From the Guidelines
Uterine fibroids are a common condition affecting up to 80% of women by age 50, causing significant morbidity, mortality, and impact on quality of life, and should be managed with a comprehensive approach including medical therapy, uterine-sparing therapies, and surgery, with the goal of alleviating symptoms and improving fertility and overall well-being. The management of uterine fibroids has evolved over the years, with a shift from traditional surgical approaches to more conservative and minimally invasive options, as seen in the study by 1. The study by 1 highlights the importance of selective progesterone receptor modulators (SPRMs) in the management of uterine fibroids, offering a new class of medications for the treatment of UF symptoms. Some key points to consider in the management of uterine fibroids include:
- The prevalence of fibroids varies with race, with Black women having an estimated incidence of fibroids by age 50 exceeding 80% 1
- Fibroid-associated symptoms peak in the perimenopausal years and decline after menopause, with menorrhagia being the most frequent symptom 1
- Patient preferences and symptom severity help inform treatment choice, with options ranging from medical therapy to surgery 1
- Uterine-sparing therapies, such as myomectomy and uterine fibroid embolization (UFE), are effective in alleviating symptoms and improving quality of life 1
- The economic burden of symptomatic fibroids to society is large, with total estimated societal costs ranging from $5.9 to $34.4 billion annually 1. The most recent and highest quality study, 1, recommends a comprehensive approach to the management of uterine fibroids, taking into account the individual woman's symptoms, preferences, and overall health status, with the goal of improving morbidity, mortality, and quality of life.
From the Research
Uterine Fibroids Treatment
- Uterine leiomyoma is the most frequently occurring solid pelvic tumor in women during the reproductive period 2
- Magnetic resonance-guided high-intensity focused ultrasound is a promising technique for decreasing menorrhagia and dysmenorrhea in symptomatic women 2
Treatment Effectiveness
- The data indicated that tumor size was reduced and that symptoms were improved after treatment with Magnetic resonance-guided high-intensity focused ultrasound 2
- MRI-guided focused ultrasound was cost effective relative to hysterectomy, with an associated incremental cost-effectiveness ratio (ICER) of $47,891/QALY 3
- The use of GnRH agonists potentiates the thermal effects of MRgFUS in women undergoing treatment of uterine fibroids 4
Prediction of Treatment Outcomes
- Magnetic resonance elastography (MRE) can be used to predict the response to magnetic resonance-guided focused ultrasound (MRgFUS) for uterine fibroids 5
- The fractional stiffness value reduction in the patients with a substantial improvement in Symptoms Severity Score (SSS) was significantly higher than that in those without 5
Treatment Considerations
- The presence of abdominal scars can limit the number of women eligible for MRI guided focused ultrasound (MRgFUS) treatment, due to absorbance of beam energy 6
- Women with scars had significant lower non-perfused volume (NPV) compared with women without scars 6
- Fibroids' volume, stopping the treatment due to severe pain and the presence of abdominal scars had a statistically significantly negative effect on NPV 6