Cited by 780Uterine Myomas and TreatmentsReproductive Health and ContraceptionGynecological conditions and treatments

Uterine fibroid management: From the present to the future

Open access
Donnez, Jacques, Dolmans, Marie-Madeleine·2016·Human Reproduction Update

Abstract

Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.

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Crossref · 10.1093/humupd/dmw023

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  • SPRMs are not an option for endometriosis because they induce progesterone modulator-associated endometrial changes (PAECs) in ectopic foci and their efficacy is limited.

    “among new drugs, selective progesterone receptor modulators (SPRMs) are not an option as they induce progesterone modulator-associated endometrial changes (PAECs) in ectopic foci and their efficacy is limited [89,90,91].”

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Cited by

Authors
Donnez, J., & Dolmans, M.-M.
Affiliations
  • UCLouvain (BE)
  • Cliniques Universitaires Saint-Luc (BE)
Corresponding author
Donnez, Jacques
Venue
Human Reproduction Update
Published
2016-07-27
Volume
22
Issue
6
Pages
665-686
ISSN
  • 1355-4786 (ISSN-L)
  • 1460-2369
OpenAlex
W2496662864
Cited by
780
References
223
Citations by year
2026: 76 · 2025: 86 · 2024: 77 · 2023: 109 · 2022: 89 · 2021: 92 · 2020: 94 · 2019: 48 · 2018: 54 · 2017: 45 · 2016: 9
FWCI
9.19
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Human Reproduction Update (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
Funders
Gedeon Richter
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
Keywords
uterine fibroids, leiomyoma, fibroid management, myomectomy, uterine artery embolization, thermal ablation, selective progesterone receptor modulators, ulipristal acetate, fertility preservation, hysterectomy alternative
MeSH terms
Contraceptive Agents, Female, Humans, Hysterectomy, Leiomyoma, Magnetic Resonance Imaging, Norpregnadienes, Progesterone, Risk Factors, Uterine Neoplasms, Randomized Controlled Trials as Topic, Pelvic Pain, Uterine Artery

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