From the Guidelines
The treatment for symptomatic fibroma typically involves a multidisciplinary approach, including medical management, minimally invasive treatment, and surgical options, with the goal of alleviating symptoms and improving quality of life. According to the most recent evidence, the American College of Radiology Appropriateness Criteria recommend a variety of treatment options for women with symptomatic fibroids, ranging from medical therapy to hysterectomy 1.
Treatment Options
- Medical therapy, such as oral contraceptive medication or gonadotropin-releasing hormone (GnRH) agonists or antagonists, can manage bleeding symptoms effectively, especially in women with small fibroids 1.
- Minimally invasive treatment, such as uterine artery embolization, can relieve symptoms by shrinking the fibroids, with equivalent patient satisfaction and clinical success compared to myomectomy 1.
- Surgical options, such as myomectomy or hysterectomy, can provide definitive treatment, with hysterectomy being the most common treatment for symptomatic fibroids, resulting in high patient satisfaction scores 1.
Considerations
- The choice of treatment depends on various factors, including the size and location of the fibroid, the severity of symptoms, and the patient's preferences and medical history.
- The economic burden of symptomatic fibroids is significant, with estimated societal costs ranging from $5.9 to $34.4 billion annually 1.
- Pelvic ultrasound and MRI are the best imaging modalities for the initial diagnosis of fibroids, the initial treatment of known fibroids, and for surveillance or post-treatment imaging 1.
Recommendation
The most effective treatment for symptomatic fibroma is a personalized approach, taking into account the individual patient's needs and circumstances, with a focus on alleviating symptoms and improving quality of life. This approach should be based on the most recent evidence and guidelines, such as those provided by the American College of Radiology Appropriateness Criteria 1.
From the Research
Treatment Options for Symptomatic Fibroma
The treatment for symptomatic fibroma, also known as uterine fibroids, can vary depending on the severity of symptoms, size and location of the fibroids, age, and the patient's desire to preserve fertility or the uterus.
- Medical Treatments: Effective medical treatments for women with abnormal uterine bleeding associated with uterine fibroids include the levonorgestrel intrauterine system, gonadotropin-releasing hormone analogues, selective progesterone receptor modulators, oral contraceptives, progestins, and danazol 2.
- Surgical Alternatives: Hysterectomy is the most effective treatment for symptomatic uterine fibroids, but it is not the preferred solution for women who wish to preserve fertility and/or their uterus 2. Myomectomy is an option for women who wish to preserve their uterus or enhance fertility, but it carries the potential for further intervention 2.
- Conservative Interventional Treatments: Uterine artery embolization has the longest track record and has been shown to be effective in properly selected patients 2. Newer focused energy delivery methods are promising but lack long-term data 2.
- GnRH Agonists and Antagonists: GnRH agonists and antagonists can be used in the therapy of symptomatic uterine fibroids, with agonists used as a preparation for surgery and antagonists used as a drug for long-term use 3. Oral GnRH antagonists, such as relugolix, elagolix, and linzagolix, have been shown to be safe and effective in improving bleeding, discomfort, uterine/leiomyoma sizes, and quality of life in premenopausal patients with symptomatic uterine fibroids 4.
- Selective Progesterone Receptor Modulators: Short-term use of selective progesterone receptor modulator (SPRM) or gonadotropin-releasing hormone (GnRH) agonist can lead to uterine fibroid shrinkage, with GnRH agonist treatment resulting in a significantly higher reduction rate than SPRM treatment 5.
Considerations for Treatment
When considering treatment options for symptomatic fibroma, it is essential to individualize treatment based on symptomatology, size and location of fibroids, age, need and desire of the patient to preserve fertility or the uterus, the availability of therapy, and the experience of the therapist 2. The cost of the therapy to the health care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat investigative or treatment modalities 2.