nursing care plan for uterine fibroids nursing care plan for uterine fibroids

Examples include: baseline characteristics of the patients (e.g., age, menopausal status; symptom status) and fibroid characteristics (e.g., size, volume, location, type, and vascularity). Surgical options for the treatment of fibroids. https://effectivehealthcare.ahrq.gov/topics/uterine-fibroids/research-2017. Will I need a medication before or after surgery? It should now be feasible, and most informative to guiding care, to restrict a review to randomized clinical comparisons of effectiveness, including medical management versus surgical, rather than restricting comparisons only to abdominal hysterectomy. In other words, they are . MRI-guided focused ultrasound surgery (FUS) is: Small particles (embolic agents) are injected into the uterine artery through a small catheter. Journal of Obstetrics and Gynaecology Canada. The analytic framework illustrates the population, interventions, outcomes, and adverse effects that guide the literature search and synthesis. PMID: 11214143, Huyck KL, Panhuysen CI, Cuenco KT, et al. What side effects can I expect from medication use? Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonanceguided focused ultrasound surgery. health information, we will treat all of that information as protected health The dye traces the shape of your uterine cavity and fallopian tubes and makes them visible on X-ray images. Uterine fibroids and endometrial polyps. Uterine leiomyomas, or fibroids, are a major cause of abnormal uterine bleeding in women. that is what your nursing instructor (s) expect of you and how you are going to learn about fibroid tumors and . information is beneficial, we may combine your email and website usage information with Also, uterine artery embolization and radiofrequency ablation may not be the best options if you're trying to optimize future fertility. Antiprogestins*. Uterine fibroids, or leiomyomas, are the most common benign tumors in women of reproductive age.1 Their prevalence is age dependent; they can be detected in up to 80% of women by 50 years of age.2 Fibroids are the leading indication for hysterectomy, accounting for 39% of all hysterectomies performed annually in the United States.3 Although many are detected incidentally on imaging in asymptomatic women, 20% to 50% of women are symptomatic and may wish to pursue treatment.4. Patient-Centered Outcomes Research Institute (PCORI). Options for traditional surgical procedures include: Abdominal myomectomy. With any procedure that doesn't remove the uterus, there's a risk that new fibroids could grow and cause symptoms. Myoma are very small in size: on average 0.3-0.4 cm. However, SPRMs can result in progesterone receptor modulatorassociated endometrial changes, although these seem to be benign.36, Other Agents. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Disagreements will be resolved through discussion. Peer reviewers do not participate in writing or editing of the final report or other products. We believe that additional evidence is needed before concluding either that the findings are stable or that the estimate of effect is close to the true effect. The Key Questions reflect the unmet need for a relevant synthesis of evidence from prospective randomized controlled trials on the relative benefits and harms of surgical, procedural, and medical interventions to manage uterine fibroids. When differences between the reviewers arise, we will err on the side of inclusion. To be excluded, publication abstracts must be reviewed and excluded independently by two members of the investigative team. However, scarring after surgery can affect future fertility. Thanks for your time and we wish you well. During the next three to 12 months, the fibroid continues to shrink, improving symptoms. During laparoscopic radiofrequency ablation, your doctor sees inside your abdomen using two special instruments. The assessment of the study limitations domain will be derived from the risk of bias of the individual studies that addressed the Key Question and specific outcome under consideration. Primary PPH - occurs when the mother loses at least 500 mL or more of blood within the first 24 hours of delivering the baby. Nulliparous. In the presence of predisposing factors, monitor maternal labor pattern closely for hypertonicity or signs of weakening uterine muscle. Stewart EA. Table 2 includes the differential diagnosis of uterine masses.31, Treatment of uterine fibroids should be tailored to the size and location of the tumors; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the physician's experience 4,11 (Table 332 42 and Table 44,16,34,38,4044 ). 