In addition, its staff members are equipped to address serious or complex medical needs. (2022). Uterine artery embolization is an option for women who wish to preserve their uterus or avoid surgery because of medical comorbidities or personal preference.4 It is an interventional radiologic procedure in which occluding agents are injected into one or both of the uterine arteries, limiting blood supply to the uterus and fibroids. Radiofrequency ablation. Risk factors include being overweight or obese and is mostly seen in African . 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. In: Current Medical Diagnosis & Treatment 2019. Among these instruments is the laparoscope, which contains fibre-optic camera heads or surgical heads (or both). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. For more information about uterine fibroids, call womenshealth.gov at 1-800-994-9662 (TDD: 888-220-5446) or contact the following organizations: American College of Obstetricians and Gynecologists Phone: 202-638-5577; Center for Uterine Fibroids Phone: 800-722-5520; National Institute of Child Health and Human Development, NIH, HHS Antiprogestins*. Myers ER BM, Couchman GM, et al. Am J Obstet Gynecol. https://effectivehealthcare.ahrq.gov/topics/uterine-fibroids/research-2017. We have limited confidence that the estimate of effect lies close to the true effect for this outcome. Each article will be reviewed for eligibility independently by two members of the investigative team. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 2006 Oct;108(4):930-7. plan writing help nursing care plan, impaired urinary elimination related to uterine fibroids, nursing care plan for chronic kidney disease, nursing care plan ncp impaired urinary elimination all, nursing diagnosis nursing intervention s and tasks, impaired urinary elimination definition of impaired Other Files Primary Care Management of Abnormal Uterine Bleeding. The management of uterine fibroids also depends on the number, size and location of the fibroids. KENNEDY K. ABNORMAL UTERINE ACTION Normal uterine Actions Normal labor is characterized by coordinated uterine . The authors of this report are responsible for its content. A study of 359 women treated with MRgFUS showed improved scores on the Uterine Fibroid Symptoms Quality of Life questionnaire at three months that persisted for up to 24 months (P < .001).40 In another study comparing women who underwent MRgFUS with those who underwent total abdominal hysterectomy, the groups had similar improvement in quality-of-life scores at six months, but the MRgFUS group had significantly fewer complications (14 vs. 33 events; P < .0001).65 In a five-year follow-up study of 162 women, the reoperative rate was 59%.66 Overall, this less-invasive procedure is well tolerated, although risks include localized pain and heavy bleeding.40 Spontaneous conception has occurred in patients after MRgFUS, but further studies are needed to examine its effect on future fertility.67, This article updates a previous article on this topic by Evans and Brunsell.68. How many fibroids do I have? The size, shape, and location of fibroids can vary greatly. However, all treatments have risks and benefits. An official website of the Department of Health & Human Services, 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 or health concerns.5,6 A disproportionate number of black women are among those with symptoms in part due to earlier age at onset of fibroids with larger and more numerous tumors.1-3,7,8, The etiology of uterine fibroids is not well understood, and a variety of factors including race/ethnicity, parity, and age at menarche have been examined. NICHD research on uterine fibroids aims to learn more about what causes them, how they grow, factors related to who develops them, and fibroid treatments. However, scarring after surgery can affect future fertility. HHSA 290-2015-00003I from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Click here for an email preview. Mayo Clinic, Rochester, Minn. May 29, 2019. Fibroids do not regrow after surgery, but new fibroids may develop. Myomectomy is the surgical removal of fibroids while leaving the uterus in place. uterine fibroids introduction and management 1. introduction uterine fibroid is a leiomyoma (benign (non- cancerous) tumor form from smooth muscle tissue) that originates from the smooth muscle layer (myometrium) of the uterus. 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. Diagnosis/definition: Uterine fibroids are the most common benign gynecologic tumors Mayo Clinic, Rochester, Minn. May 2, 2019. During hysterosonography (his-tur-o-suh-NOG-ruh-fee), a care provider uses a thin, flexible tube (catheter) to inject salt water (saline) into the hollow part of the uterus. There is some literature about the relationship of imaging findings and symptom profiles, but the correlation is not tight. Clinical Obstetrics and Gynaecology. View Abnormal UTERINE ACTIVITY.pptx from NURSING DIAGNOSIS at University of Nairobi. American College of Obstetricians and Gynecologists, Agency for Healthcare Research and Quality, Cumulative Index to Nursing and Allied Health, Comparing Options for Management: Patient-Centered Results for Uterine Fibroids, International Federation of Gynecologists and Obstetricians, Magnetic resonance guided focused