Table 2.

Surgical management of uterine fibroids

Treatment	Evidence-based recommendation
Hysteroscopic myomectomy	Decreases and removes intracavitary fibroids and improves symptoms; typically preserves the integrity of the myometrium; recommended for FIGO 0, FIGO 1, and some FIGO 2 submucosal fibroids and for patients desiring to retain fertility; associated with a 15–50% risk of recurrence [31, 41, 46]
Abdominal myomectomy (laparoscopic, robotic, or laparotomic)	Reduces uterine volume and improves symptoms; recommended for intramural, subserosal, and very large submucosal fibroids that are not amenable to hysteroscopic resection [31]
Endometrial ablation/myolysis	Reduces HMB; uses electrical energy, cryotherapy, heated saline, or radiofrequency energy to destroy the endometrium; recommended for premenopausal patients who do not desire future fertility [31, 41, 46]
Radiofrequency volumetric thermal ablation	Minimally invasive; reduces fibroid volume and improves symptoms; impact on fertility requires further investigation [31]
Hysterectomy	Advised for patients who desire definitive treatment for symptomatic fibroids; should be performed minimally invasively when possible [31, 41, 46]

FIGO, International Federation of Gynecology and Obstetrics; HMB, heavy menstrual bleeding