Clinical Review

Fibroids: diagnosis and management

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4887 (Published 13 October 2015) Cite this as: BMJ 2015;351:h4887
  1. Mary Ann Lumsden, professor of gynaecology and medical education1,
  2. Ibraheem Hamoodi, specialist trainee and research fellow1,
  3. Janesh Gupta, professor of obstetrics and gynaecology2,
  4. Martha Hickey, professor of obstetrics and gynaecology3
  1. 1University of Glasgow, Glasgow Royal Infirmary Campus, Glasgow G31 2ER, UK
  2. 2University of Birmingham, Birmingham Women’s Hospital, Birmingham, UK
  3. 3The University of Melbourne and the Royal Women’s Hospital, Royal Women’s Hospital, Parkville, Melbourne, Australia
  1. Correspondence to: M A Lumsden Maryann.Lumsden{at}glasgow.ac.uk

The bottom line

  • Fibroids are commonly asymptomatic and usually do not require treatment once the diagnosis is confirmed by ultrasonography or, when required, by magnetic resonance imaging

  • Women should be made aware of all available treatment options; medical, radiological, and surgical, and why they may or may not be appropriate

  • Medical treatments for heavy menstrual bleeding may be effective in those with fibroids, but there is relatively little evidence to support this

  • Women should also understand that advice on treatment is often based on inadequate evidence, particularly for well established treatments such as myomectomy

  • Hysterectomy is effective, but other conservative surgical and radiological treatments may be preferable and treatment should be individualised

  • Submucosal and possibly intramural fibroids may decrease pregnancy rates; however, evidence to support a role for myomectomy in enhancing fertility by any route is inconclusive

Uterine leiomyomas (fibroids) are the most common benign tumours in women. They may be single or multiple and their size varies from a few millimetres to 30 cm or more. By age 50 nearly 70% of white women and more than 80% of black women have had at least one fibroid.1 Box 1 lists the several risk factors for fibroids. Symptomatic fibroids are often managed surgically, and this confers a considerable burden on healthcare costs.2 This review aims to update non-specialists on the investigation and management of fibroids. Gaps in current knowledge are highlighted.

Sources and selection criteria

The literature search used a combination of MeSH, text words, and appropriate word variants of “fibroids” and “leiomyoma”. We searched Medline and Embase, Cochrane Reviews, personal references and reference lists in general articles on uterine fibroids. Searching was limited to publications in English and to studies in women and we have included reference to evidence based guidelines, such as those by the National Institute of Health and Care Excellence.

Box 1 Risk factors for uterine fibroids

  • Race—incidence …

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