ultrasound, Population, Intervention, Comparators, Outcomes, Timing, Setting, Royal College of Obstetricians and Gynaecologists, Selective progesterone receptor modulator, Merck Serono (EMD Serono, Inc.), Rockland, MA, USA, AstraZeneca Pharmaceuticals, Wilmington, DE, USA, Eli Lilly and Company, Indianapolis, IN, USA. The Task Order Officer reviewed contract deliverables for adherence to contract requirements and quality. Nursing Care Plan: Uterine Myoma. called uterine cancer, but there are other cells in the uterus that can become After 4 hours of nursing interventions, the patient will display appropriate range of feelings and lessened fear. UNIT-3_15_Nursing Care of a Family During Labor & Birth.docx. We will retrieve and review all articles that meet our predetermined inclusion criteria from abstract screening or for which we have insufficient information to make a decision about eligibility. Differences between the reviewers will be adjudicated by a senior team member or via team discussion. The Fibroid Clinic at Mayo's campus in Rochester, Minnesota, offers a full range of noninvasive and minimally invasive treatment options for fibroids. Develop early identification of the changes in skin integrity. Peer reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. The uterus is anatomically divided into 3 regions; the fundus (uppermost part), the body (main part), and the cervix (lower part). We will compare the information in the SIPs with the biomedical literature and grey literature retrieval. "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. AHRQ Publication No. Causes The cause is unknown but is thought of muscle cells are immature. Expectant management is recommended for asymptomatic patients because most fibroids decrease in size during menopause. Here are six (6) nursing care plans (NCP) and nursing diagnosis (NDx) for . Also, complications during open surgery are more common than the chance of spreading an undiagnosed cancer in a fibroid during a minimally invasive procedure. If confirmation is needed, your doctor may order an ultrasound. The ideal treatment satisfies four goals: relief of signs and symptoms, sustained reduction of the size of fibroids, maintenance of fertility (if desired), and avoidance of harm. How big are they? 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. Search date: October 25, 2015. The Food and Drug Administration (FDA) advises against the use of a device to morcellate the tissue (power morcellator) for most women having fibroids removed through myomectomy or hysterectomy. "I was like, 'Wow, I've got a lot of them.'. Papadakis MA, et al., eds. Researchers Link Toxic Phthalates to Uterine Fibroid Growth - An ultrasound led to the discovery for uterine fibroids. 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. 2012;12:6. 2014 Dec 23PMID: 25542564. Under what circumstances do you recommend surgery? New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. https://familydoctor.org/familydoctor/en/diseases-conditions/uterine-fibroids.html. Additionally, because these supplements are not FDA regulated, they may be dangerous to your health. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Quantifying study-level heterogeneity via random effects is preferable to the use of an arbitrary variance cutoff value or statistical tests for heterogeneity, such as Q statistics or I2 scores. 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. Fertility of Women in the United States: June 2012. Does risk of cancer dissemination from morcellation differ by patient or fibroid characteristics (e.g., age; race/ethnicity; symptoms; menopausal status; imaging characteristics; vascular supply to fibroids; or number, size, type, location, or total volume of fibroids)? Uterine fibroids. Uterine leiomyomas. 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. One of the main goals . The EPC considers all peer review comments on the draft report in preparation of the final report. PMID: 12636944, Stewart EA. We may include in the analysis high of risk of bias studies that have a large sample size or that evaluate outcomes not addressed in other studies. We will search web sites of organizations likely to conduct research, issue guidance, or generate policies relevant to management of uterine fibroids (Table A-5 in the Appendix). Laughlin-Tommaso SK (expert opinion). Most women with uterine fibroids may be able to choose to keep their ovaries. No evidence is available or the body of evidence has unacceptable deficiencies, precluding reaching a conclusion. Hum Reprod Update. Limited data does not support the use of herbal supplements like black cohosh or vaginal steaming. 