Nonsurgical Management of Uterine Fibroids

Uterine leiomyomas, commonly referred to as fibroids, are benign smooth muscle tumors that have an estimated prevalence of 20% to 40% in women of reproductive age.1 They are often asymptomatic, making their true prevalence difficult to determine, but they are clinically significant in approximately one-third of those affected.2 Fibroids are the leading indication for hysterectomy in the United States, resulting in approximately one-third of hysterectomies.3 Symptoms vary depending on the size, location, and number of myomas as well as the patient’s age. The most common symptoms associated with myomas are pelvic pressure and abnormal uterine bleeding. Treatment of uterine fibroids varies widely and is based on symptoms. Treatment may range from expectant management for women with asymptomatic myomas to myomectomy for those desiring fertility or hysterectomy for women who have completed childbearing and have debilitating symptoms.4 In general, the indications for surgery include the desire for definitive treatment, infertility or recurrent pregnancy los s, abnormal uterine bleeding unresponsive to medical therapy, growth of the myoma after menopause, and suspicion of pelvic malignancy.5 First-line treatment generally consists of less-invasive modalities. Because there are a number of new nonsurgical approaches to the treatment of uterine myomata, there is a gap between typical practice and potential opportunities. To address this gap, this review will focus on various nonsurgical interventions for uterine fibroids in patients who are not candidates for or do not desire surgical management (Table 1).