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A Systematic Review of Minimally Invasive Approaches to Uterine Fibroid Treatment for Improving Quality of Life and Fibroid-Associated Symptoms

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Abstract

Improvement in symptom severity and quality of life (QoL) are critical concerns for women with fibroids as they evaluate treatment options. This systematic review analyzed available evidence regarding minimally invasive approaches to fibroid treatment and compared validated QoL and fibroid-associated symptom scores before and after treatment. A comprehensive search was conducted using PubMed, Embase, Cochrane Library, and Scopus from January 1990 to July 2020. English-language publications were included if they evaluated associations between minimally invasive approaches to fibroid treatment and QoL or fibroid-associated symptoms, and they used validated questionnaires before and after treatment. QoL or fibroid-associated symptom scores were compared and summarized for each minimally invasive approach. Thirty-seven studies were ultimately included in this review: 26 evaluating individual approaches and 11 which were comparative studies of minimally invasive approaches and surgical interventions. Radiofrequency ablation (RFA) and ultrasound-guided sclerotherapy (USGS) significantly improved overall QoL. Uterine artery embolization (UAE) and ultrasound-guided high-intensity frequency ultrasound (US-HIFU) improved overall QoL to a similar extent as surgical interventions. Twenty-eight studies assessed fibroid-associated symptoms with the Uterine Fibroid Symptoms Quality of Life Questionnaire (UFS-QoL). UAE, magnetic resonance imaging-guided high-intensity frequency ultrasound (MR-HIFU), US-HIFU, RFA, and percutaneous microwave ablation (PMWA) significantly decreased Symptom Severity Score by a range of 21 to 39 points (out of 100) at 6 months. Minimally invasive approaches to treat fibroids were effective alternatives to surgical interventions for improving quality of life, fibroid-associated symptoms, and pain. Outcomes among minimally invasive approaches were similar, presenting patients with numerous options for fibroid treatment.

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Data Availability

The data that support the findings of this study were derived from the following resources available in the public domain: PubMed, Embase, Cochrane Library, and Scopus.

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Acknowledgements

The authors would like to thank the Howard and Georgeanna Jones Endowment for funding part of this research. The authors would also like to thank Caitlin Hendricks (Johns Hopkins University) for her assistance in data collection. No acknowledged individual has any disclosures pertaining to this review.

Funding

This research was supported in part by the Howard and Georgeanna Jones Endowment.

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Author notes

  1. Joshua M. Morris and Angela Liang contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA

    Joshua M. Morris

  2. Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA

    Angela Liang

  3. Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA

    Katarina Fleckenstein

  4. Division of Reproductive Science and Women’s Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, 21205, USA

    Bhuchitra Singh & James Segars

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Contributions

JS conceived of the presented idea and supervised the findings of this work. BS screened titles and abstracts per eligibility criteria; JM and KF screened full-text articles. AL assessed study quality and risk of bias. JM and AL interpreted the data and wrote the manuscript with help from KF and BS.

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Correspondence to James Segars.

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JS reports prior research funding for clinical trials from BioSpecifics Technologies Corporation, Bayer, Allergan, AbbVie Inc, and ObsEva. JS has served as a consultant to Bayer and Myovant Sciences. JS reports service on the American Gynecological and Obstetrical Society. The other authors report no conflict of interest.

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Morris, J.M., Liang, A., Fleckenstein, K. et al. A Systematic Review of Minimally Invasive Approaches to Uterine Fibroid Treatment for Improving Quality of Life and Fibroid-Associated Symptoms. Reprod. Sci. 30, 1495–1505 (2023). https://doi.org/10.1007/s43032-022-01120-9

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