1988 Jul;9(8):756-61. Using both instruments provides your doctor with two views of a uterine fibroid, allowing for more-thorough treatment than would be possible with just one view. Accessed May 3, 2019. Across types of interventions, direct annual healthcare costs in the United States are projected to exceed $9.1 billion. We will review the titles and abstracts of all publications identified through our searches against our inclusion/exclusion criteria. The incidence of fibroids is higher in black women than in white women, and black women appear to have larger . This content does not have an Arabic version. Before deciding on a treatment plan for fibroids, a complete fertility evaluation is recommended if you're actively trying to get pregnant. Ongoing observational studies such as COMPARE21 will provide data about sequencing of treatments when completed. Uterine fibroids, or leiomyomas, are the most common benign tumors in women of reproductive age.1 Their prevalence is age dependent; they can be detected in up to 80% of women by 50 years of age.2 Fibroids are the leading indication for hysterectomy, accounting for 39% of all hysterectomies performed annually in the United States.3 Although many are detected incidentally on imaging in asymptomatic women, 20% to 50% of women are symptomatic and may wish to pursue treatment.4. However surgery is an option for lower part of a systematic medical issues with the help of a 7 step uterine wall. Funding administered by the Agency for Healthcare Research and Quality: 2014. You may opt-out of email communications at any time by clicking on We will use a date limit of 1985 for the search of indexed literature. You may benefit from nonsurgical approaches to manage fibroid symptoms, such as drugs to reduce the amount . Fibroids are also known as uterine myomas or fibromyomas. How much the fibroids grow and how fast varies from person to person. If the fibroids are few in number, you and your doctor may opt for a laparoscopic or robotic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Uterine fibroids or leiomyomata are the most common benign tumor affecting women. To provide you with the most relevant and helpful information, and understand which 1from Table 4 in "Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions".23. Jarell JF, et al. In a small prospective trial of 18 patients, tamoxifen did not reduce fibroid size or uterine volume, but did reduce menstrual blood loss by 40% to 50% and decrease pelvic pain compared with the control group.56 Based on its adverse effects (e.g., hot flashes, dizziness, endometrial thickening), the authors concluded that its risks outweigh its marginal benefits for fibroid treatment. Another selective estrogen receptor modulator, raloxifene (Evista), has also shown inconsistent results, with two of three studies included in a Cochrane review showing significant benefit.57, Hysterectomy. Am J Obstet Gynecol. 2011 Nov;205(5):492 e1-5. Also, with magnetic resonance imaging, large uterine vessels, large nodes, are noticeable. Hartmann KE, et al. Uterine fibroids. Complications may occur if the blood supply to your ovaries or other organs is compromised. They include: Uterine artery embolization. But this data is weak and furthermore, avoiding these exposures has not been shown to treat, shrink or prevent fibroids. Rockville, MD: Agency for Healthcare Research and Quality; 2011. We will search ClinicalTrials.gov for information about relevant ongoing trials and to confirm that we have obtained available publications of results from completed trials. So exercise and eating a nutritious diet to maintain a healthy weight can help. Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs. Below is the list of the 16 new NANDA Nursing Diagnoses 1. 2015 2015-01-02 22:52:22;349:g7647. Never hesitate to ask your medical team any questions or concerns you have. 2003 Jan;188(1):100-7. Be upfront about your treatment goals and concerns. Larger fibroids can be removed through smaller incisions by breaking them into pieces (morcellation), which can be done inside a surgical bag, or by extending one incision to remove the fibroids. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Women with uterine fibroids are more likely have pregnancies complicated by fetal malpresentation, preterm birth, preterm premature rupture of membranes (PPROM), placenta previa, placental abruption, cesarean delivery, and severe postpartum hemorrhage. 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. It is defined as excessive menstrual bleeding with a loss of more than 80ml of blood per month. Technical Experts constitute a multi-disciplinary group of clinical, content, and methodological experts who provide input in defining populations, interventions, comparisons, or outcomes and identify particular studies or databases to search. Accessed May 2, 2019. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. The uterus is made of muscle, and fibroids grow from the muscle. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonanceguided focused ultrasound surgery. Clinical practice. 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. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. https://www.uptodate.com/contents/search. Descent. Uploaded by shiramu. Major Primary PPH - losing 500 mL to 1000 mL of blood. In: Netter's Obstetrics and Gynecology. So a hysterectomy, in which the uterus and cervix are removed, is the only treatment that can actually guarantee fibroids won't return. 2018;46:74. 7th ed. Total abdominal hysterectomy bilateral salpingo-oophorectomy (TAHBSO) is the removal of the entire uterus, the ovaries, fallopian tubes, and the cervix. Kellerman RD, et al. 