The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of "Major Recommendations" field.
The following recommendations and conclusions are based on good and consistent scientific evidence (Level A):
- Abdominal myomectomy is a safe and effective alternative to hysterectomy for treatment of women with symptomatic leiomyomas.
- Based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri.
- Use of gonadotropin-releasing hormone (GnRH) agonists have been shown to improve hematologic parameters, shorten hospital stay, and decrease blood loss, operating time, and postoperative pain when given for 2–3 months preoperatively. Benefits of preoperative use of GnRH agonists should be weighed against their cost and side effects for individual patients.
- Several studies suggest that the infiltration of vasopressin into the myometrium decreases blood loss at the time of myomectomy.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- The clinical diagnosis of rapidly growing leiomyomas should not be used as an indication for myomectomy or hysterectomy.
- Hysteroscopic myomectomy is an accepted method for the management of abnormal uterine bleeding caused by submucosal leiomyomas.
The following recommendations and conclusions are based primarily on consensus and expert opinion (Level C):
- There is insufficient evidence to support hysterectomy for asymptomatic leiomyomas solely to improve detection of adnexal masses, to prevent impairment of renal function, or to rule out malignancy.
- Leiomyomas should not be considered the cause of infertility, or significant component of infertility, without completing a basic fertility evaluation to assess the woman and her partner.
- Hormone therapy may cause some modest increase in uterine leiomyoma size but does not appear to have an impact on clinical symptoms. Therefore, this treatment option should not be withheld from women who desire or need such therapy.
- The effect of uterine artery embolization on pregnancy remains understudied.
Definitions:
Grades of Evidence
I Evidence obtained from at least one properly designed randomized controlled trial.
II-1 Evidence obtained from well-designed controlled trials without randomization.
II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A - Recommendations are based on good and consistent scientific evidence.
Level B - Recommendations are based on limited or inconsistent scientific evidence.
Level C - Recommendations are based primarily on consensus and expert opinion.
