From the Guidelines
Uterine fibroid treatment should prioritize medical management as the first line of treatment, with options including NSAIDs, estrogen-progestin oral contraceptive pills, and tranexamic acid, as these have been shown to reduce bleeding symptoms and improve quality of life 1. When considering treatment options for uterine fibroids, it is essential to take into account the severity of symptoms, fibroid size, location, and the patient's desire for future fertility.
- Medical treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and hormonal medications like combined oral contraceptives, can control heavy bleeding and reduce symptoms.
- GnRH agonists, like leuprolide, can temporarily shrink fibroids and reduce bleeding but are typically limited to 3-6 months due to side effects like bone loss 1.
- For more persistent symptoms, minimally invasive procedures, such as uterine artery embolization or focused ultrasound surgery, may be considered.
- Surgical options, ranging from myomectomy to hysterectomy, are typically reserved for severe cases where fertility preservation is not a concern. The choice of treatment should be individualized based on symptom severity, fibroid characteristics, desire for pregnancy, and personal preferences, with regular follow-up essential to monitor fibroid growth and symptom changes regardless of the treatment approach selected 1. Key considerations in treatment selection include the potential impact on fertility, the risk of side effects, and the patient's overall quality of life, with the goal of minimizing morbidity and mortality while maximizing quality of life 1.
From the Research
Uterine Fibroid Treatment Options
- Uterine fibroids are common benign neoplasms that can cause abnormal uterine bleeding, pelvic pressure, and other symptoms 2
- Treatment options for symptomatic uterine fibroids include medical, surgical, and radiologically guided interventions 3
Medical Treatment
- Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs 2
- Gonadotropin-releasing hormone (GnRH) agonists and selective progesterone receptor modulators (SPRMs) are effective medical therapies for reducing fibroid volume and symptomatic improvement in menstrual bleeding 3, 4
- GnRH analogs (agonists and antagonists) modulate the pulsatile release of GnRH and are used in therapy, with agonists used as a preparation for surgery and antagonists used for long-term use 4
Surgical Treatment
- Surgical treatment options include hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery 2
- The choice of treatment depends on the patient's personal treatment goals, as well as efficacy and need for repeated interventions 3
Emerging Treatment Options
- There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids, leading to increasing use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate 5
- SPRMs have been proven to treat fibroid symptoms effectively, providing a new tool for gynecologists in the management of uterine fibroids 5