From the Guidelines
Uterine fibroids typically require treatment when they cause significant symptoms or complications, or when they are very large, typically over 3 cm in diameter. The decision to treat uterine fibroids is based on their impact on quality of life, rather than their mere presence, as many women with fibroids experience no symptoms and require no intervention 1. Treatment is generally needed when fibroids cause:
- Heavy or prolonged menstrual bleeding leading to anemia
- Severe pelvic pain or pressure
- Urinary frequency or difficulty emptying the bladder
- Constipation
- Backache
- Fertility issues The specific treatment approach depends on the severity of symptoms, the size and location of fibroids, the patient's age, and whether future pregnancy is desired 1. Options include:
- Watchful waiting for asymptomatic small fibroids
- Medications like hormonal contraceptives or GnRH agonists to manage symptoms
- Minimally invasive procedures such as uterine artery embolization or focused ultrasound surgery
- Surgical interventions like myomectomy or hysterectomy for severe cases It's worth noting that 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. Therefore, treatment should be prioritized based on the severity of symptoms and the impact on quality of life, rather than the size of the fibroid alone.
From the Research
Uterine Fibroid Size and Treatment
- The size of uterine fibroids is an important factor in determining the appropriate treatment approach 2.
- Expectant management is recommended for asymptomatic patients, as most fibroids decrease in size during menopause 2.
- For symptomatic patients, treatment options include medical therapy, such as hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs, as well as surgical treatments like hysterectomy, myomectomy, and uterine artery embolization 2, 3.
Factors Influencing Treatment Decisions
- The decision to treat uterine fibroids depends on various factors, including the size and location of the fibroids, patient age, symptoms, desire to maintain fertility, and access to treatment 2, 3.
- The experience of the physician and the availability of treatment options also play a crucial role in determining the best course of treatment 2, 3.
Medical Therapy for Uterine Fibroids
- Gonadotropin-releasing hormone (GnRH) agonists and antagonists are used in the medical management of uterine fibroids 4, 5.
- GnRH agonists are often used as a preparation for surgery, while GnRH antagonists are used for long-term treatment 4.
- Oral GnRH antagonists, such as relugolix, elagolix, and linzagolix, have been shown to be safe and effective in reducing menstrual bleeding and discomfort in patients with symptomatic uterine fibroids 5.
Surgical Treatment for Uterine Fibroids
- Surgical treatment options for uterine fibroids include hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery 2, 3.
- The choice of surgical treatment depends on the size and location of the fibroids, as well as the patient's overall health and desire to maintain fertility 2, 3.