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Review
. 2025 Jul;32(7):583-591.e1.
doi: 10.1016/j.jmig.2024.12.012. Epub 2024 Dec 27.

Conservative Treatment of Uterine Myomas: A Network Meta-Analysis of Randomized Controlled Studies

Mattia Dominoni  1 , Barbara Gardella  2 , Andrea Gritti  2 , Marianna Francesca Pasquali  2 , Arsenio Spinillo  2
Affiliations
Review

Conservative Treatment of Uterine Myomas: A Network Meta-Analysis of Randomized Controlled Studies

Mattia Dominoni et al. J Minim Invasive Gynecol. 2025 Jul.

Abstract

Objective: To comparatively evaluate the effectiveness of uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), radiofrequency ablation treatment (RFT), and laparoscopic/laparotomic surgery in the conservative treatment of uterine fibroids.

Data sources: The research was performed via electronic databases PubMed, Embase, and Cochrane Library, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.

Methods of study selection: The network included 10 randomized trials between 2000 and 2024 and 1002 randomized subjects.

Tabulation, integrations, and results: The network meta-analysis was conducted with subroutine netmeta on R. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The surface under the cumulative ranking curve (SUCRA) was computed by Bayesian network meta-analysis. Incidences of reintervention per 100 person/year of follow-up were 4.13 (range, 0-19.4), 16.1 (6.2-32.8), 14.3 (0-15.1), and 6 (4.3-6.7) for myomectomy, UAE, HIFU, and RFT, respectively. The incidence rate ratios compared with myomectomy were 2.45 (95% confidence interval [CI], 1.38-4.37), 5.23 (95% CI, 1.59-17.3), and 4.59 (95% CI, 0.77-27.3; p = .09) for UAE, HIFU, and RFT, respectively. RTF had the highest (SUCRA, 1.25% and 3%) whereas myomectomy had the lowest risk of reintervention (SUCRA, 98% and 95%) or hysterectomy during follow-up (median, 12 months; range, 3-24). The risk of major complications was significantly lower after UAE (odds ratio, 0.38; 95% CI, 0.17-0.85) than myomectomy. The procedure with the lowest likelihood of major complications was HIFU (SUCRA, 81.5%). Finally, in the evaluation of QoL at follow-up visits, there were no differences between the treatments studied, although the model was highly heterogeneous and inconsistent.

Conclusion: In the analysis of randomized trials, surgical myomectomy carried the least risk of reintervention and subsequent hysterectomy during a relatively short follow-up period. HIFU was the method with the lowest risk of major complications.

Keywords: Artery embolization; HIFU; Meta-analysis; Myomectomy; Radiofrequency.

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