EMAS position statement: Management of uterine fibroids

• Published in: Maturitas Vol. 79; no. 1; pp. 106 - 116
• Main Authors: Pérez-López, Faustino R, Ornat, Lía, Ceausu, Iuliana, Depypere, Herman, Erel, C. Tamer, Lambrinoudaki, Irene, Schenck-Gustafsson, Karin, Simoncini, Tommaso, Tremollieres, Florence, Rees, Margaret
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.09.2014; Elsevier
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antifibrinolytic Agents - therapeutic use; Biological and medical sciences; Decision Making; Embolization, Therapeutic - methods; Female; Female genital diseases; Fibroids; Gn-RH analogs; Gonadotropin-Releasing Hormone - therapeutic use; Gynecology. Andrology. Obstetrics; High-intensity focused ultrasound; High-Intensity Focused Ultrasound Ablation - methods; Humans; Hysterectomy; Hysterectomy - methods; Internal Medicine; Leiomyoma - drug therapy; Leiomyoma - therapy; Medical sciences; Medicin och hälsovetenskap; Myomectomy; Obstetrics and Gynecology; Patient Care Planning; Pelvic Pain - etiology; Progestins - therapeutic use; Puberal and climacteric disorders (male and female); Radiology, Interventional - methods; Receptors, Progesterone - antagonists & inhibitors; Treatment Outcome; Tumors; Ulipristal; Uterine artery embolization; Uterine Hemorrhage - etiology; Uterine Myomectomy - methods; Uterine Neoplasms - drug therapy; Uterine Neoplasms - therapy; Myomectomy; High-intensity focused ultrasound; Fibroids; Gn-RH analogs; Hysterectomy; Uterine artery embolization; Ulipristal; Human; Position; Progesterone receptor; Uterine artery; Female genital diseases; Analog; Uterine diseases; Embolization; Uterine leiomyoma; Contraceptive; Focused ultrasound; Benign neoplasm; Agonist antagonist; Hormonal receptor
• ISSN: 0378-5122; 1873-4111; 1873-4111
• DOI: 10.1016/j.maturitas.2014.06.002

Abstract Introduction Uterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract. Aim The aim of this position statement is to provide and critically appraise evidence on the management of women with uterine fibroids. Methods Literature review and consensus of expert opinion. Results and conclusions Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth. Fibroid-associated symptoms include heavy menstrual bleeding and pain or pelvic discomfort. The association between infertility and fibroids increases with age. Fibroids do not increase the risk of malignant uterine disease and leiomyosarcomas are extremely rare (less than one in 1000). It is unknown at present whether leiomyosarcoma represents de novo growth or malignant transformation from benign uterine fibroids. Treatment options for symptomatic fibroids include pharmacologic, surgical and radiologically guided interventions. The range of medical treatments allows flexible management of fibroid-related symptoms; the options include tranexamic acid, non-steroidal anti-inflammatory drugs, contraceptive steroids, gonadotropin-releasing hormone analogs, antiprogesterone, and selective progesterone receptor modulators. However, these medical options do not remove the tumors and symptoms may return when treatment is stopped. Surgical and radiologically guided procedures may be tailored to age, general health, and individual patient wishes. Hysterectomy is the most effective treatment, although in some cases myomectomy may be sufficient to control symptoms. Alternatives to surgery include uterine artery embolization, myolysis and ablation by high-intensity focused ultrasound (guided with magnetic resonance imaging or ultrasound). The choice of treatment depends on fibroid size, the underlying symptoms and their severity and the woman's desire for subsequent fertility and pregnancy, as well as efficacy and need for repeated interventions.