The National Institute for Health and Care Excellence (NICE) published interventional procedure guidance 486 on hysteroscopic morcellation of uterine fibroids in April 2014 but later withdrew the guidance because there was an error in the patient commentary considered by the Committee when it made its recommendations.
NICE interventional procedure guidance 522 on hysteroscopic morcellation of uterine leiomyomas (fibroids) was published in June 2015 and replaces interventional procedure guidance 486.
Uterine leiomyomas (also known as uterine myomas or fibroids) are benign tumours that develop within the uterine wall. They can be single or multiple. They are one of the most common gynaecological problems among women in the UK. They are often asymptomatic but they can cause symptoms such as menorrhagia, intermenstrual bleeding, a feeling of pelvic pressure, pain, and urinary incontinence. They may also be associated with reproductive problems such as subfertility and miscarriage.
Treatment depends on whether the leiomyomas cause symptoms and on the woman’s desire for future childbearing. Asymptomatic leiomyomas need no treatment. Depending on their size, number and location, symptomatic leiomyomas can be managed by hysterectomy (surgical removal of the uterus) or myomectomy (surgical removal of the leiomyomas). Smaller submucous leiomyomas can be removed by hysteroscopic resection. Uterine artery embolisation may also be used. Other treatments include endometrial ablation, using energy such as microwave or heat, which may be suitable for some leiomyomas. Hormone-based treatments may be used on a short-term basis to relieve symptoms, or to shrink the leiomyomas before surgery or other interventional treatment.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.