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. The management of uterine fibroids has evolved over the years, with a focus on improving quality of life and reducing symptoms. According to a study published in the American Journal of Obstetrics and Gynecology 1, selective progesterone receptor modulators (SPRMs) have emerged as a new class of medications for the treatment of uterine fibroids.
Symptoms and Diagnosis
Uterine fibroids can cause a range of symptoms, including abnormal uterine bleeding, anemia, bulk symptoms, and fertility issues. A study published in the Journal of the American College of Radiology 1 highlights the importance of considering patient preferences and symptom severity when guiding treatment choice. The economic burden of symptomatic fibroids is also significant, with estimated societal costs ranging from $5.9 to $34.4 billion annually 1.
Treatment Options
Treatment options for uterine fibroids include medical therapy, such as gonadotropin-releasing hormone agonists, levonorgestrel-releasing intrauterine devices, and tranexamic acid, as well as uterine-sparing therapies like myomectomy and uterine fibroid embolization (UFE) 1. Myomectomy and UFE have been shown to result in equivalent symptomatic improvement at 2 years, making them viable options for women seeking to preserve their uterus. Hysterectomy is also a curative option, although it is typically considered a last resort.
Quality of Life and Morbidity
The impact of uterine fibroids on quality of life and morbidity cannot be overstated. Regular gynecological check-ups are essential for maintaining uterine health, especially for women experiencing abnormal bleeding, pelvic pain, or fertility issues. By prioritizing comprehensive management and individualized treatment plans, healthcare providers can help reduce the significant morbidity, mortality, and economic burden associated with uterine fibroids.
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