Medical management and minimally invasive interventions for uterine fibroids: a perspective
Keywords:
Leiomyoma, UterusAbstract
Uterine fibroids are found in up to 70% of women by the age of 50 years, of whom up to 40% experience symptoms including heavy menstrual bleeding, urinary or bowel dysfunction, pelvic discomfort, pressure symptoms, reproductive dysfunction, and mood disturbances. Uterine fibroids have a detrimental effect on quality of life and cause a large proportion of gynaecological hospitalisations. Although hysterectomy is the definitive treatment, up to 3% and 4% of patients experience intra- and post-operative complications, respectively. Moreover, hysterectomy is unacceptable in women who wish to preserve their fertility. Medical management of uterine fibroids includes hormonal and nonhormonal (tranexamic acid) medications. Commonly used hormonal medications include combined oral contraceptives and progestogens, levonorgestrel-releasing intrauterine devices, selective progesterone receptor modulators, and gonadotrophin receptor agonists and antagonists. Other less commonly used agents include androgens, selective oestrogen receptor modulators, androgens, and aromatase inhibitors. Minimally invasive interventions include
uterine artery embolisation, high-intensity focused ultrasound, and radiofrequency ablation. Treatment should be personalised to suit each woman’s needs without compromising fertility, reproductive, or obstetric outcomes. Surgery must still be considered when symptoms are intractable, malignancy is suspected, or in an emergency setting in which fibroid-related complications such as torsion or obstructive uropathy arise. Shared decision making is essential, particularly in women of reproductive age, to balance efficacy, fertility goals, and treatment risks.
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