of national and international uterine fibroid management guidelines: a systematic review

Abstract

Background Guidelines standardise high-quality evidence-based management strategies for clinicians. Uterine fibroids are a highly prevalent condition and may exert significant morbidity. Objectives The purpose of this study was to appraise national and international uterine fibroid guidelines using the validated AGREE-II instrument. Selection Strategy An electronic database search of PubMed and EMBASE from inception to October 2020 for all published English-language uterine fibroid clinical practice guidelines was undertaken. Data Collection and Analysis 939 abstracts were screened for eligibility by two reviewers independently. Three reviewers used the AGREE-II instrument to assess guideline quality in six domains (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence). Recommendations were mapped to allow a narrative synthesis regarding areas of consensus and disagreement. Main Results Eight national (AAGL, SOGC 2014, ACOG, ACR, SOGC 2019, CNGOF, ASRM, and SOGC 2015) and one international guideline (RANZOG) were appraised. The highest scoring guideline was RANZOG 2001(score 56.5%). None of the guidelines met the a priori criteria for being high-quality overall (score >= 66%). There were 166 recommendations across guidelines. There were several areas of disagreement and uncertainty. Conclusions There is a need for high-quality fibroid guidelines given heterogeneity across individuals and a large range of treatment modalities available. There are also areas of controversy in the management of fibroids (e.g. Ulipristal acetate, power morcellation) which also should be addressed in any guidelines. Future guidelines should be methodologically robust to allow high-quality decision-making regarding fibroid treatments.

Dysmenorrhea across the lifespan: a biopsychosocial perspective to understanding the dysmenorrhea trajectory and association with comorbid pain experiences

“…101 Secondary dysmenorrhea is menstrual pain associated with underlying pathology. 101 Significantly, more research focuses on secondary dysmenorrhea 7,69,129 ; yet, across dysmenorrhea types, biomedical etiological and treatment models have prevailed. For example, endometriosis is the commonest condition associated with period and pelvic pain, with the gold standard for identification necessitating laparoscopic surgery.…”

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

“…By guiding the patient to take a comfortable position, relax the abdominal muscle, chat, watch TV and other methods to distract attention, in order to alleviate pain. Severe pain can be given analgesics according to the doctor' s advice, so that patients with postoperative pain greatly reduced [21][22][23].…”

Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding

“…Treatment options are dictated by patient compliance, age, fertility preservation, and other common (co)morbidities such as endometriosis, adenomyosis, endometrial polyps, and endometrial hyperplasia that cause overlapping symptoms [pain and abnormal uterine bleeding ( 4 )]. Follow-up evaluations of the tumor growth rate are recommended for asymptomatic fibroids by most evidence-based guidelines ( 18 ). Treatment options can be loosely classified by degree of invasiveness and the risk of reintervention ( Table 1 ).…”