nursing care plan for uterine fibroids

Accessed April 24, 2019. The needles heat up the fibroid tissue, destroying it. PMID: 18823754, Viswanathan M, Ansari MT, Berkman ND, et al. Develop early identification of the changes in skin integrity. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. https://www.uptodate.com/contents/search. urinary elimination related to uterine fibroids, impaired physical mobility nursing care plan, nursing care plans for a urinary tract . To ensure comprehensive retrieval of relevant studies, we will search MEDLINE via PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), EMBASE, and the Cochrane Library to identify relevant publications. AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the effective health-care program. Uterine fibroids, which your doctor may call leiomyomas or myomas, are muscular tumors that can grow on your uterus. Obstet Gynecol. Nursing Care Plan Uterine Fibroids Many physicists using number of factors are plagued homeopathy in all other treatment must aim to eliminate. In other words, they are . Uterine fibroids may be associated with infertility, and some experts recommend that women with infertility be evaluated for fibroids, with potential removal if the tumors have a submucosal component.14 However, there is no evidence from randomized controlled trials to support myomectomy to improve fertility.15 One meta-analysis included two studies that showed improvement in spontaneous conception rates in women who underwent myomectomy for submucosal fibroids (relative risk [RR] = 2.034; 95% confidence interval [CI], 1.081 to 3.826; P = .028).16 However, no statistically significant difference was noted in the ongoing pregnancy/live birth rate. We summarize the inclusion criteria in Table 2. 2003 Mar;101(3):431-7. Compared with hysterectomy and myomectomy, uterine artery embolization has a significantly decreased length of hospitalization (mean of three fewer days), decreased time to normal activities (mean of 14 days), and a decreased likelihood of blood transfusion (OR = 0.07; 95% CI, 0.01 to 0.52).42 Long-term studies show a reoperation rate of 20% to 33% within 18 months to five years.24 Contraindications include pregnancy, active uterine or adnexal infections, allergy to intravenous contrast media, and renal insufficiency. The forms used for the full-text screening level will include additional questions to identify studies that meet all the inclusion criteria. Clinical practice. In this procedure, a thin tube called an endoscope is passed through the cervix and into the uterus. Your doctor views your abdominal area on a monitor using a small camera attached to one of the instruments. Older cost data also have limited utility. Jun 11, 2019. Laughlin-Tommaso SK (expert opinion). However, SPRMs can result in progesterone receptor modulatorassociated endometrial changes, although these seem to be benign.36, Other Agents. It is defined as excessive menstrual bleeding with a loss of more than 80ml of blood per month. Kaunitz AM. Am J Obstet Gynecol. Available at. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids. 2011 Nov;205(5):492 e1-5. The search and selection literature sources may be refined following discussions with Technical Experts. Laboratory examination. Self-reported heavy bleeding associated with uterine leiomyomata. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication, Updated [WebContent]. 2015;372:1646. 3rd ed. This technique can be effective in shrinking fibroids and relieving the symptoms they cause. This review will not include studies that evaluate the effectiveness of preoperative or adjunctive interventions to minimize blood loss or otherwise improve operative outcomes. Generally, trial sizes are too small for sub-group analyses within individual studies to have adequate statistical power. The quantity and quality of research on fibroid management has steadily improved in recent years. If you have symptoms of uterine fibroids, your doctor may order these tests: Ultrasound. Hysteroscopic myomectomy is the preferred surgical procedure for women with submucosal fibroids who wish to preserve their uterus or fertility. Patient information: A handout on this topic is available at https://familydoctor.org/familydoctor/en/diseases-conditions/uterine-fibroids.html. Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF). The domains of consistency and precision will be assessed based on the direction and variation of the estimates. Chicago Med's . Rockville, MD: Agency for Healthcare Research and Quality; 2011. Obstetrics and Gynecology Clinics of North America. Although studies have had conflicting results on the change in fibroid size during pregnancy,17,18 a large retrospective study of women with uterine fibroids found a significantly increased risk of cesarean delivery compared with a control group (33.1% vs. 24.2%), as well as increases in the risk of breech presentation (5.3% vs. 3.1%), pre-term premature rupture of membranes (3.3% vs. 2.4%), delivery before 37 weeks' gestation (15.1% vs. 10.5%), and intrauterine fetal death with growth restriction (3.9% vs. 1.5%).19 Therefore, fibroids in pregnant women warrant additional maternal and fetal surveillance. What is the risk of cancer dissemination from morcellation of uterine fibroids at the time of myomectomy or hysterectomy? The American College of Obstetrics and Gynecology (ACOG) has just released updated guidelines on management of symptomatic uterine fibroids (leiomyomas). 3rd ed. Being informed makes all the difference. It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. Aromatase inhibitors (e.g., letrozole [Femara], anastrozole [Arimidex], fadrozole [not available in the United States]) block the synthesis of estrogen. If you have small fibroids, develop a plan with your healthcare provider to monitor them. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of . This nursing care plan for a Hysterectomy and includes a diagnosis and care plan for nurses with nursing interventions and outcomes for the following conditions: Risk for Infection and Grieving related to loss of body part. Uterine leiomyomas, or fibroids, are a major cause of abnormal uterine bleeding in women. Uterine carcinosarcoma (considered an epithelial neoplasm), Uterine sarcoma (leiomyosarcoma, endometrial stromal sarcoma, mixed mesodermal tumor), Preoperative treatment to decrease size of tumors before surgery or in women approaching menopause, Decrease blood loss, operative time, and recovery time, Long-term treatment associated with higher cost, menopausal symptoms, and bone loss; increased recurrence risk with myomectomy, Levonorgestrel-releasing intrauterine system (Mirena), Treats abnormal uterine bleeding, likely by stabilization of endometrium, Most effective medical treatment for reducing blood loss; decreases fibroid volume, Irregular uterine bleeding, increased risk of device expulsion, Yes, if discontinued after resolution of symptoms, Anti-inflammatories and prostaglandin inhibitors, Do not decrease fibroid volume; gastrointestinal adverse effects, Treat abnormal uterine bleeding, likely by stabilization of endometrium, Reduce blood loss from fibroids; ease of conversion to alternate therapy if not successful, Selective progesterone receptor modulators, Decrease blood loss, operative time, and recovery time; not associated with hypoestrogenic adverse effects, Headache and breast tenderness, progesterone receptor modulatorassociated endometrial changes; increased recurrence risk with myomectomy, Reduces blood loss from fibroids; ease of conversion to alternate therapy, Does not decrease fibroid volume; medical contraindications, Surgical removal of the uterus (transabdominally, transvaginally, or laparoscopically), Definitive treatment for women who do not wish to preserve fertility; transvaginal and laparoscopic approach associated with decreased pain, blood loss, and recovery time compared with transabdominal surgery, Surgical risks higher with transabdominal surgery (e.g., infection, pain, fever, increased blood loss and recovery time); morcellation with laparoscopic approach increases risk of iatrogenic dissemination of tissue, Magnetic resonanceguided focused ultrasound surgery, In situ destruction by high-intensity ultrasound waves, Noninvasive approach; shorter recovery time with modest symptom improvement, Heavy menses, pain from sciatic nerve irritation, higher reintervention rate, Surgical or endoscopic excision of tumors, Resolution of symptoms with preservation of fertility, Recurrence rate of 15% to 30% at five years, depending on size and extent of tumors, Interventional radiologic procedure to occlude uterine arteries, Minimally invasive; avoids surgery; short hospitalization, Recurrence rate > 17% at 30 months; postembolization syndrome, Infertile women with distorted uterine cavity (i.e., submucosal fibroids) who desire future fertility, Symptomatic women who desire future fertility, Symptomatic women who do not desire future fertility but wish to preserve the uterus, Medical treatment, myomectomy, uterine artery embolization, magnetic resonanceguided focused ultrasound surgery, Symptomatic women who want definitive treatment and do not desire future fertility, Hysterectomy by least invasive approach possible. Radiofrequency ablation. After locating a fibroid, your doctor uses a specialized device to deploy several small needles into the fibroid. https://effectivehealthcare.ahrq.gov/topics/uterine-fibroids/research-2017. We will compare the information in the SIPs with the biomedical literature and grey literature retrieval. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Uterine-Morcellation-for-Presumed-Leiomyomas. All myomectomies carry the risk of cutting into an undiagnosed cancer, but younger, premenopausal women generally have a lower risk of undiagnosed cancer than do older women. Food and Drug Administration. The growth promoting effects of these steroid hormones appear to be mediated . But if you are having bothersome symptoms, treatment is absolutely an option. They are much smaller in size than polyps, and they also do not have a pedicel. 11-EHC023-EF. We will conduct literature search updates periodically during preparation of the review and will conduct a final literature search update at the time of peer review of the draft report. The analytic framework illustrates the population, interventions, outcomes, and adverse effects that guide the literature search and synthesis. How big are they? However, studies do show that fibroids can continue to keep growing after menopause because there are other tissues in our body that produce estrogen besides the ovaries. Large fibroids, usually those bigger than 3 to 5 centimeters and cause issues with the placenta, growth of the baby, excessive bleeding during childbirth, preterm labor, and sometimes cause problems with delivery of the baby. Because of their role as end-users, individuals are invited to serve as Key Informants and those who present with potential conflicts may be retained. PMID: 22244472, Wechter ME, Stewart EA, Myers ER, et al. Your doctor may prescribe a GnRH agonist to shrink the size of your fibroids before a planned surgery or to help transition you to menopause. Expected outcomes: Pain does not exist or can be controlled . GnRH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone. So far, there's no scientific evidence to support the effectiveness of these techniques. Compared with placebo, a 5-mg dose of ulipristal significantly reduces mean blood loss (94% vs. 48% per cycle; 95% CI, 55% to 83%; P < .001), decreases fibroid volume by more than 25% (85% vs. 45%; 95% CI, 4% to 39%; P = .01), and induces amenorrhea in significantly more patients (94% vs. 48%; 95% CI, 50% to 77%; P < .001).52 Treatment is limited to three months of continuous use. Figure 1 presents an algorithm for the management of uterine fibroids.4, About 3% to 7% of untreated fibroids in premenopausal women regress over six months to three years, and most decrease in size at menopause. But this data is weak and furthermore, avoiding these exposures has not been shown to treat, shrink or prevent fibroids. This should be determined based on the design and quality of the studies, independently of the studies' relative effect sizes. In women undergoing hysterectomy for treatment of uterine fibroids, the least invasive approach possible should be chosen. Primary Care Management of Abnormal Uterine Bleeding. Uterine fibroids are benign uterine tumors of smooth muscle origin. New fibroids, which may or may not require treatment, also can develop. But just because they come back doesn't mean they need to be treated. We will use established concepts of the quantity of evidence (e.g., numbers of studies, aggregate ending-sample sizes), the quality of evidence (from the quality ratings on individual articles), and the coherence or consistency of findings across similar and dissimilar studies and in comparison to known or theoretically sound ideas of clinical or behavioral knowledge. Background and Objectives for the Systematic Review Topic background Most women will develop one or more uterine fibroids (i.e., leiomyomata), benign smooth muscle tumors of the uterus, during their reproductive lifespan.1 In the United States, an estimated 26 million women between the ages of 15 and 50 have uterine fibroids.1-4 More than 15 million of them will experience associated symptoms . Hartmann KE, Jerome RN, Lindegren ML, et al. 13(14)-EHC 130-EF. Across types of interventions, direct annual healthcare costs in the United States are projected to exceed $9.1 billion. Which nursing statement would best assess the client's coping abilities?, A 39-year-old female client has been experiencing intermittent vaginal bleeding for several months. Can treatment of uterine fibroids improve my fertility? Obstet Gynecol. Risk factors. The procedure is performed while you're inside an MRI scanner. We believe that additional evidence is needed before concluding either that the findings are stable or that the estimate of effect is close to the true effect. Nursing Care Plan: Uterine Myoma - Free download as Word Doc (.doc), PDF File (.pdf), Text File (.txt) or read online for free. Cheung VYT. Ferri FF. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. PMID: 19300327. The uterine wall consists of three layers: the . These benign tumours develop during the reproductive years and their growth has been shown to be dependent on the ovarian steroid hormones oestradiol and progesterone. Uterine fibroids can lead to gynecologic complications. 