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. that is what your nursing instructor (s) expect of you and how you are going to learn about fibroid tumors and . The needles heat up the fibroid tissue, destroying it. The most common adverse effects include headache and breast tenderness. We will create data extraction forms to collect detailed information on the study characteristics, intervention(s), comparator(s), arm details, reported outcomes and outcome measures, and risk of bias assessment. Some differences among study populations may be accounted for in the model by adjusting for factors such as age distribution, demographic attributes, and the prevalence of concomitant conditions in the study sample. Accessed April 24, 2019. needing to urinate (wee) a lot. Rockville, MD: Agency for Healthcare Research and Quality; November 2013. www.effectivehealthcare.ahrq.gov, Non FDA-labeled indications: Menorrhagia, uterine leiomyoma (preoperative). Accessed April 24, 2019. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. For all procedures except hysterectomy, seedlings tiny tumors that your doctor doesn't detect during surgery could eventually grow and cause symptoms that warrant treatment. The cause of fibroids is unknown. In this procedure, radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. Maintain frequent Hysterectomy by the least invasive approach possible is the most effective treatment for symptomatic uterine fibroids.39 Vaginal hysterectomy is the preferred technique because it provides several statistically significant advantages, including shorter surgery time than total laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy (70 minutes vs. 151 minutes vs. 130 minutes, respectively), decreased blood loss (183 mL vs. 204 mL vs. 358 mL), shorter hospitalization (51 hours vs. 77 hours vs. 77 hours), and shorter paralytic ileus time (19 hours vs. 28 hours vs. 26 hours); however, vaginal hysterectomy is limited by the size of the myomatous uterus.43 Abdominal hysterectomy is an alternative approach, but the balance of risks and benefits must be individualized to each patient.44, The laparoscopic extraction of the uterus may be performed with morcellation, whereby a rotating blade cuts the tissue into small pieces. Recognize signs of impending rupture, immediately notify the physician, and call for assistance. Myolysis. What medications are available to treat uterine fibroids or my symptoms? Frequent urination (this can happen when a fibroid puts pressure on your bladder). Management of uterine fibroids (Evidence Report/Technology Assessment No. Does treatment effectiveness differ by patient or fibroid characteristics (e.g., age, race/ethnicity; symptoms; vascular supply to fibroids; menopausal status; or number, size, type, location, or total volume of fibroids)? Santaguida P, Raina P. McMaster Quality Assessment Scale of Harms (McHarm) for primary studies: Manual for use of the McHarm. Journal of Obstetrics and Gynaecology Canada. Fibroids can grow on the inside of the uterus, within the muscle wall of the uterus, or on the outer surface of the uterus. What is the comparative effectiveness (benefits and harms) of treatments for uterine fibroids, including comparisons among and within these interventions? Abstract. Related financial conflicts of interest that cumulatively total greater than $1,000 will usually disqualify EPC core team investigators. Don't be afraid to ask for a second opinion or referral to a fibroid specialist. Using the laparoscopic camera and a laparoscopic ultrasound tool, your doctor locates fibroids to be treated. 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 . Scribd is the world's largest social reading and publishing site. Any treatment that preserves the uterus means that fibroids can occur in the future. Uterine fibroids. In addition, the Key Questions address the potential harms associated with morcellation, as well as an exploration of patient and tumor characteristics that may predict success or adverse events in patients considered for morcellation. https://www.fda.gov/medical-devices/surgery-devices/laparoscopic-power-morcellators. Telephone: (301) 427-1364, Powered by the Evidence-based Practice Centers, https://effectivehealthcare.ahrq.gov/products/uterine-fibroids/research-protocol, Comment on Key Questions and Draft Reports, 25 Years of the AHRQ Evidence-based Practice Center Program, http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm424443.htm, http://www.pcori.org/research-results/2014/comparing-options-management-patient-centered-results-uterine-fibroids-compare, Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents, Diagnostic Errors in the Emergency Department: A Systematic Review, Strategies for Patient, Family and Caregiver Engagement, Impact of Community Health Worker Certification on Workforce and Service Delivery for Asthma and Other Selected Chronic Diseases, Maternal and Fetal Effects of Mental Health Treatments in Pregnant and Breastfeeding Women: A Systematic Review of Pharmacological Interventions, U.S. Department of Health & Human Services, Women who are being treated for uterine fibroids (KQs 1-4). Overview of treatment of uterine leiomyomas (fibroids). Am J Obstet Gynecol. Stewart EA, et al. Many are discovered incidentally on clinical examination or imaging in asymptomatic women. health information, we will treat all of that information as protected health Kaunitz AM. Future reproduction. We will use an adapted version of the McMaster Quality Assessment Scale of Harms tool to assess harms reporting.23,24 We will enumerate the risk of bias assessments and source of bias for all studies.