Minimally Invasive Treatment Options for Uterine Fibroids

518 JCOM September 2006 Vol. 13, No. 9 www.turner-white.com Uterine fibroids are the most common tumors of the female reproductive tract. These benign tumors occur in approximately 20% to 25% of women of childbearing age, with increased prevalence rates of over 50% among African-American women [1]. Fibroids may vary in size, from microscopic to larger than a basketball, with many women having multiple fibroids. Most women with fibroids are asymptomatic; these women may be diagnosed when an enlarged firm uterus is palpated on routine examination or incidentally noted on an imaging study. Symptoms caused by uterine fibroids include heavy and irregular vaginal bleeding, pelvic pain and pressure, abdominal distension, dyspareunia, and urinary frequency. Infertility and pregnancy complications are also associated with uterine fibroids. While usually not life-threatening, fibroids may have significant negative impact on a woman’s quality of life [1]. Treatment options for symptomatic fibroids range from expectant management to major surgery. Expectant management of uterine fibroids should always be offered, although its acceptability will depend on the severity of symptoms and the individual patient’s tolerability threshold. This may be an especially good option in perimenopausal women, whose fibroid volume and symptoms may spontaneously decrease with the decreasing estrogen and progesterone levels of menopause. Depending on the severity of a woman’s complaints, most symptomatic women will initially attempt medical treatment. Medications most often prescribed to treat fibroids include analgesics (usually nonsteroidal anti-inflammatory drugs [NSAIDs]) and combination oral contraceptive pills. Gonadotropin-releasing hormone (GnRH) agonists have been shown to temporarily reduce fibroid volume up to 40% while also decreasing vaginal bleeding [2]. They have a significant side effect profile (including hot flashes, mood swings, and bone loss) and are costly, and fibroids rapidly return to baseline size and symptomatology once therapy is discontinued; therefore, GnRH agonists are useful only in select situations, such as to temporarily shrink the fibroid or to increase a patient’s low red blood cell count prior to surgery [1]. Hysterectomy or myomectomy have been the most common treatments for women with symptomatic uterine fibroids Minimally Invasive Treatment Options for Uterine Fibroids