ABSTRACT: Uterine leiomyomas (fibroids) are the most common solid and symptomatic neoplasm in women. They are the leading indication for hysterectomy 1 2, which is a definitive and effective surgical treatment for leiomyoma. However, many patients benefit from and seek out management options other than hysterectomy because they desire future childbearing or wish to retain their uterus. The purpose of this Practice Bulletin is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas. Discussion of the use of morcellation in the surgical management of leiomyomas is beyond the scope of this document and is addressed in a separate American College of Obstetricians and Gynecologists (ACOG) publication 3.
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Subscribe![Figure 1. FIGO Abnormal Uterine Bleeding System 2 classification system including the FIGO leiomyoma subclassification system. Abbreviation: FIGO, International Federation of Gynecology and Obstetrics. (Reprinted from Munro MG, Critchley HO, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. FIGO Menstrual Disorders Committee [published erratum appears in Int J Gynaecol Obstet 2019; 144:237]. Int J Gynaecol Obstet 2018; 143:393–408.)](/-/media/project/acog/acogorg/clinical/images/practice-bulletin/articles/2021/06/management-of-symptomatic-uterine-leiomyomas/ong-21-661tt1.png)