A comprehensive approach to the treatment of uterine leiomyomata

Karen Stein, Charles Ascher-Walsh, Charles Ascher‐Walsh
The Mount Sinai journal of medicine, New York · 2009 · vol. 76(6) , pp. 546–556 · doi:10.1002/msj.20145 · PMID:20014416 · W2028724522
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This paper reviews current and expanding treatment options for symptomatic uterine leiomyomata, including medical therapies, minimally invasive procedures, and surgical approaches tailored to individual patient needs and fertility desires.

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Abstract

Leiomyomas (fibroids) are the most common tumors in women, with a prevalence between 30% and 50%. They affect women primarily during their reproductive years, spontaneously regressing after menopause in most women. They may cause significant symptoms of pain, dysmenorrhea, abnormal uterine bleeding, and infertility. Because leiomyomas are so common, treatment should be reserved for those patients with symptoms. Treatment options have recently expanded beyond hysterectomy. Medical therapies, including gonadotropin-releasing hormone agonists and progesterone modulators, have become more widely used. Less invasive options such as uterine fibroid embolization, magnetic resonance imaging-guided focused ultrasound, and radiofrequency ablation are being used to avoid more invasive surgery. Because of limited and negative information regarding these alternatives to surgery, they are not recommended for women desiring future fertility. If surgery is desired or required, often less invasive approaches via hysteroscopy for intracavitary lesions or robot-assisted laparoscopy for patients with a small number of myomas have become preferred options. Treatment should be tailored to the patient.

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Condition tags

dysmenorrheainfertility

MeSH descriptors

Leiomyomatosis Uterine Neoplasms Antineoplastic Agents, Hormonal Antineoplastic Agents, Hormonal Aromatase Inhibitors Aromatase Inhibitors Catheter Ablation Contraceptive Agents Contraceptive Agents Embolization, Therapeutic Female Humans Hysterectomy Hysteroscopy Laparoscopy Leiomyomatosis Myometrium Myometrium Uterine Neoplasms

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References (43)

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License: CC0 · commercial use OK