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Review
. 2014 Dec 22;111(51-52):877-83.
doi: 10.3238/arztebl.2014.0877.

The conservative and interventional treatment of fibroids

Alexander Stephan Boosz  1 , Peter Reimer, Matthias Matzko, Thomas Römer, Andreas Müller
Affiliations
Review

The conservative and interventional treatment of fibroids

Alexander Stephan Boosz et al. Dtsch Arztebl Int. .

Abstract

Background: Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures.

Methods: Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews.

Results: Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators.

Conclusion: Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.

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Figures

Figure 1
Figure 1
Fibroid locations (schematic): a) subserosal fibroid, b) submucosal fibroid, c) intramural fibroid, d) pedunculated fibroid
Figure 2
Figure 2
Ultrasonography: 1 Submucosal posterior wall fibroid distorting the endometrial cavity 2 Myometrium 3 Endometrium (uterine cavity)
Figure 3
Figure 3
Intracavitary fibroid before hysteroscopic resection (left), hysteroscopic enucleation of a fibroid (right). (1, Fibroid and fibroid fragments; 2, uterine cavity)
Figure 4
Figure 4
Incision of the myometrium for laparoscopic enucleation of a fibroid 1 Fibroid 2 Myometrium
See this image and copyright information in PMC

Comment in

  • Missing treatment option.
    Strunkg H, Marinova M. Strunkg H, et al. Dtsch Arztebl Int. 2015 May 1;112(18):328. doi: 10.3238/arztebl.2015.0328a. Dtsch Arztebl Int. 2015. PMID: 26037469 Free PMC article. No abstract available.
  • In reply.
    Boosz A, Müller A. Boosz A, et al. Dtsch Arztebl Int. 2015 May 1;112(18):328. doi: 10.3238/arztebl.2015.0328b. Dtsch Arztebl Int. 2015. PMID: 26037470 Free PMC article. No abstract available.

References

    1. Ciavattini A, Di Giuseppe J, Stortoni P, et al. Uterine fibroids: pathogenesis and interactions with endometrium and endomyometrial junction. Obstet Gynecol Int. 2013:173–184. - PMC - PubMed
    1. Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Womens Health. 2012;12 - PMC - PubMed
    1. Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod. 2002;17:1424–1430. - PubMed
    1. Metwally M, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2012 Nov 14; CD003857. - PubMed
    1. Ciavattini A, Clemente N, Delli Carpini G, Di Giuseppe J, Giannubilo SR, Tranquilli AL. Number and size of uterine fibroids and obstetric outcomes. J Matern Fetal Neonatal Med. 2014;5:1–5. - PubMed

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