Uterine Fibroid Treatment: Medical Management, Uterine Artery Embolization, and Hysterectomy for Fertility Preservation

Uterine fibroids, also known as leiomyomas or fibromas, are the most common benign tumors of the female genital tract. While many women may be asymptomatic, a significant percentage experience symptoms that affect their quality of life, such as abnormal uterine bleeding, pelvic pain, and fertility issues. The management of uterine fibroids should be individualized, considering factors such as the patient's age, the desire for fertility preservation, and the severity of symptoms.

Medical Management and Interventional Procedures

The medical management of uterine fibroids focuses on symptom control. GnRH analogs and selective progesterone receptor modulators have been shown to be effective in reducing the size of fibroids and improving bleeding-related symptoms [1]. However, these treatments are often temporary and are primarily indicated for preoperative management or in women nearing menopause.

Uterine artery embolization is a minimally invasive technique that has gained popularity as an alternative to surgery. This procedure reduces blood flow to the fibroids, leading to a decrease in size and relief of symptoms [2]. While it is a viable option for many women, it is important to discuss the potential risks and benefits, especially for those wishing to preserve their fertility.

Surgical Options

Hysterectomy remains the definitive treatment for symptomatic fibroids, particularly in women who do not wish to preserve their uterus. However, for those seeking to maintain their fertility, myomectomy is a surgical option that allows for the removal of fibroids while preserving the uterus [3]. The choice between these procedures should be based on a careful evaluation of symptoms, the size and location of the fibroids, as well as the patient's preferences.

Conclusions

The treatment of uterine fibroids has evolved significantly, offering a variety of options ranging from medical management to surgical and radiological interventions. The decision regarding the most appropriate treatment should be personalized, taking into account the patient's desires regarding fertility preservation and the severity of symptoms. Collaboration between the physician and the patient is crucial to achieve the best possible outcomes.

Referencias

• [1] Progesterone and progesterone receptor modulators in the management of symptomatic uterine fibroids.
• [2] Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy.
• [3] The management of uterine leiomyomas.

Created 6/1/2025