2014 Dec 23PMID: 25542564. We will evaluate the methodologic risk of bias of individual studies. Morcellation a process of breaking fibroids into smaller pieces may increase the risk of spreading cancer if a previously undiagnosed cancerous mass undergoes morcellation during myomectomy. synonyms: myoma, fibromyoma. 2008 Feb;198(2):168 e1-9. They rarely interfere with pregnancy. Nursing Management. Though hysterectomy and myomectomy by a variety of routes are frequently used, perhaps with insufficient consideration of alternative treatment prior to surgery,16 the range of fibroid-specific treatments including interventions like extended medical management with ulipristal acetate, magnetic resonance image-guided focused ultrasound (MRgFUS), uterine artery embolization, radiofrequency volumetric thermal ablation, and techniques for myolysis are increasingly generating comparative effectiveness data7,9 as is the clinical trials literature about improving bleeding symptoms.17 Furthermore, as the literature evolves, including larger studies of stronger design with longer followup, a clearer picture of anticipated outcomes is likely to emerge. In a large population-based study, more than 80% of women with adenomyosis had a hysterectomy, and almost 40% used chronic pain medications. Hysterectomy provides a definitive cure for women with symptomatic fibroids who do not wish to preserve fertility, resulting in complete resolution of symptoms and improved quality of life. The conditions that can also affect pregnancy are fibroids, endometriosis, ovarian cysts, cervical dysplasia and more. The final report does not necessarily represent the views of individual reviewers. What is the comparative effectiveness (benefits and harms) of treatments for uterine fibroids, including comparisons among and within these interventions? Hierarchical random effects allow results from individual studies to be partially pooled, meaning that each study can contribute to inference in the meta-analysis without assuming that the set of studies are identical. Uterine fibroids can lead to gynecologic complications. Many women who have uterine fibroids do not have symptoms. Cost data are linked with operative time and clinician skill sets, which may be affected by a number of factors. Compared with hysterectomy and myomectomy, uterine artery embolization has a significantly decreased length of hospitalization (mean of three fewer days), decreased time to normal activities (mean of 14 days), and a decreased likelihood of blood transfusion (OR = 0.07; 95% CI, 0.01 to 0.52).42 Long-term studies show a reoperation rate of 20% to 33% within 18 months to five years.24 Contraindications include pregnancy, active uterine or adnexal infections, allergy to intravenous contrast media, and renal insufficiency. Within the EPC program, the Key Informant role is to provide input into identifying the Key Questions for research that will inform healthcare decisions. Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions. If we are unable to resolve a discrepancy in the reporting of data from a publication we may contact study authors for additional information or clarification. Uterine fibroids may be associated with infertility, and some experts recommend that women with infertility be evaluated for fibroids, with potential removal if the tumors have a submucosal component.14 However, there is no evidence from randomized controlled trials to support myomectomy to improve fertility.15 One meta-analysis included two studies that showed improvement in spontaneous conception rates in women who underwent myomectomy for submucosal fibroids (relative risk [RR] = 2.034; 95% confidence interval [CI], 1.081 to 3.826; P = .028).16 However, no statistically significant difference was noted in the ongoing pregnancy/live birth rate. Her health care provider (HCP) tells her that she has uterine fibroids and recommends an abdominal hysterectomy. Rockville, MD: Agency for Healthcare Research and Quality; November 2013. www.effectivehealthcare.ahrq.gov, Non FDA-labeled indications: Menorrhagia, uterine leiomyoma (preoperative). Obstet Gynecol. Preventing an increase in skin reactions, lowering the . Farris M, et al. We have listed known pharmaceutical companies (Table A-1) and device manufacturers (Table A-2) in the Appendix. Obstet Gynecol. [1] Fibroids originate from uterine smooth muscle cells (myometrium) whose growth is primarily dependent on the levels of circulating estrogen. In particular, we hope to estimate probabilities of an outcome associated with potential trajectories of care for women under differing circumstances (e.g., likelihood of progressing to increasingly invasive options, particularly hysterectomy). We will summarize data related to symptom status and prioritize patient-reported measures. For example, oral contraceptives can help