Uterine fibroid management: From the present to the future
Open accessAbstract
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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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].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [89]
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Monleón, J., Martínez‐Varea, A., Galliano, D., & Pellicer, A. (2014) · Case Reports in Obstetrics and Gynecology · doi:10.1155/2014/314587 · Cited by 26 · see citing works
Wilkens, J., Williams, A. R. W., Chwalisż, K., Han, C., Cameron, I. T., & Critchley, H. (2009) · Human Reproduction · doi:10.1093/humrep/den494 · Cited by 25 · see citing works
Berman, J. M., Bolnick, J. M., Pemueller, R. R., et al. (2015) · PubMed · Cited by 25 · see citing works
Flagged first, then by citations
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Donnez, J., & Dolmans, M.-M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10051085 · Cited by 182 · see citing works
Self-citationGonadotropin-releasing hormone antagonist (linzagolix): A new therapy for uterine adenomyosis
Donnez, O., & Donnez, J. (2020) · Fertility and Sterility · doi:10.1016/j.fertnstert.2020.04.017 · Cited by 58 · see citing works
Self-citationDonnez, J., & Dolmans, M.-M. (2020) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2020.05.017 · Cited by 50 · see citing works
Self-citationDonnez, J., & Dolmans, M.-M. (2020) · Fertility and Sterility · doi:10.1016/j.fertnstert.2020.07.028 · Cited by 20 · see citing works
Self-citation
- Authors
- Donnez, J., & Dolmans, M.-M.
- Affiliations
- UCLouvain (BE)
- Cliniques Universitaires Saint-Luc (BE)
- Corresponding author
- Donnez, Jacques
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-07-27
- Volume
- 22
- Issue
- 6
- Pages
- 665-686
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- PMC
- PMC5853598
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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