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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

Don’t offer hysterectomy for asymptomatic fibroids on the basis of the risk of malignancy.

However, growth and/or new onset of symptoms, especially if in a post-menopausal patient, should carry a higher index of suspicion for malignancy.

When is the procedure indicated?

Hysterectomy is indicated for large, symptomatic fibroids or if there are red flags for malignancy.

If a fibroid is rapidly enlarging, or shows atypical features on imaging, then surgery should be considered, particularly in older, post-menopausal patients, someone on tamoxifen, someone from an at-risk racial group, or for a new isolated fibroid in peri or post-menopause.

Best care recommendations

Fibroids do not need to be treated if they are not symptomatic. 

Over time they will often shrink and disappear without treatment, particularly after menopause.

If the patient is symptomatic, myomectomy, hysteroscopic resection, uterine artery embolisation or hysterectomy should be considered.

Evidence

National Institute for Health and Care Excellence. Heavy menstrual bleeding. London (UK): National Institute for Health and Care Excellence; 2018 [cited 2020 Jun 29]. 

Society of Obstetricians and Gynaecologists of Canada. Choosing Wisely Canada Obstetrics and Gynaecology: Ten things physicians and patients should question. Ottawa (ON): Society of Obstetricians and Gynaecologists of Canada; 2017 [cited 2020 Jun 13]. 

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Heavy menstrual bleeding. Melbourne (VIC): The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2018 [cited 2020 Jun 13].

Page last updated: 23 Dec 2020

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