control menstrual bleeding, but they don't reduce fibroid size. Zimmermann A, Bernuit D, Gerlinger C, et al. include protected health information. Inpatient hysterectomy surveillance in the United States, 2000-2004. Total abdominal hysterectomy bilateral salpingo-oophorectomy (TAHBSO) is the removal of the entire uterus, the ovaries, fallopian tubes, and the cervix. There are some small studies looking into possible dietary and environmental factors that may promote fibroid growth. The domains of consistency and precision will be assessed based on the direction and variation of the estimates. Women with uterine fibroids are more likely have pregnancies complicated by fetal malpresentation, preterm birth, preterm premature rupture of membranes (PPROM), placenta previa, placental abruption, cesarean delivery, and severe postpartum hemorrhage. Women with large fibroids may experience minimal symptoms while women with small fibroids may have significant symptoms. . US Department of Health and Human Services, Food and Drug Administration; Issued: Nov 24, 2014. Have a full discussion of the risks and benefits of these procedures with your doctor if you want to preserve the ability to become pregnant. Uterine fibroids are more common in multiparous women compared with women who have a history of giving birth frequency of 1 (one) or 2 (two) times (Khashaeva, 1992). All myomectomies carry the risk of cutting into an undiagnosed cancer, but younger, premenopausal women generally have a lower risk of undiagnosed cancer than do older women. American Family Physician. PMID: 19300327. PMID: 15738025, Laughlin SK, Baird DD, Savitz DA, et al. Most women will develop one or more uterine fibroids (i.e., leiomyomata), with roughly $4,624 in costs per women in the first year of diagnosis.10,11. What medications are available to treat uterine fibroids or my symptoms? In 2014, the U.S. Food and Drug Administration recommended limiting the use of laparoscopic power morcellation to reproductive-aged women who are not candidates for en bloc uterine resection. Ultrasonography is the recommended initial imaging modality for diagnosis of uterine fibroids. The American College of Obstetricians and Gynecologists. An observational study of 26 women treated with uterine artery embolization and 40 treated with hysterectomy found no difference in live birth rates.42 In a retrospective study with five years of follow-up in women who received uterine artery embolization for fibroids, 27 (4.2%) had one (n = 20) or more (n = 7) pregnancies after uterine artery embolization.64 Of these pregnancies, there were 15 miscarriages and 19 live births, 79% of which were cesarean deliveries because of complications. Uterine fibroids are the most common benign (not cancerous) tumors, or growths, in women of childbearing age. Am J Obstet Gynecol. Management should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the experience of the physician. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. The investigative team will also scan the reference lists of articles that are included after the full-text review phase for studies that potentially could meet our inclusion criteria. How big are they? Content last reviewed May 2019. Limited data have shown that they help reduce fibroid size as well as decrease menstrual bleeding, with adverse effects including hot flashes, vaginal dryness, and musculoskeletal pain.53,54 Overall, there is insufficient evidence to support the use of aromatase inhibitors for the treatment of uterine fibroids.55 Selective estrogen receptor modulators act as partial estrogen receptor agonists in bone, cardiovascular tissue, and the endometrium. 2003 Jan;188(1):100-7. Develop early identification of the changes in skin integrity. Expected outcomes: Pain does not exist or can be controlled . https://www.uptodate.com/contents/search. Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication, Updated [WebContent]. It can occur during both vaginal and cesarean delivery . Accessed April 24, 2019. Be upfront about your treatment goals and concerns. There is insufficient evidence on the effect of uterine artery embolization on future fertility. The search and selection literature sources may be refined following discussions with Technical Experts. These tumors are not linked to cancer and don't increase a woman's risk for uterine cancer. that would be palgeurism. Hysteroscopic myomectomy is the preferred surgical procedure for women with submucosal fibroids who wish to preserve their uterus or fertility. Some websites and consumer health books promote alternative treatments, such as specific dietary recommendations, magnet therapy, black cohosh, herbal preparations or homeopathy. Most fibroids are benign i.e. (2022). NURSING-CARE-PLAN-2021 - Read online for free. 2016;43:397. Stewart EA, et al. The transcervical or through the cervix approach to radiofrequency ablation (Sonata) also uses ultrasound guidance to locate fibroids. Rockville (MD); 2013. Current Population Reports. Therefore, eligible studies for Key Question 1 and Key Question 2 must be randomized trials evaluating the benefits or harms of a medical, procedural, or surgical intervention compared with an inactive control, including expectant management, or alternate intervention. Stewart EA. Do your symptoms seem to be related to your menstrual cycle? Scribd is the world's largest social reading and publishing site. There is some literature about the relationship of imaging findings and symptom profiles, but the correlation is not tight. Tranexamic acid (Cyklokapron) is an oral nonhormonal antifibrinolytic agent that significantly reduces menstrual blood loss compared with placebo (mean reduction = 94 mL per cycle; 95% CI, 36 to 151 mL).37,38 One small nonrandomized study reported a higher rate of fibroid necrosis in patients who received tranexamic acid compared with untreated patients (15% vs. 4.7%; OR = 3.60; 95% CI, 1.83 to 6.07; P = .0003), with intralesional thrombi in one-half of the 22 cases involving fibroid necrosis (manifesting as apop-totic cellular debris with inflammatory cells, and usually hemorrhage).49 However, in a systematic review of four studies with 200 patients who received tranexamic acid, none of the studies detailed the adverse effects of fibroid necrosis or thrombus formation.50, Nonsteroidal Anti-inflammatory Drugs. Preoperative administration of GnRH agonists (e.g., leuprolide [Lupron], goserelin [Zoladex], triptorelin [Trelstar Depot]) increases hemoglobin levels preoperatively by 1.0 g per dL (10 g per L) and postoperatively by 0.8 g per dL (8 g per L), as well as significantly decreases pelvic symptom scores.32 Adverse effects resulting from the hypoestrogenized state, including hot flashes (OR = 6.5), vaginitis (OR = 4.0), sweating (OR = 8.3), and change in breast size (OR = 7.7), affect the long-term use of these agents.32, Compared with placebo, the SPRM mife-pristone (Mifeprex) significantly decreases heavy menstrual bleeding (OR = 18; 95% CI, 6.7 to 47) and improves fibroid-specific quality of life, but does not affect fibroid volume.35 Ulipristal (Ella) is an SPRM approved as a contraceptive in the United States but used in other countries for the treatment of fibroids in adult women who are eligible for surgery. This review will not include studies that evaluate the effectiveness of preoperative or adjunctive interventions to minimize blood loss or otherwise improve operative outcomes. Further . Accessed May 3, 2019. . Nursing Diagnosis and Interventions for Uterine Fibroids 1. It is defined as excessive menstrual bleeding with a loss of more than 80ml of blood per month. Larger fibroids can be removed through smaller incisions by breaking them into pieces (morcellation), which can be done inside a surgical bag, or by extending one incision to remove the fibroids. Kaunitz AM. If that's the case for you, watchful waiting could be the best option. They can grow as a . Acute Pain. Her blood pressure is 160/100 mm Hg. The EPC refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel (TEP). https://www.acog.org/Patients/FAQs/Uterine-Fibroids. No medications have been specifically approved by the U.S. Food and Drug Administration (FDA) for treatment of fibroid symptoms, though several medications are used off-label (see Table A-1). We believe that the findings are stable, i.e., another study would not change the conclusions. Obstet Gynecol. Since fibroids are hormonally responsive growths, most people do experience a decrease in fibroid size and fibroid-related issues as they get closer to menopause and beyond. In this procedure, a thin tube called an endoscope is passed through the cervix and into the uterus. If traditional ultrasound doesn't provide enough information, your doctor may order other imaging studies, such as: Our caring team of Mayo Clinic experts can help you with your uterine fibroids-related health concerns New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. GnRH agonists include leuprolide (Lupron Depot, Eligard, others), goserelin (Zoladex) and triptorelin (Trelstar, Triptodur Kit). We will use explicit criteria for rating the overall strength of the evidence for intervention-final outcome pairs for which the overall risk of bias is not overwhelmingly high. 1. Below is the list of the 16 new NANDA Nursing Diagnoses 1. All Rights Reserved. Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. Abdominal myomectomy. After locating a uterine fibroid, your doctor uses another thin device to send several small needles into the fibroid. This input is intended to ensure that the key questions are specific and relevant. NICHD research on uterine fibroids aims to learn more about what causes them, how they grow, factors related to who develops them, and fibroid treatments. The specific meta-analysis or meta-regression will depend on the data available. Types of Postpartum Hemorrhage. Major Primary PPH - losing 500 mL to 1000 mL of blood. Changes will not be incorporated into the protocol. 3rd ed. Nursing Care Plan for Uterine Fibroids (Myoma) Apr 29, 2015. uterine fibroids features, types, diagnosis, mangement. They are selected to provide broad expertise and perspectives specific to the topic under development. painful sex. If you have symptoms of uterine fibroids, your doctor may order these tests: Ultrasound. Copyright 2017 by the American Academy of Family Physicians. Here are six (6) nursing care plans (NCP) and nursing diagnosis (NDx) for . The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyomata among affected sisters. We will review the titles and abstracts of all publications identified through our searches against our inclusion/exclusion criteria. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Women with intramural fibroids had no differences in pregnancy rates after undergoing myomectomy. PMID: 25555855. One is a laparoscopic camera positioned above the uterus, and the other is a laparoscopic ultrasound wand that sits directly on the uterus. Fibroids in the uterine cavity can cause miscarriage or make it more difficult to get pregnant. Hartmann KE, Jerome RN, Lindegren ML, et al. If we need to amend this protocol, we will give the date of each amendment, describe the change, and give the rationale in this section. Uterine fibroids. constipation. Fibroids are made of muscle cells and fibrous tissues that grow in and around the wall of the uterus. But depending on the size and location of the fibroids, your doctor may advise that you have a C-section in a future pregnancy because the scar on the uterus can open during labor. https://familydoctor.org/familydoctor/en/diseases-conditions/uterine-fibroids.html. Fibroids are benign tumors that originate from the uterine smooth muscle tissue (myometrium) whose growth is dependent on estrogen and progesterone.5,6 Fibroids are rare before puberty, increase in prevalence during the reproductive years, and decrease in size after menopause.6 Aromatase in fibroid tissue allows for endogenous production of estradiol, and fibroid stem cells express estrogen and progesterone receptors that facilitate tumor growth in the presence of these hormones.5 Protective factors and risk factors for fibroid development are listed in Table 1.79 The major risk factors for fibroid development are increasing age (until menopause) and African descent.7,8 Compared with white women, black women have a higher lifetime prevalence of fibroids and more severe symptoms, which can affect their quality of life.10, Uterine fibroids are classified based on location: subserosal (projecting outside the uterus), intramural (within the myometrium), and submucosal (projecting into the uterine cavity). HHSA 290-2015-00003I from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Comments did not necessitate any significant changes to the Key Questions, review scope, or inclusion criteria. We will prespecify the harms that we will extract and will use consistent and precise terminology for reporting data on harms to the degree the literature includes operational definitions.22 We will check sources other than published literature (e.g., FDA, clinical trial data from device manufacturers or pharmaceutical companies via SIPs) for additional information on harms. EPC core team members must disclose any financial conflicts of interest greater than $1,000 and any other relevant business or professional conflicts of interest. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids. The appearance of heterogeneous areas may indicate the process of transformation . Don't hesitate to have your doctor repeat information or to ask follow-up questions. The forms will also include questions to assist in preliminary grouping of the eligible studies by Key Question. We do not anticipate that current studies can offer meaningful data to address a sequencing question. Nursing Care Plan Uterine Fibroids Many physicists using number of factors are plagued homeopathy in all other treatment must aim to eliminate. Management of Uterine Fibroids. The embolic agents then flow to the fibroids and lodge in the arteries that feed them. These random effects will allow estimates of overall (population) effects as well as an estimate of the variance of the effect across studies, after controlling for available study-level covariates. Internet Citation: Hysterectomy and endometrial ablation won't allow you to have a future pregnancy. 