2005 Mar;105(3):563-8. An ultrasound probe gets images of the inside of the uterus to check for anything unusual. Obstet Gynecol. Hysteroscopic myomectomy - the fibroids are removed via the dilated cervix, so no abdominal incisions are . Key Informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. The methods for this systematic review will follow the AHRQ Methods Guide for Effectiveness and Comparative Effectiveness Reviews19 and the PRISMA-P20 statement checklist. The cause of fibroids is unknown. Small particles (embolic agents) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die. Age-specific incidence rates for self-reported uterine leiomyomata in the Black Women's Health Study. AHRQ Publication No 01-E052 Rockville, MD: Agency for Healthcare Research and Quality. Stewart EA (expert opinion). Uterine fibroids. Subgroup analysis can be undertaken in a variety of ways, from completely separate models at one extreme, to simply including a subgroup covariate in a single model at the other, with multilevel and random effects models somewhere in the middle. Mayo Clinic is a not-for-profit organization. During the next three to 12 months, the fibroid continues to shrink, improving symptoms. The conditions that can also affect pregnancy are fibroids, endometriosis, ovarian cysts, cervical dysplasia and more. This article updates a previous article on this topic by Evans and Brunsell. We do not anticipate that current studies can offer meaningful data to address a sequencing question. 2014 May-Jun;20(3):309-33. Jun 2, 2019. For studies that meet the eligibility criteria from the full-text review assessment, we will extract study characteristics (e.g., study design, year, setting, funding source, etc. Accessed April 24, 2019. Management of Uterine Fibroids. We will summarize data related to symptom status and prioritize patient-reported measures. A preliminary assessment of the published literature on uterine fibroid treatment suggests that limiting the search to studies published in or after 1985 does not omit critical literature. Click here for an email preview. Anti-progesterone effect - reduces action and number of progesterone receptors in fibroids and myometrium. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonanceguided focused ultrasound surgery. Listed below are six (6) nursing care plans (NCP) for Hysterectomy and TAHBSO. Her pre pregnancy weight was 250 lb, and she gained 30 lb during the pregnancy. Your first appointment will likely be with either your primary care provider or a gynecologist. PMID: 24401287, Hartmann KE, Birnbaum H, Ben-Hamadi R, et al. other information we have about you. Fibroids are not cancerous and are not thought to be able to become cancerous. With laparoscopic radiofrequency ablation (Acessa), also called Lap-RFA, your doctor makes two small incisions in the abdomen to insert a slim viewing instrument (laparoscope) with a camera at the tip. Jarell JF, et al. Patients who have underwent surgery for a hysterectomy, which is the removal of the female reproductive organs, are at risk for infection and may experience grieving . Also, some procedures such as laparoscopic or robotic myomectomy, radiofrequency ablation, or MRI-guided focused ultrasound surgery (FUS) may only treat some of the fibroids present at the time of treatment. Parker WH. Age. 2014 Dec 23PMID: 25542564. PMID: 18226615, Segars JH, Parrott EC, Nagel JD, et al. It is also known as Leiomyoma or Myoma. Nursing Care Plan: Uterine Myoma. In: Williams Gynecology. Health effects range from profound bleeding and anemia, to pelvic pressure or pain, urinary frequency, abnormal bowel function, and pain with intercourse, as well as concerns about influence on fertility and pregnancy outcomes.9, Fibroids are prevalent and symptoms are common among women with fibroids, creating considerable personal and societal costs including diminished quality of life, disruption of usual activities and roles, lost work time associated with symptoms, and substantial healthcare expenditures. When differences between the reviewers arise, we will err on the side of inclusion. Although aetiology and natural history of the conditions are markedly different, symptoms can overlap and make differential diagnoses necessary, often using invasive methods such as laparoscopy. It uses sound waves to get a picture of your uterus to confirm the diagnosis and to map and measure fibroids. Technical Experts do not do analysis of any kind nor do they contribute to the writing of the report. Uterine fibroids, or leiomyomas, are the most common . Randomized controlled trials are best suited to provide data for comparative effectiveness and there has been substantial growth in the variety and sophistication of trials since the prior