From the Guidelines
Uterine fibroid management should be tailored to the patient's symptoms, fibroid characteristics, and reproductive goals, with medical management being the first line of treatment, as recommended by the most recent guidelines 1. For symptomatic fibroids, medical management options include:
- Hormonal medications like combined oral contraceptives to reduce menstrual bleeding
- GnRH agonists (e.g., leuprolide acetate) to temporarily shrink fibroids and control symptoms
- Tranexamic acid to reduce heavy bleeding
- Progesterone receptor modulators such as ulipristal acetate, which reduce both bleeding and bulk symptoms For more definitive treatment, minimally invasive procedures include:
- Uterine artery embolization, which blocks blood flow to fibroids
- Focused ultrasound surgery Surgical options range from myomectomy (removing fibroids while preserving the uterus) to hysterectomy for women who have completed childbearing. The choice between these approaches depends on:
- Fibroid size and location
- Symptom severity
- Desire for future pregnancy
- Patient preferences As stated in the guidelines, medical management should be trialed prior to pursuing more invasive therapies 1. It's also important to note that uterine fibroid embolization is an alternative to hormonal therapy and myomectomy for the treatment of women with symptomatic fibroids who wish to retain fertility, with equivalent patient satisfaction and clinical success compared to myomectomy 1.
From the Research
Uterine Fibroid Management Options
- Uterine fibroids are common benign neoplasms that can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia 2
- Management options include expectant management for asymptomatic patients, medical therapy to reduce heavy menstrual bleeding, and surgical treatment such as hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery 2, 3
Medical Therapy
- Medical therapy includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs to reduce heavy menstrual bleeding 2
- Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause 2, 3
- Gonadotropin-releasing hormone analogs (agonists and antagonists) modulate the pulsatile release of GnRH and are used in therapy, agonists as a preparation for surgery, and antagonists as a drug for long-term use 4
Surgical Treatment
- Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery 2, 5
- Hysterectomy is the first choice of treatment, but medical therapies have been used prior to surgery to improve outcomes 6
- Myomectomy and uterine-preserving fibroid studies have comparable outcomes, and the choice of treatment depends on the patient's personal treatment goals, as well as efficacy and need for repeated interventions 5
Preoperative Medical Therapy
- Preoperative medical therapy with gonadotropin-hormone-releasing analogues (GnRHa) may reduce uterine volume, fibroid volume, and preoperative bleeding, and probably increases preoperative haemoglobin levels, but probably also increases the number of adverse events 6
- Selective progesterone receptor modulators (SPRMs) such as ulipristal acetate seem to offer similar advantages, probably reducing uterine volume, increasing haemoglobin level before surgery, and may reduce fibroid volume and fibroid-related bleeding 6