| What factors should be considered when selecting patients with submucus fibroids for treatment? | selection should be based on size and proportion of the fibroid projecting into the uterine cavity | Any hormone should be given orally daily in divided doses for a duration of three weeks and repeated in a cyclical manner for total of 4-6 cycles of treatment Uterine artery embolization Surgical Myomectomy (younger age &/ or low parity) Hysterectomy (to be avoided in young patients aged <35 years as far as possible) Fibroid Polyps Hysteroscopic removal • Endometrial polyps • Select appropriate patient with submucus fibroids (selection should be based on size and proportion of the fibroid projecting into the uterine cavity) Fibroids • Heavy menstrual bleeding/ Irregular bleeding or spotting • Urinary symptoms • Heaviness in lower abdomen • Awareness of mass • Pain abdomen, dysmenorrhea • Infertility • Asymptomatic/ USG diagnosis | 430 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | Any hormone should be given orally daily in divided doses for a duration of three weeks and repeated in a cyclical manner for total of 4-6 cycles of treatment Uterine artery embolization Surgical Myomectomy (younger age &/ or low parity) Hysterectomy (to be avoided in young patients aged <35 years as far as possible) Fibroid Polyps Hysteroscopic removal • Endometrial polyps • Select appropriate patient with submucus fibroids (selection should be based on size and proportion of the fibroid projecting into the uterine cavity) Fibroids • Heavy menstrual bleeding/ Irregular bleeding or spotting • | 1 | page=1,block=26 | 0.700 | valid |
| What advanced diagnostic methods are available at tertiary care hospitals for gynecological conditions? | Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. | 605 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. |
| What are examples of minimally invasive procedures for gynecological conditions? | Laproscopic or hysteroscopic myomectomy and polypectomy | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. | 774 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. |
| What are some alternative management strategies for patients not desiring surgery for fibroids? | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments | 0 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. |
| What are some common problems associated with fibroids? | heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments | 755 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments |
| What are the red flag signs associated with fibroids? | • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - Levonorgestrel-releasing intrauterine system (if uterine cavity normal) - Progestogenic agents* ALL THERAPUTIC OPTIONS NEED TO BE EXPLAINED TO THE PATIENT INCLUDING JUST KEEPING THE PATIENT ON OBSERVATION. | 15 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | RED FLAG SIGNS • Severe Anemia • Severe pain eg due to degeneration, torsion • Excessive bleeding not responding to medical management • Acute retention of urine FIGO CLASSIFICATION Submucosal Group • Type0- Pedunculated , intracavitary • Type1- <50% intramural • Type 2- >50% intramural Other Group • Type3-100% intramural touching endometrium • Type4- Intramural • Type5-subserosal >50% intramural • Type6 -subserosal <50% intramural • Type7-subserosal pedunculated • Type8-Others like cervical, parasitic Individualized management at tertiary centre Medical Management: - Tranexamic acid - |
| What factors should be considered when individualizing treatment for a patient? | patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. • Referral: Cases requiring definitive diagnosis, special- ized treatment, or surgery Tertiary Care Hospitals Advanced Diagnostics: Transvaginal ultrasound, saline infusion sonography, MRI, and hysteroscopy Therapeutic Surgical Interventions: Myomectomy or hysterectomy Minimally Invasive Procedures: Laproscopic or hysteroscopic myomectomy and polypectomy Specialized non-surgical Management: May be considered in specialised situations eg fibroid with subfertility. | 78 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | Treatment modality should be individualized to each patient after considering patient’s age, parity, severity of symptoms, need for fertility preservation, presence of other gynecological diseases and any other co-morbidity • Primary and secondary Care Hospitals: Initial Detec- tion and Counselling • Symptom Management: Non-Steroidal Anti-Inflamma- tory Drugs (NSAIDs), iron and folic acid • Basic Medical Therapy: oral contraceptives or progestin for abnormal bleeding. |
| What diagnostic tests are considered essential for fibroid management? | CBC , Ultrasound | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. • During Pre- operative optimization • Short term alternative to surgery in perimenopausal women Counselling + Patient Education Approximately 80 percent of females will have fibroids in their lifetime Fibroids are commonest benign uterine tumours and risk of malignancy is very low Treatments are available for fibroid-related problems like heavy menstrual bleeding, pain or pressure in the pelvis, or problems with pregnancy or infertility There are chances of recurrence in case of conservative surgical or non-surgical treatments | 171 | list | 0.740 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | Uterine artery embolization (UAE), radiofrequency ablation (RFA), and MRI-guided focused ultrasound surgery (FUS) may be considered if facilities are available Essential- CBC , Ultrasound Desirable – TFT Optional – HIGHER IMAGING LIKE MRI ASYMPTOMATIC FIBROIDS <5CM DO NOT NEED TO BE TREATED SUPPORTIVE MEASURES MAY BE REQUIRED Indications for alternative management strategies • Patient not desirous of surgery. |
| What is the basis for the broad guidelines mentioned in the STW? | expert opinions and available scientific evidence | This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India | 198 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. | 1 | page=1,block=2 | 0.700 | valid |
| Where can one find more information about the STW prepared by the Indian Council of Medical Research? | (icmr.gov.in) | This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his/her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. ©Indian Council of Medical Research, Ministry of Health & Family Welfare, Government of India | 510 | factual | 0.490 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1768382529_updateduterinefibroidsandpolyps.pdf | Kindly visit the website of ICMR for more information: (icmr.gov.in) for more information. | 1 | page=1,block=2 | 0.700 | valid |