Guideline No. 461: The Management of Uterine Fibroids.

Objective: To provide clinicians with an understanding of the clinical significance of fibroids for individuals with uteruses and provide evidence-based guidance on currently available treatment options.

Target population: This clinical practice guidelines seeks to improve the lives of individuals with uterine fibroids and fibroid-associated menstrual bleeding or pressure symptoms. Fertility considerations are not discussed in detail, as they are described in the SOGC's Clinical Practice Guideline on The Management of Uterine Fibroids in Women with Otherwise Unexpected Infertility guideline.¹ OPTIONS: This guideline reviews the available medical and surgical management options available for treatment of fibroid-related symptoms. Alternate procedural options, such as uterine artery embolization and energy-based treatment options are also reviewed.

Outcomes: This clinical practice guideline is intended to facilitate the decision-making process between patients and healthcare providers regarding the assessment and management of symptomatic uterine fibroids.

Benefits, harms, and costs: A majority of fibroid patients are asymptomatic and require no intervention. For patients with abnormal uterine bleeding, iron deficiency anemia, or pelvic pain or pressure symptoms, selected treatment should take into consideration fibroid characteristics and be directed towards patient symptoms and fertility goals. The cost of therapy to the healthcare system for individuals with fibroids must be interpreted in the context of the economic burden, lost productivity, and adverse impacts on quality of life that can be associated with untreated disease.

Evidence: This clinical practice guideline is an update of the SOGC's Clinical Practice Guideline No. 318 on The Management of Uterine Leiomyomas.⁴ Using relevant MeSH headings and keywords, published literature was retrieved through searches of PubMed and Cochrane Systematic Reviews the date of last search in February 2013 to January 2025. Grey literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies.

Validation methods: A national panel of patient partners were gathered to provide feedback and perspective on the recommendations and summary statements for this guideline. Patient partners were purposefully selected to ensure representation of Canadian geographic region, racial representation, and fibroid-related symptom and treatment received.