review. Zimmermann A, Bernuit D, Gerlinger C, et al. Many women have significant hot flashes while using GnRH agonists. Fibroids (otherwise known as myomas or leiomyomas) are abnormal non-cancerous growths in the uterus. AskMayoExpert. Depending upon the quantity and size of the sources for the data, we may attempt to establish thresholds to assess overall high, medium or low risk of bias.25. Here are six (6) nursing care plans (NCP) and nursing diagnosis (NDx) for . New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Hysterectomy provides a definitive cure for women with symptomatic fibroids who do not wish to preserve fertility, resulting in complete resolution of symptoms and improved quality of life. 34, contract 290-97-0014 to the Duke Evidence-based Practice Center). The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. Sometimes, uterine fibroids can cause complications. painful sex. No evidence is available or the body of evidence has unacceptable deficiencies, precluding reaching a conclusion. Robotic myomectomy gives your surgeon a magnified, 3D view of your uterus, offering more precision, flexibility and dexterity than is possible using some other techniques. Uterine fibroids are frequently found incidentally during a routine pelvic exam. Below is the list of the 16 new NANDA Nursing Diagnoses 1. The best evidence we have for vitamin supplements is for vitamin D. Vitamin D deficiency, which is very common in people with dark skin, has been associated with fibroid growth in some studies. During hysteroscopy, a thin, lighted instrument (hysteroscope) provides a view of the inside of the uterus. This content does not have an Arabic version. Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia. Limited data does not support the use of herbal supplements like black cohosh or vaginal steaming. information and will only use or disclose that information as set forth in our notice of All Rights Reserved. The body of evidence has some deficiencies. This content does not have an English version. Larger fibroids can cause you to experience a variety of symptoms, including: Excessive or painful bleeding during your period (menstruation). Laughlin-Tommaso SK. Stewart EA, et al. It remains the only proven permanent solution for uterine fibroids. Prior reviews have reported on the effectiveness preoperative adjunctive treatments such as gonadotropin-releasing hormone (GnRH) agonists or cell savers. Never hesitate to ask your medical team any questions or concerns you have. Additionally, because these supplements are not FDA regulated, they may be dangerous to your health. Management of uterine fibroids (Evidence Report/Technology Assessment No. AHRQ Publication No. These random effects will allow estimates of overall (population) effects as well as an estimate of the variance of the effect across studies, after controlling for available study-level covariates. PMID: 11214143, Huyck KL, Panhuysen CI, Cuenco KT, et al. Hysterectomy. Patient-Centered Outcomes Research Institute (PCORI). 2016;43:397. Most women with uterine fibroids may be able to choose to keep their ovaries. Preoperative administration of GnRH agonists (e.g., leuprolide [Lupron], goserelin [Zoladex], triptorelin [Trelstar Depot]) increases hemoglobin levels preoperatively by 1.0 g per dL (10 g per L) and postoperatively by 0.8 g per dL (8 g per L), as well as significantly decreases pelvic symptom scores.32 Adverse effects resulting from the hypoestrogenized state, including hot flashes (OR = 6.5), vaginitis (OR = 4.0), sweating (OR = 8.3), and change in breast size (OR = 7.7), affect the long-term use of these agents.32, Compared with placebo, the SPRM mife-pristone (Mifeprex) significantly decreases heavy menstrual bleeding (OR = 18; 95% CI, 6.7 to 47) and improves fibroid-specific quality of life, but does not affect fibroid volume.35 Ulipristal (Ella) is an SPRM approved as a contraceptive in the United States but used in other countries for the treatment of fibroids in adult women who are eligible for surgery. showed that the estimated incidence of fibroids in women by age 50 was 70% for white women and reached over 80% black women. Compared with total laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy is associated with shorter operative time, less blood loss, shorter paralytic ileus time, and shorter hospitalization. Acute Pain. Make a donation. most common benign neoplasm in the female. The Key Questions reflect the unmet need for a relevant synthesis of evidence from prospective randomized controlled trials on the relative benefits and harms of surgical, procedural, and medical interventions to manage uterine fibroids. Hierarchical random effects allow results from individual studies to be partially pooled, meaning that each study can contribute to inference in the meta-analysis without assuming that the set of studies are identical. Rockville MD: Agency for Healthcare Research and Quality; March 2012. www.effectivehealthcare.ahrq.gov/. