Treatment of uterine leiomyoma: How to choose a therapeutic method?

Abstract

Uterine leiomyomas (myomas or fibroids) are the most common benign pelvic tumors in reproductive aged women occurring in 25% to 40%. They may cause symptoms of heavy or prolonged menstrual bleeding, pelvic pressure symptoms and pain, subfertility, adverse pregnancy outcomes. Therapeutic methods are variable and include expectant management, medical treatment (GnRH agonist, levonorgestrel-releasing intrauterine system, and progesterone receptor modulator), surgical treatment (myomectomy, hysterectomy, and endometrial ablation), myolysis, and uterine artery embolization. Most women who are asymptomatic or have mild symptoms can be followed without intervention. In cases with significant symptoms, the clinicians should understand many factors including age, parity, proximity to menopause, desire for fertility preservation, size, location and number of myomas, severity of symptoms and possibility of malignancy for the choice of treatment modality. The type and timing of the intervention should be individualized after considering and discussing treatment benefit and risk.