Uterine Fibroids Data Elements*
Medical history
General medical historyHigh blood pressure Diabetes Thyroid problemsBlood clots in legs or lungs Endometriosis Adenomyosis
Menstrual cycle/flowAre your periods regular (in timing and predictable within 5 days)?Do you have a history of anemia related to your heavy periods or fibroids? If yes, did this anemia ever require A blood transfusion? Heaviness of flow
Pregnancy historyHave you ever been pregnant? If yes, how many pregnancies have You had? For each pregnancy, outcome:For each pregnancy, when did you Deliver? For each pregnancy, what type of Delivery did you have?
Uterine fibroid historyAre you currently having any symptoms related to your fibroids?If yes, select all fibroid-related Symptoms you are currently Experiencing
Prior uterine fibroid proceduresHow many prior procedures? Abdominal myomectomy (open surgery to remove the fibroids, abdominal incision) If yes, year of procedure Hysteroscopic myomectomy (telescope inside the uterus removing fibroids) If yes, year of procedure Laparoscopic or robotic myomectomy, (davinci robotic surgery) If yes, year of procedure Myomectomy, vaginal (open surgery to remove fibroids, vaginal incision) If yes, year of procedure Focused ultrasound (exablate; sonalleve) If yes, year of procedureEndometrial ablation (any type; examples include: novasure impedance, her option, hydrotherm, microsulis (microwave), thermachoice balloon, resectoscope) If yes, year of procedure Radiofrequency ablation (acessa) (destroying the fibroid with heat from a needle that is inserted into the fibroid using a telescope inserted through a small abdominal incision) If yes, year of procedure Uterine arterial embolization/ uterine fibroid embolization (uae) (inserting particles to block fibroid blood vessels using a slender, flexible tube) If yes, year of procedure
Current uterine fibroid therapies or supplementsDo you use hormonal birth control? If yes, what do you use it for: If yes, what type of hormonal birth Control?Tranexamic acid (lysteda) Lupron Anti-inflammatory medication or nsaids (e.g., Ibuprofen, motrin, aleve, advil, anaprox, etc.)
Imaging data
Imaging dataDate of imaging Type of modality Fibroid location Fibroid sizes/measurement How many fibroids are visualized (e.g., Present or seen)?How many fibroids are measured? Report all dimensions listed Adenomyosis? Endometriosis? Uterine lesion suspicious for malignancy?
Procedure data
Planned procedurePlanned procedure Was the planned procedure completed?If no, was another uterine fibroid Procedure performed?
All proceduresProcedure date Discharge date Primary surgeon Primary procedure performed Intraoperative adverse events (aes) If any aes, was ae device-related?Ovarian pathology findings Uterine pathology findings Other operative findings Estimated blood loss (in cc/ml) Post-operative events Other procedures performed
HysterectomySurgical route Route for removal of uterus Uterine weightWas morcellation used? If yes, was morcellation contained? If yes, what device was used to Morcellate and/or contain tissue?
Abdominal myomectomyIncision type # of excised fibroidsCumulative weight of excised fibroids
Hysteroscopic myomectomyCumulative weight of excised fibroids# of excised fibroids
Endometrial ablationType
Laparoscopic or robotic myomectomyWas morcellation used? If yes, was morcellation contained? If yes, what device was used to Morcellate and/or contain tissue?Cumulative weight of excised fibroids # of excised fibroids
Uterine artery embolizationUterine arteries embolized?Ovarian arteries embolized?
Magnetic resonance-guided focused ultrasoundDevice # of treated fibroidsInjury to other structures diagnosed post-procedure
Radiofrequency ablation via laparoscopy# of fibroids visualized on ultrasound# of treated fibroids
Post-procedure data
Post-procedure dataTreatment failure: did you have another fibroid procedure? Was cancer found during follow up?If cancer was found, was it lms? Post-procedure adverse events
Long-term follow-up data
Long-term follow-up dataTreatment failure: did you have another fibroid procedure? Was cancer found during follow up?If cancer found, was it lms? Post-procedure adverse events
*These data elements may be entered by patients, by physicians, or through a hybrid approach based on available technology.
Note: This table originally appeared in The Women’s Health Technologies Coordinated Registry Network (WHT-CRN) report.13