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Current Trends in the Evaluation and Management of Uterine Fibroids

  • Reproductive Endocrinology and Infertility (REI) (R Anchan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Evaluation and management of uterine fibroids is an ever evolving area of medicine, impacting a large percentage of the female population. We present contemporary trends in evidence-based practice and research.

Recent Findings

Point of care intraoperative ultrasound may improve surgical ability to detect and remove small myomas, improving surgical success and decreasing the likelihood of fibroid recurrence. Imaging modalities including elastography, augmented reality, and 3D printing are not currently optimized for clinical practice but offer promise as potential avenues through which to better gauge tumor burden. Pregnancies have been reported after uterine artery embolization and radiofrequency ablation for fibroid management, but the rate of pregnancy loss is substantial, and additional information regarding fertility and pregnancy outcomes after non-surgical intervention for treatment of fibroids is needed before these technologies can find safe applicability in women who have not completed childbearing. Robotic myomectomy may have advantages over laparoscopic myomectomy in the hands of skilled operators. Non-cavity distorting intramural fibroids are clearly associated with reduced odds of live birth in an infertile patient population, but additional research is needed to indicate whether removal of these tumors improves fertility and pregnancy outcomes.

Summary

The high prevalence of fibroids in the general population results in a high incidence of fibroid-associated morbidity and high frequency of gynecology visits for discussion of fibroid management. MRI remains the gold standard imaging modality for pre-operative evaluation of fibroids. There is data to support the use of both GnRH-agonists and GnRH-antagonists as short-term treatment strategies. These medications can be used to optimize patients prior to surgery. Selective progesterone receptor modulators (SPRMs) are not currently approved in the USA, but nonetheless they remain a promising option for the medical treatment of uterine fibroids in the future. There is a growing body of literature on the role of non-surgical intervention (UAE, radiofrequency ablation, MR-guided ultrasound) for the treatment of fibroids, but there is insufficient data on fertility and pregnancy outcomes to recommend these strategies as first-line treatment to women desiring future fertility. Ultimately, surgery is the most definitive fibroid management option. Minimally invasive myomectomy is associated with improved outcomes when compared to open myomectomy, but choice of surgical management should be guided by fibroid burden as well as patient preference and—ultimately—surgeon experience.

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  1. Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Anna C. Vanderhoff & Antonio R. Gargiulo

  2. Harvard Medical School, Boston, MA, USA

    Anna C. Vanderhoff, Jason Silberman & Antonio R. Gargiulo

  3. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA

    Jason Silberman

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  1. Anna C. Vanderhoff
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Vanderhoff, A.C., Silberman, J. & Gargiulo, A.R. Current Trends in the Evaluation and Management of Uterine Fibroids. Curr Obstet Gynecol Rep 11, 125–132 (2022). https://doi.org/10.1007/s13669-022-00331-w

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