When Should Uterine Fibroids Be Treated?

Abstract

Fibroids are a common disorder of women, but in general, are best left untreated unless they are significantly symptomatic or an imminent health hazard. When treatment is needed, surgery remains the gold standard. For fertility, fibroids that impinge upon the uterine cavity should be removed to increase future pregnancy rates. There is no evidence that myomectomy for intramural fibroids, even those as large as 6 cm, increases fertility potential, or improves pregnancy outcome. Prophylactic myomectomy of large fibroids (largest diameter > 5 cm) to decrease delivery complications is not recommended because it confers worse outcomes at delivery versus women with these large fibroids in situ. Medical treatment is transient, with most fibroids returning to pretreatment size a few months after treatment is stopped. It may, however, have a place for pretreating women before surgical removal, to treat anemia, or in perimenopausal women. Invasive radiological treatments (eg, uterine artery embolization and magnetic resonance guided ultrasound surgery) are effective for treating fibroids, but must be evaluated further before they can be recommended for women interested in future fertility. © 2012 Springer Science+Business Media, LLC.