Guidelines

NICE guidelines on Heavy Menstrual Bleeding (HMB) 2007 – View link
“When surgery for fibroid-related HMB is felt necessary then UAE, myomectomy and hysterectomy must all be considered, discussed and documented.”
“Women should be informed that UAE or myomectomy will potentially allow them to retain their fertility.”
“UAE is recommended for women with HMB associated with uterine fibroids and who want to retain their uterus and/or avoid surgery.”
“Hysterectomy should not be used as a first-line treatment solely for HMB.”
Hysterectomy should be considered only when:

  • other treatment options have failed, are contraindicated or are declined by the woman
  • there is a wish for amenorrhoea
  • the woman (who has been fully informed) requests it
  • the woman no longer wishes to retain her uterus and fertility

Women offered a hysterectomy should have a full discussion of the implications of the surgery before a decision is made.

Women offered hysterectomy should be informed about the increased risk of serious complications (such as intraoperative haemorrhage or damage to other abdominal organs) associated with hysterectomy when uterine fibroids are present.”

Guidance published 24.11.2010 IPG367View link

NICE guidelines (IPG367) Uterine Artery Embolisation for Fibroids.
Published November 2010
Current evidence on uterine artery embolisation (UAE) for fibroids shows that the procedure is efficacious for symptom relief in the short and medium term for a substantial proportion of patients. There are no major safety concerns. Therefore this procedure may be used provided that normal arrangements are in place for clinical governance and audit.

During the consent process patients should be informed, in particular, that symptom relief may not be achieved in some women, that symptoms may return and that further procedures may therefore be required. Patients contemplating pregnancy should be informed that the effects of the procedure on fertility and on pregnancy are uncertain.

Patient selection should be carried out by a multidisciplinary team, including a gynaecologist and an interventional radiologist.

Joint Guidelines from the Royal College of Obstetrics and Gynaecology and Royal College of Radiology (RCOGView link and RCRView link)
“The early and mid-term results of uterine artery embolisation (UAE) are promising indicating that it is at least as safe as the surgical alternatives. It provides good symptom relief and is particularly effective fort heavy menstrual bleeding”
‘’For women with symptomatic fibroids, UAE should be considered as one of the treatment options as well as the conventional surgical treatments such as myomectomy and hysterectomy.”
‘’The procedure should only be undertake by Radiologists with specialised experience in embolisation who have undergone appropriate training”