Uterine fibroids
Also known as: leiomyoma · myoma
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Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228
American College of Obstetricians and Gynecologists (ACOG) · 2021 · Practice Bulletin No. 228
ACOG's practice bulletin on managing symptomatic uterine fibroids, covering medical, procedural and surgical treatment options. It reflects that many patients seek alternatives to hysterectomy because they wish to preserve fertility or retain the uterus. Metadata record only.
Heavy menstrual bleeding: assessment and management
National Institute for Health and Care Excellence (NICE) · 2018 · NICE guideline NG88 (last updated July 2026)
The UK national guideline on heavy menstrual bleeding, which is where NICE places its recommendations on investigating and treating uterine fibroids, including imaging to detect them and treatment pathways stratified by fibroid size. There is no separate NICE guideline dedicated solely to fibroids. Metadata record only.
- Published 14 March 2018 and last updated 7 July 2026; replaces NICE clinical guideline CG44 (2007). source
- Includes assessment recommendations for detecting fibroids and separate management pathways for fibroids at or above 3 cm in diameter. source
- Scope is heavy menstrual bleeding overall, so fibroid guidance sits within that broader document rather than standing alone. source
US vs EU key differences
- Document scope differs: the US guidance is a dedicated leiomyoma practice bulletin spanning medical, procedural and surgical management, whereas the UK/EU guidance addresses fibroids only within a broader heavy menstrual bleeding guideline. source
- NICE organises treatment around an explicit 3 cm size threshold, naming the 52 mg LNG-IUS as the first treatment to consider for fibroids under 3 cm that do not distort the uterine cavity; the ACOG bulletin sets no comparable size cut-off and lists the LNG-IUD as one bleeding option among several, noting higher expulsion rates in fibroid patients. source
- Drug availability diverges: NICE lists ulipristal acetate for fibroids (with mandatory liver monitoring after EMA restricted it in 2020 following cases of liver injury requiring transplantation), a drug that was never approved by the FDA for fibroids and so does not appear as a US option. source
- ACOG endorses oral GnRH antagonists (elagolix, relugolix) with hormonal add-back for abnormal uterine bleeding due to leiomyomas for up to 2 years, an FDA-capped duration driven by bone-loss concerns; in the UK these agents are handled through separate NICE technology appraisals rather than the guideline itself. source
What changed recently
- EUNICE guideline NG88 (March 2018) → NICE guideline NG88 (last updated July 2026)2026-07-07
The July 2026 update withdrew the recommendation on serum ferritin testing from the laboratory investigations section for women presenting with heavy menstrual bleeding. NG88 originally replaced the 2007 heavy menstrual bleeding guideline CG44.
- USPractice Bulletin No. 96 (August 2008) → Practice Bulletin No. 2282021-06-01
Bulletin 228 replaced the 2008 leiomyoma bulletin No. 96 and brought in treatment options that did not exist in the earlier edition, notably oral GnRH antagonists such as elagolix with hormonal add-back for bleeding associated with fibroids, capped at about two years because of bone-loss risk, and laparoscopic radiofrequency ablation as a uterine-preserving option with counselling about limited reproductive-outcome data.
source ↗curation confidence 90%
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