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 To appraise national and international uterine fibroid guidelines using the validated AGREE-II instrument.Selection strategy Database search of PubMed and EMBASE from inception to October 2020 for all published English-language uterine fibroid clinical practice guidelines.Data collection and analysis In all, 939 abstracts were screened for eligibility by two reviewers independently. Three reviewers used the AGREE-II instrument to assess guideline quality in six domains. Recommendations were mapped to allow a narrative synthesis regarding areas of consensus and disagreement.

Uterine‐preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: A retrospective cohort study of long‐term outcomes

“…Although UAE is uterine-preserving, national fibroid management guidelines advocate against its use in those who have pregnancy aspirations because of uncertain adverse effects on the endometrium or ovarian reserve. 5 Several small studies indicate patient-reported quality of life and satisfaction scores are not significantly different after UAE and myomectomy, at least in the short-term. [6][7][8] These treatments may be associated with acceptable postprocedural length of stays and few major complications.…”

“…Myomectomy represents an option for those requiring fertility preservation. Although UAE is uterine‐preserving, national fibroid management guidelines advocate against its use in those who have pregnancy aspirations because of uncertain adverse effects on the endometrium or ovarian reserve 5 …”

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.…”

Relugolix/Estradiol/Norethisterone (Norethindrone) Acetate: A Review in Symptomatic Uterine Fibroids

“…A comparative effectiveness review conducted by the Agency for Healthcare Research and Quality in the USA in 2017 concluded that the current state of evidence base does not permit drawing definitive conclusions about the relative risks, benefits and costs of available treatment options for uterine fibroids [ 31 ]. This deficit is, perhaps, reflected in the low quality of national and international treatment guidelines for uterine fibroids, where there are several areas of disagreement and uncertainty, with very little consensus [ 32 ]. Accentuating this reality, current NICE guidelines for the medical treatment of HMB due to uterine fibroids in women of reproductive age includes several treatments that are not specifically approved for use in this population [ 33 ].…”