REMEDY : BNSSG referral pathways

Fibroids

Checked: 08-11-2017 by Rob.Adams Next Review: 08-11-2018

Principles of Management

Guidelines are available for assessment and management of fibroids in CKS (last revised June 2017).

Minimally Symptomatic/Asymptomatic Fibroids.

NICE guidelines suggest that these can usually be managed expectantly.

Referral is only required if there are:

  • Symptoms (for example, heavy menstrual bleeding) that have not improved despite initial treatments. Use of NSAIDs and/or tranexamic acid should be stopped if symptoms have not improved within 3 menstrual cycles.

  • Complications, such as compressive symptoms from large fibroids (for example dyspareunia, pelvic pain or discomfort, constipation, or urinary symptoms).

  • Fertility or obstetric problems associated with fibroids (but please note that locally fertility criteria based access policy applies).

  • A clinical or radiological suspicion of malignancy.

  • Fibroids which are palpable abdominally, or intracavity fibroids and/or whose uterine length is measured at ultrasound, or hysteroscopy, greater than 12 cm.

Referral Guidance

Treatment of fibroids is provided in secondary care and at Emersons Green Treatment Centre.

Referrals should be make by e-referral and include a recent BP and BMI.