Benefits, Harms, and Costs
- 1Prolonged intermittent administration of selective progesterone receptor modulators can be used to treat fibroid-related symptoms and is generally safe, well tolerated, and efficacious (I-B).
- 2Women treated with ulipristal acetate should be screened for risk of liver impairment prior to commencing therapy and undergo liver enzyme monitoring monthly during treatment courses and 2 to 4 weeks following completion of the course of therapy. Physicians should be aware of the signs and symptoms of liver failure, and patients should be apprised of the symptoms of liver failure (III-C).
- 3Gonadotropin-releasing hormone agonists have been shown to decrease fibroid size, improve anemia, and reduce the probability of perioperative blood transfusions (I-A).
- 4Preoperative anemia (hemoglobin <120 g/dL) prior to elective gynaecologic surgery has been associated with adverse outcomes. Attempts should be made to correct anemia with menstrual suppression and/or iron therapy (II-A).
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- Long-term medical management of uterine fibroids with ulipristal acetate.Fertil Steril. 2016; 105 (165–73.e4)
- Safety after extended repeated use of ulipristal acetate for uterine fibroids.PLoS One. 2017; 12e0173523
- Product Monograph Including Patient Medication Information: Fibristal. Submission Control No. 209518.Allergan Inc., Markham, ON2018 (Available at:)http://fibristal.ca/docs/Fibristal_Product_Monograph_ E.pdfDate accessed: February 18, 2019
- Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: a systematic review and meta-analysis.PLoS One. 2017; 12e0186158
- Preoperative medical therapy before surgery for uterine fibroids.Cochrane Database Syst Rev. 2017; 11CD000547
- Impact of preoperative anaemia and blood transfusion on postoperative outcomes in gynaecological surgery.PLoS One. 2015; 10e0130861
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
All people have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate, and tailored to their needs.
This guideline was written using language that places women at the centre of care. That said, the SOGC is committed to respecting the rights of all people–including transgender, gender non-binary, and intersex people–for whom the guideline may apply. We encourage health care providers to engage in respectful conversation with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs, and individual needs of each patient and their family should be sought and the final decision about the care and treatment options chosen by the patient should be respected.