A Review of Treatment Options Available for Women with Uterine Fibroids

Abstract

Background: The quest for ideal treatment and understanding of fibroid biology has resulted in further studies in pharmacological, radiological and surgical options with the goals of being safe, less invasive, cost-effective and enhancing reproductive potentials. However, surgery remains the mainstay of present effective management for large symptomatic fibroids. Aim: The aim is to review the treatment options available for women with uterine fibroids. Methods: Publications on the management of uterine fibroids were accessed using medline, google scholar and pubmed databases. Relevant materials on treatment of uterine fibroids, selected references from internet services, journals, textbooks and lecture notes on management of uterine fibroids were also accessed and critically reviewed. Results: The mainstay of management for large symptomatic fibroids is surgical (myomectomy or hysterectomy). Minimally invasive procedures are becoming more commonly performed via both laparoscopic or hysteroscopic approaches, minimizing recovery time, postoperative pain and morbidity. Uterine artery embolization (UAE) carries a risk of pelvic infection with limited evidence regarding the risks for future pregnancies. Levonorgestrel-releasing intrauterine system (LNG-IUS) is effective as a treatment for heavy menstrual bleeding. However, it is not recommended if the uterine cavity is markedly enlarged or distorted by fibroids. Gonadotrophin releasing hormone analogue (GnRHa) is the most widely used medical option. It can reduce the size of fibroids by about 30-35%, but only used for short-term course or preoperative mode of management since the resulting hypoestrogenic state can cause osteoporosis in long-term course. Furthermore, it can restore haemoglobin levels and apparently reduce blood loss at operation but notorious for rebound growth of fibroids upon cessation of therapy with major adverse effects. Newly introduced treatment options are poorly understood, still unclear with lots of theoretical advantages not fully backed with long-term effects. Little is known about their risks, cost and adverse effects. Conclusion: Fibroids are commonly found in women of reproductive age. Most women do not require treatment because fibroids are benign and most times asymptomatic. For symptomatic fibroids, many treatment options exist and should be considered before the decision to perform hysterectomy which precludes future fertility.