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Review
. 2017 Sep 5:9:607-617.
doi: 10.2147/IJWH.S138982. eCollection 2017.

Updated approaches for management of uterine fibroids

Aymara Mas  1   2 , Marta Tarazona  3 , Joana Dasí Carrasco  3 , Gloria Estaca  4   5 , Ignacio Cristóbal  4   5 , Javier Monleón  3
Affiliations
Review

Updated approaches for management of uterine fibroids

Aymara Mas et al. Int J Womens Health. .

Abstract

Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient's quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations. Moreover, the development of several noninvasive surgical techniques, especially the appearance of ulipristal acetate as a medical etiological treatment, has substantially changed the clinical indications. As a consequence, after almost 2 decades without relevant updates, it has been necessary to update the protocols for the management of UFs in the Spanish Society of Gynecology and Obstetrics twice. Accordingly, we believe that it is necessary to translate our experience to protocolize the medical care for patients with UFs, incorporating these new therapeutic options, and selecting the best treatment for them. We highlight the importance of achieving the patient's goals and decisions by improving the clinical diagnosis for these type of pathologies, allowing enhanced personalized treatments, as well as the reduction of potential risks and unnecessary surgeries.

Keywords: UFs; UPA; sPRM; selective progesterone receptor modulator; ulipristal acetate; uterine fibroids.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Surgical, nonsurgical, and medical therapy currently used for the management of UFs. Abbreviations: GnRHa, gonadotropin-releasing hormone agonists; IUD, intrauterine device; MRgFUS, magnetic resonance-guided focused ultrasound surgery; NSAIDs, nonsteroidal anti-inflammatory drugs; RF, radiofrequency ablation; sPRMs, selective progesterone receptor modulators; UAE, uterine artery embolization; UFs, uterine fibroids.
Figure 2
Figure 2
Diagram showing the relationship and the expected changes in uterine fibroids’ diameter corresponding to the changes in volume (A), both in percentage (B) and fixed values (C). As volume is proportional to the radius to the cube, significant changes in volume mean smaller differences in radius or diameter.
Figure 3
Figure 3
The International Federation of Gynecology and Obstetrics classification system for uterine fibroids.
Figure 4
Figure 4
Medical algorithm for the management of UFs according to the patient’s profile. Abbreviations: LNG-IUS, levonorgestrel intrauterine system; MRgFUS, magnetic resonance-guided focused ultrasound surgery; NSAID, nonsteroidal anti-inflammatory drug; RF, radiofrequency ablation; UAE, uterine artery embolization; UF, uterine fibroid; UPA, ulipristal acetate.
See this image and copyright information in PMC

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