Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Sep 14;14(18):2046.
doi: 10.3390/diagnostics14182046.

Tailoring the Diagnostic Pathway for Medical and Surgical Treatment of Uterine Fibroids: A Narrative Review

Gabriele Centini  1 , Alberto Cannoni  1 , Alessandro Ginetti  1 , Irene Colombi  1 , Matteo Giorgi  1 , Giorgia Schettini  1 , Francesco Giuseppe Martire  1 , Lucia Lazzeri  1 , Errico Zupi  1
Affiliations
Review

Tailoring the Diagnostic Pathway for Medical and Surgical Treatment of Uterine Fibroids: A Narrative Review

Gabriele Centini et al. Diagnostics (Basel). .

Abstract

Uterine leiomyomas are the most common benign uterine tumors in women and are often asymptomatic, with clinical manifestation occurring in 20-25% of cases. The diagnostic pathway begins with clinical suspicion and includes an ultrasound examination, diagnostic hysteroscopy, and, when deemed necessary, magnetic resonance imaging. The decision-making process should consider the impairment of quality of life due to symptoms, reproductive desire, suspicion of malignancy, and, of course, the woman's preferences. Despite the absence of a definitive cure, the management of fibroid-related symptoms can benefit from various medical therapies, ranging from symptomatic treatments to the latest hormonal drugs aimed at reducing the clinical impact of fibroids on women's well-being. When medical therapy is not a definitive solution for a patient, it can be used as a bridge to prepare the patient for surgery. Surgical approaches continue to play a crucial role in the treatment of fibroids, as the gynecologist has the opportunity to choose from various surgical options and tailor the intervention to the patient's needs. This review aims to summarize the clinical pathway necessary for the diagnostic assessment of a patient with uterine fibromatosis, presenting all available treatment options to address the needs of different types of women.

Keywords: diagnosis; fibroid; gynecological surgery; hysteroscopy; leiomyoma; medical therapy; robotic surgery; ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Uterine leiomyoma with atypical vascular features.
Figure 2
Figure 2
(a) Three-dimensional ultrasound coronal view of a uterine fibroid; (b) sonohysterography: sagittal view of a G0 (FIGO classification) leiomyoma.
Figure 3
Figure 3
A pragmatic scheme to follow in the evaluation of a patient with uterine leiomyomas.
See this image and copyright information in PMC

References

    1. Zupi E., Centini G., Sabbioni L., Lazzeri L., Argay I.M., Petraglia F. Nonsurgical Alternatives for Uterine Fibroids. Best Pract. Res. Clin. Obstet. Gynaecol. 2016;34:122–131. doi: 10.1016/j.bpobgyn.2015.11.013. - DOI - PubMed
    1. Finco A., Centini G., Lazzeri L., Zupi E. Surgical management of abnormal uterine bleeding in fertile age women. Womens Health. 2015;11:513–525. doi: 10.2217/WHE.15.12. - DOI - PubMed
    1. Baird D.D., Dunson D.B., Hill M.C., Cousins D., Schectman J.M. High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am. J. Obstet. Gynecol. 2003;188:100–107. doi: 10.1067/mob.2003.99. - DOI - PubMed
    1. Kim J.J., Kurita T., Bulun S.E. Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer. Endocr. Rev. 2013;34:130–162. doi: 10.1210/er.2012-1043. - DOI - PMC - PubMed
    1. Giuliani E., As-Sanie S., Marsh E.E. Epidemiology and management of uterine fibroids. Int. J. Gynaecol. Obstet. 2020;149:3–9. doi: 10.1002/ijgo.13102. - DOI - PubMed

LinkOut - more resources