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 2018;46:113. not cancerous. Management of uterine fibroids should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to preserve fertility, and access to therapy; and the physician's experience. In: Netter's Obstetrics and Gynecology. Medications include: Gonadotropin-releasing hormone (GnRH) agonists. As part of this research, NICHD scientists are exploring genetics, hormones, the immune system, and environmental factors that may play a role in starting the growth of fibroids or in continuing that growth. Therefore, eligible studies for Key Question 1 and Key Question 2 must be randomized trials evaluating the benefits or harms of a medical, procedural, or surgical intervention compared with an inactive control, including expectant management, or alternate intervention. Identification of Future Research Needs in the Comparative Management of Uterine Fibroid Disease. 195. Impaired Urinary Elimination Nursing Care Plan nursing care plan guide revised 5 04 template net, nursing diagnosis for urinary tract infection uti best, 4 impaired urinary elimination chronic renal failure, . Levonorgestrel-releasing intrauterine system, Bayer Healthcare Pharmaceuticals, Inc, Whippany, NJ, USA, Merck Sharp & Dohme Limited, Hertfordshire, UK, Gynecare Morcellex Tissue Morcellator Models Mx0100 And Mx0100r, Pks Plasma Morcellator Models 962000pk 3620pk, Ksea Sawahle Electromechanical Morcellator, Ksea Rotocut G1 Electromechanical Morcellator, Coherent Tissue Morcellator Kit And Accessories, Lumenis Versacut Tissue Morcellator System, Morce Power Plus And Variocarve Morcellator, Riwo Cut-Morcellator Existing Of Knife/Cutting Sleeve/Protection Sleeve/Claw Grasping Forceps, Iur Reciprocating Morcellator Model # 7210517, Truclear Morcellation System And Truclear Morcellators, VizAblate not FDA-approved for use in the U.S.), Thermachoice Thermal Balloon Ablation system, NovaSure Impedance Controlled Endometrial Ablation System, Doppler-Guided Uterine Artery Occlusion (DUAO) Device (Gynecare Gynocclude D-UAO), MyoSure Hysteroscopic Tissue Removal System (Hysteroscopic), Notes: Drug therapy[mh] includes hormone therapy; Surgical procedures, operative[mh] includes ultrasound ablation, embolization, and hysterectomy, ((leiomyoma[mh]) OR (fibroma[mh] AND (uterine diseases[mh] OR uterus[mh]))), (Uterine[tiab] AND (fibroma*[tiab] OR fibroid*[tiab] OR leiomyoma*[tiab] OR myoma*[tiab] OR fibromyoma*[tiab])) OR (submucous fibroid*[tiab] OR submucosal fibroid*[tiab] OR Intramural fibroids [tiab]) NOT medline[sb], (((((("Mifepristone"[Mesh] OR "ulipristal"[Supplementary Concept]) OR "Anti-Inflammatory Agents, Non-Steroidal"[Mesh]) OR "Antifibrinolytic Agents"[Mesh]) OR "Goserelin"[Mesh]) OR "cetrorelix"[Supplementary Concept]) OR "Selective Estrogen Receptor Modulators"[Mesh]) OR "Levonorgestrel"[Mesh], therapy[sh:noexp] OR drug therapy[mh] OR drug therapy[sh] OR complementary therapies[mh] OR Treatment outcome[mh], (Mifepristone[tiab] OR Ulipristal acetate[tiab] OR NSAID[tiab] OR antifibrinolytic[tiab] OR Goserelin[tiab] OR cetrorelix acetate[tiab] OR Selective estrogen receptor modulators[tiab] OR SERM[tiab] OR mirena[tiab] OR lng-ius[tiab] OR levonorgestrel-releasing intrauterine system[tiab]) NOT medline[sb], surgery[sh] OR surgical procedures, operative[mh] OR embolization, therapeutic[mh], (Hysterectomy[tiab] OR myomectomy[tiab] OR emboliz*[tiab] OR ablation[tiab] OR ultrasound[tiab] OR uterine artery occlusion[tiab] OR Uterine artery embolization[tiab] OR UAE[tiab]) NOT medline[sb], ("Electrosurgery/adverse effects"[Mesh]) OR "Uterine Myomectomy/adverse effects"[MeSH] OR morcellat*, ("Electrosurgery/adverse effects"[Mesh] AND uterine) OR "Uterine Myomectomy/adverse effects"[MeSH] OR morcellat*, Hysterectomy via abdominal, vaginal, laparoscopic, or robotic approach, Myomectomy via laparotomy, laparoscopy, hysteroscopy, or robotic approach, Uterine artery embolization including ligation and occlusion, Ablative procedures (e.g., MRgFUS, cryoablation), Progestin-containing intrauterine devices, Medications to improve or resolve symptoms or reduce size of fibroids, Inactive treatment including wait list control, expectant management, or placebo, Conversion to alternate operative procedure, Misdirected embolization / non-target tissue embolization, Uterine fibroid treatment/intervention outcome (KQs 1, 2), Harm or adverse event from uterine fibroid treatment/intervention (KQs 1-4), Sufficient detail of methods and results to enable data extraction (KQs 1-4), Reports outcome data by target population or intervention (KQs 1-4), Baird DD, Dunson DB, Hill MC, et al.

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