2010 May;63(5):502-12. It does appear that fibroid growth is related to increasing weight. After locating a fibroid, your doctor uses a specialized device to deploy several small needles into the fibroid. Nursing care plan on Uterine fibroids//Uterine fibroids/leiomyomas or myomas Nursing care plan//NCPs@Anand's nursing files @Anand's nursing files #nursingca. Another selective estrogen receptor modulator, raloxifene (Evista), has also shown inconsistent results, with two of three studies included in a Cochrane review showing significant benefit.57, Hysterectomy. Women who use combined oral contraceptives have significantly less self-reported menstrual blood loss after 12 months compared with placebo.33 However, the levonorgestrel-releasing intra-uterine system (Mirena) results in a significantly greater reduction in menstrual blood loss at 12 months vs. oral contraceptives (mean reduction = 91% vs. 13% per cycle; P < .001).33 In six prospective observational studies, reported expulsion rates of intrauterine devices were between zero and 20% in women with uterine fibroids.45 There is a lack of high-quality evidence regarding oral and injectable progestin for uterine fibroids.4648, Tranexamic Acid. Researchers Link Toxic Phthalates to Uterine Fibroid Growth - An ultrasound led to the discovery for uterine fibroids. A surgical option to treat heavy bleeding is hysteroscopic myomectomy. We have no evidence, we are unable to estimate an effect, or we have no confidence in the estimate of effect for this outcome. Risk for Adverse Reaction to Iodinated Contrast Media 3. AHRQ Publication No 01-E052 Rockville, MD: Agency for Healthcare Research and Quality. Also searched were the Agency for Healthcare Research and Quality evidence reports, Clinical Evidence, the Cochrane database, the Database of Abstracts of Reviews of Effects, Essential Evidence Plus, and the National Guideline Clearinghouse database. Fibroids (leiomyoma) are non-cancerous tumors of the uterine muscle. Maintain frequent Leiomyoma-related hospitalization and surgery: prevalence and predicted growth based on population trends. Recognize signs of impending rupture, immediately notify the physician, and call for assistance. Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative. Most women with uterine fibroids may be able to choose to keep their ovaries. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Uterine fibroids: Diagnosis and treatment. July 2001, Wegienka G, Baird DD, Hertz-Picciotto I, et al. We are moderately confident that the estimate of effect lies close to the true effect for this outcome. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The nursing management for uterine fibroids involves pain management, fluid replacement, bleeding control, and patient education. Comparative effectiveness review no. The procedure is performed while you're inside an MRI scanner. We will record exclusion codes in an EndNote (Thomson Reuters, New York, NY) bibliographic database and will compile a list of excluded papers and exclusion reasons in the report. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. The ideal treatment satisfies four goals: relief of signs and symptoms, sustained reduction of the size of fibroids, maintenance of fertility (if desired), and avoidance of harm. The American College of Obstetrics and Gynecology (ACOG) has just released updated guidelines on management of symptomatic uterine fibroids (leiomyomas). 2003 Mar;101(3):431-7. These growths are made up of muscle cells and tissue. Studies reporting only intermediate outcomes will not be included. Typically, endometrial ablation is effective in stopping abnormal bleeding. Some predictors of malignancy on magnetic resonance imaging include age older than 45 years (odds ratio [OR] = 20), intratumoral hemorrhage (OR = 21), endometrial thickening (OR = 11), T2-weighted signal heterogeneity (OR = 10), menopausal status (OR = 9.7), and nonmyometrial origin (OR = 4.9).27,28 Risk factors for leiomyosarcoma include radiation of the pelvis, increasing age, and use of tamoxifen,29,30 which has implications for surgical management of fibroids. Gynecological disorders. For uterine fibroids, some basic questions to ask include: Make sure that you understand everything your doctor tells you. 2012 Mar;206(3):211.e1-9. Uterine fibroids: An update on current and emerging medical treatment options. This content does not have an Arabic version. Peer reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. Agency for Healthcare Research and Quality. AskMayoExpert. Secondary PPH - occurs when the mother has heavy or abnormal vaginal . Management of abnormal uterine bleeding. Uterine fibroids.