Uterine fibroids
AbstractObjective. The article covers recent data about fibroids origin and pathogenesis, which are the most common gynecologic tumors, occurring in 70 % of women over 30 years of age. The efficacy of different surgical strategies is discussed. Although treatment of fibroids relies on surgical strategies, the current trend is for uterinesparing treatment to preserve fertility and avoid unnecessary surgery. Approved current options for medical treatment are overviewed in this issue.
Aims: 1) to compare effectiveness and side effects of different conservative surgery approaches (myomectomy, uterine artery embolization, uterine artery occlusion, ethanol intratumor injection, high-intensity focused ultrasound; 2) to evaluate the efficacy of selective progesterone receptor modulators administration in symptomatic fibroids for women who refused surgery; 3) to investigate ulipristal acetate effects on fibriods, life quality and safety during three-month administration, a possibility of its long-time administration in cases of symptomatic fibroids; 4) to analyze modern possibilities of therapy choice due to fertility planning.
Materials and methods. To form the review devoted to fibroids problem PubMed, EMBASE, MedLine and the Cochrane Library were searched for randomised trials in 2014, limited to the English literature.
Results. The results of uterine artery embolization are tolerable: method is not less effective than myomectomy, but introduces the risk of further reoperation. In the treatment of uterine fibroids, high-intensity focused ultrasound combined with sonographically guided intratumoral ethanol injection requires less treatment time and a lower dose and significantly reduces the pain and side effects commonly experienced by patients. Highintensity focused ultrasound combined with sonographically guided intratumoral ethanol injection is a feasible, safe, and more effective way to treat patients with uterine fibroids.
Selective progesterone receptor modulators are the best therapy for symptomatic fibroids, while conservative therapy is chosen. This effective new method seems to be safe and facilitates better life quality for patients in a short time period. Intermittent regime of ulipristal acetate implementation may become long-time therapy for symptomatic fibroids.
Due to evidence based medicine we cannot recommend the only definite method of fibroid therapy to reproductive-aged women if they have planned fertility realization; the choice should be performed after comprehensive discussion.
Keywords:fibroids, sex steroids, fibroids treatment, myomectomy, uterine artery embolization, uterine artery occlusion, ethanol, high-intensity focused ultrasound, progestagens, selective progesterone receptor modulators, selective estrogen receptor modulators