From the Guidelines
Leiomiomatosis uterina treatment should prioritize uterine artery embolization (UAE) as a minimally invasive option for symptom management, considering its effectiveness in reducing symptoms and improving quality of life, despite a 20-25% incidence of symptom recurrence at 5-7 years, as reported by 1. When considering treatment options for leiomiomatosis uterina, it is essential to evaluate the patient's symptom severity, fibroid size, location, and reproductive plans.
- For mild symptoms, watchful waiting with regular monitoring is appropriate.
- Medical treatments include hormonal options such as combined oral contraceptives to control bleeding, or GnRH agonists like leuprolide acetate to temporarily shrink fibroids and reduce bleeding before surgery.
- Tranexamic acid can reduce heavy bleeding, and levonorgestrel-releasing intrauterine devices (Mirena) effectively reduce bleeding without shrinking fibroids.
- Surgical options include myomectomy to remove fibroids while preserving the uterus, or hysterectomy for definitive treatment in women who have completed childbearing. According to 1, the American College of Radiology Appropriateness Criteria provide evidence-based guidelines for the radiologic management of uterine leiomyomas, emphasizing the importance of understanding the role of various treatment options in different clinical scenarios. The effectiveness of UAE in managing symptoms and improving quality of life is supported by studies, such as 1, which reported continued symptom relief in 67 of 93 women (72%) at median follow-up of 54 months. However, it is crucial to consider the potential for symptom recurrence and the impact of factors such as fibroid location, size, and patient age on treatment outcomes, as highlighted by 1. Ultimately, treatment choice should be individualized based on the patient's unique characteristics and needs, with regular follow-up to assess treatment effectiveness and potential side effects.
From the Research
Treatment Options for Uterine Leiomyomatosis
- Medical management: tailored to the needs of the woman presenting with uterine fibroids, geared to alleviating the symptoms 2
- Hysterectomy: a definitive solution for symptomatic uterine fibroids, but not the preferred solution for women who wish to preserve their uterus 3, 2
- Myomectomy: an option for women who wish to preserve their uterus, but carries the potential for further intervention 3, 2
- Uterine artery occlusion: may be offered as an alternative to selected women with symptomatic uterine fibroids who wish to preserve their uterus 3, 2
- Conservative interventional treatments: such as uterine artery embolization, have the longest track record and have been shown to be effective in properly selected patients 3
Conservative Treatment for Diffuse Uterine Leiomyomatosis
- "Extreme" myomectomy: removal of a large portion of corporal myometrium, may result in restoration of normal cycles and eventually in the birth of a viable fetus 4
- Medical treatment with GnRH analogues: may result in restoration of normal cycles and eventually in the birth of a viable fetus 4
Management of Symptomatic Uterine Leiomyomas
- The purpose of management is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas 5
- Treatment should be individualized 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 3