Uterine Fibroids
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
Fibroid management depends on symptoms, size, location, number, cavity distortion and reproductive goals. Finding a fibroid does not automatically establish the cause of bleeding or require surgery.
Assessment & interpretation
- Map fibroids with ultrasound and assess bleeding-related anaemia. Consider cavity assessment when submucosal disease is suspected.
Decisions that change management
- Submucosal fibroids may be suitable for hysteroscopic removal. Fibroids at least 3 cm merit discussion in specialist care.
- Treatment choices include appropriate medication, uterine artery embolisation, myomectomy or hysterectomy; discuss fertility implications and the effect of size on treatment success.
Follow-up & safety-netting
- Reassess symptoms and haemoglobin. Before embolisation or myomectomy, define fibroid anatomy and use MRI if further information is needed.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Admit uncontrolled heavy bleeding, instability/syncope, severe symptomatic anaemia, suspected infection or a surgical emergency. Acute pain requires assessment for other causes rather than assuming fibroids.
When clinic, day care or home care may be suitable
- Stable bleeding/fibroid symptoms can usually be investigated and treated through gynaecology follow-up. Exclude pregnancy where relevant and assess anaemia and cancer risk.
Before going home
- Bleeding is controlled to a safe level, observations and symptoms are satisfactory and the investigation/definitive treatment plan is documented.
- If a procedure occurred, recovery, pain, bladder function and complications have been assessed; anaemia needs its own treatment/response plan.
Discharge medicines and treatment changes
- Use the selected bleeding-control/contraceptive or iron regimen with duration and review dates, after contraindication assessment. Do not prescribe all listed alternatives together.
Medicine doses — use only when indicated
Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.
Only the selected heavy-menstrual-bleeding course after contraindication review.
- Indication: Heavy uterine bleeding unrelated to pregnancy after assessment
- Renal / hepatic: Reduce dose with renal impairment
- Bleeding response, Hb/iron deficiency; investigate persistent or changed bleeding
For suitable pain symptoms; severe/worsening pain still needs assessment.
- Indication: Short-term maternal postoperative/postpartum pain or other mild pain after assessment; adult ≥50 kg
- MSF oral monograph: no pregnancy or breastfeeding contraindication. The dose does not replace assessment of the cause of pain.
- Pain and functional recovery; investigate increasing pain, fever or other warning symptoms.
- Check all prescribed/OTC paracetamol, weight and hepatic risk; suspected excess dosing requires urgent assessment.
Tests, pending results and their reviewer
- Review CBC and any indicated imaging/endometrial sampling; assign responsibility for pathology and persistent/abnormal bleeding results.
- Record the fibroid location/size and the planned imaging or surgical review; hysterectomy/myomectomy recovery needs the actual procedure-specific plan.
Home care and counselling
- Explain expected bleeding, what counts as deterioration, treatment adherence, contraception/fertility goals and access to the next review.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
At the booked gynaecology/result review | Assess response and complete evaluation of persistent bleeding or a suspected structural/malignant cause. |
2–4 weeks if treating anaemia | Check Hb response and investigate inadequate improvement. |
Return urgently
- Very heavy bleeding, fainting, chest pain/breathlessness, severe pain or fever requires urgent assessment.
Treatment
① Immediate stabilization — first minutes
③ First-line treatment & drug regimens
| Scenario | Approach |
|---|---|
HMB small intramural/submucous | Medical +/- hysteroscopic resection |
Bulk symptoms/large | Myomectomy or hysterectomy (family complete) |
Completed family declines surgery | UAE after imaging mapping (fertility impact counselled) |
Pre-op anaemia optimisation | Selective GnRH agonist 3 months + iron |
④ Drug treatment detail (1 agents)
- Indication: Heavy uterine bleeding unrelated to pregnancy after assessment
- Renal / hepatic: Reduce dose with renal impairment
- Bleeding response, Hb/iron deficiency; investigate persistent or changed bleeding
Definitive treatment
Surgical resolution per scenario table.
Monitoring
- Post-myomectomy contraception interval discussion (cavity-entry rupture risk)
- Red degeneration pregnancy: analgesia, exclude torsion/abruption
⑮ Complications & their management
Pedunculated leiomyoma torsion
Emergency laparoscopic myomectomy
Sarcoma suspicion
Oncology pathway; no uncontained morcellation
Post-treatment care
- Histopathology always; fertility follow-up as appropriate
Diagnosis & assessment
- Haemodynamic instability / severe anaemia -> acute pathway
Principles & follow-up
Management principles
Sources (9)
2021-07 · updated 2025-12-22 (page review; guidance itself unchanged) · checked 2026-08-23 · verified-live
Open source ↗
CDC pages + wall chart: uncomplicated gonorrhoea cervix/urethra/rectum → ceftriaxone 500 mg IM single dose (<150 kg; 1 g if ≥150 kg); pharyngeal same; conjunctivitis 1 g IM; DGI 1 g IV/IM q24h; PID outpatient → ceftriaxone 500 mg IM ×1 + doxycycline 100 BD ×14 d + metronidazole 500 BD ×14 d; chlamyd…
14 March 2018 · updated 07 July 2026 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for aub, fibroids. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge ch…
· checked 2026-10-17 · verified-live
Open source ↗
Heavy abnormal uterine bleeding: 1 g three times daily, up to four times daily, at most 5 days, and renal/thrombotic cautions.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary oral monograph read: adult 1 g 3–4 times daily, maximum 4 g/day, ≥50 kg adult table, 500 mg tablets, duration according to response, hepatic caution and pregnancy/breastfeeding. Pain chapter also checked for 6–8-hour interval. Smaller adults require an individual weight-based prescripti…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.