Uterine Fibroid Management

Introduction to Uterine Fibroids

The American College of Radiology suggests that the treatment of uterine fibroids should be based on symptoms, size and location of the fibroids, age, and desire to preserve fertility or the uterus, and should be individualized according to each patient's needs 1
Uterine fibroids are the most common benign tumors of the female reproductive tract, with a prevalence of up to 80% in women of 50 years 2, 3
The growth of uterine fibroids is driven by progesterone and its receptors, which are necessary for cellular proliferation and growth 4, 3
Uterine fibroids express high levels of both types of progesterone receptors (PR-A and PR-B) compared to the surrounding myometrium 4, 3

Uterine fibroids can cause symptoms such as pressure symptoms (pelvic pressure, pain) 1
Uterine fibroids can cause fertility problems 2, 3

Mymectomy: For patients who desire to preserve fertility 1
Hysterectomy: Definitive treatment for patients who do not desire to preserve fertility 1

Uterine artery embolization (UAE): Reduces fibroid volume by 40-50% and controls symptoms in approximately 80% of cases 6, 7
Laparoscopic uterine artery occlusion: Alternative to UAE with less reduction in fibroid diameter 5
Magnetic resonance-guided focused ultrasound surgery (MRgFUS): Non-invasive option for selected patients 7

Surgical planning for myomectomy should be based on location, size, and number of fibroids with appropriate imaging 1
Anemia should be corrected before elective surgery 5
The pregnancy rate after myomectomy is less than 50% in follow-ups of up to 3 years 5
Uterine artery embolization has a reintervention rate of approximately 7% due to persistent symptoms 7