{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:32:23Z","timestamp":1785393143679,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,9,30]],"date-time":"2021-09-30T00:00:00Z","timestamp":1632960000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Guidelines standardise high\u2010quality evidence\u2010based management strategies for clinicians. Uterine fibroids are a highly prevalent condition and may exert significant morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To appraise national and international uterine fibroid guidelines using the validated AGREE\u2010II instrument.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection strategy<\/jats:title><jats:p>Database search of PubMed and EMBASE from inception to October 2020 for all published English\u2010language uterine fibroid clinical practice guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>In all, 939 abstracts were screened for eligibility by two reviewers independently. Three reviewers used the AGREE\u2010II instrument to assess guideline quality in six domains. Recommendations were mapped to allow a narrative synthesis regarding areas of consensus and disagreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Eight national guidelines (AAGL, SOGC 2014, ACOG, ACR, SOGC 2019, CNGOF, ASRM and SOGC 2015) and one international guideline (RANZOG) were appraised. The highest scoring guideline was RANZOG 2001(score 56.5%). None of the guidelines met the a priori criteria for being high\u2010quality overall (score \u226566%). There were 166 recommendations across guidelines. There were several areas of disagreement and uncertainty. There were only three areas of consensus. Supporting evidence was not evident for many recommendations; 27.7% of recommendations were based on expert opinion only.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is a need for high\u2010quality guidelines on fibroids given their heterogeneity across individuals and the large range of treatment modalities available. There are also areas of controversy in the management of fibroids (e.g. Ulipristal acetate, power morcellation), which should also be addressed in any guidelines. Future guidelines should be methodologically robust to allow high\u2010quality decision\u2010making regarding fibroid treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Current national fibroid guidelines have deficiencies in quality when appraised using the validated AGREE instrument.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.16928","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T08:08:47Z","timestamp":1631866127000},"page":"356-364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Appraisal of national and international uterine fibroid management guidelines: a systematic review"],"prefix":"10.1111","volume":"129","author":[{"given":"A","family":"Amoah","sequence":"first","affiliation":[{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Joseph","sequence":"additional","affiliation":[{"name":"University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Reap","sequence":"additional","affiliation":[{"name":"University of Leicester Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SD","family":"Quinn","sequence":"additional","affiliation":[{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,30]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.99"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.03.019"},{"issue":"11","key":"e_1_2_8_4_1","first-page":"1","article-title":"Treating symptomatic uterine fibroids with myomectomy: current practice and views of UK consultants","volume":"14","author":"Sirkeci RF","year":"2017","journal-title":"Gynecol Surg"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000233933.13684.05"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61034-3"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.091716"},{"key":"e_1_2_8_8_1","first-page":"182","article-title":"Development of the AGREE II, part 1: performance, usefulness and areas for improvement. 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[https:\/\/www.ema.europa.eu\/en\/medicines\/human\/referrals\/ulipristal\u2010acetate\u20105mg\u2010medicinal\u2010products] Accessed 21 July 2020."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-9-3"},{"key":"e_1_2_8_22_1","unstructured":"HartmannKE FonnesbeckC SurawiczT KrishnaswamiS AndrewsJC WilsonJE et\u2009al. Management of uterine fibroids. comparative effectiveness review no. 195. (Prepared by the Vanderbilt Evidence\u2010based Practice Center under Contract No. 290\u20102015\u201000003\u2010I.) [Internet]. 2017. [www.ahrq.gov]. 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