Fibroids (uterine myomatosis, leiomyomas)

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Fibroids (uterine leiomyomas) are benign tumours of the smooth muscle cells of the uterus. Women with fibroids can be asymptomatic, or may present with menorrhagia, pelvic pain with or without dysmenorrhoea, or pressure symptoms, infertility, and recurrent pregnancy loss. Fibroids are the most common gynaecological tumour.

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Focus of the review

To date, open surgery has been the mainstay of treatment. There are now minimally invasive surgical as well as interventional radiological treatment options. This review will focus on the evidence surrounding the radiological interventions of magnetic resonance-guided focused ultrasound surgery and uterine artery embolisation.

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Comments on evidence

For four of the six comparisons, no evidence was identified for the specified outcomes. For the other two comparisons (uterine artery embolisation [UAE] v hysterectomy and UAE v myomectomy), only one systematic review was identified with three and two RCTs. None of the trials were blinded, which may have influenced some of the outcome estimates. Additional quality concerns included potential selection bias for one trial included in the UAE v hysterectomy comparison and difficulties in generalisability for the UAE v myomectomy comparison (with different participants in the two relevant trials). Where evidence was found, it was generally of low quality.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, June 2009, to May 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. Searching of electronic databases retrieved 186 studies. After deduplication and removal of conference abstracts, 68 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 46 studies and the further review of 22 full publications. Of the 22 full articles evaluated, two systematic reviews and three RCTs were added at this update.

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Substantive changes at this update

Magnetic resonance-guided focused ultrasound surgery versus no treatment/sham treatment New option. One systematic review added.[16] Categorised as 'unknown effectiveness'.

Magnetic resonance-guided focused ultrasound surgery versus other interventions (uterine artery embolisation, myomectomy, hysterectomy, hysteroscopic resection, rollerball endometrial ablation, thermal balloon ablation, thermal myolysis with laser) New option. One systematic review added.[16] Categorised as 'unknown effectiveness'.

Uterine artery embolisation versus no treatment/sham treatment New option. Categorised as 'unknown effectiveness'.

Uterine artery embolisation versus hysterectomy New option. One systematic review added[17] and one RCT added to the Comment section.[20] Categorised as 'trade-off between benefits and harms'.

Uterine artery embolisation versus myomectomy New option. One systematic review added[17] and one RCT.[21] Categorised as 'trade-off between benefits and harms'.

Uterine artery embolisation versus other interventions (magnetic resonance-guided focused ultrasound surgery, hysteroscopic resection, rollerball endometrial ablation, thermal balloon ablation, or thermal myolysis with laser) New option. One systematic review added.[17] Categorised as 'unknown effectiveness'.

Abstract

INTRODUCTION: Between 50% and 77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, mass and pressure effects, infertility, or recurrent pregnancy loss. Risk factors for fibroids include obesity, having no children, and no long-term use of the oral contraceptive pill. Fibroids tend to shrink or fibrose after the menopause. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of surgical/interventional radiological treatments in women with fibroids? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: Five studies were included. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: magnetic resonance-guided focused ultrasound surgery versus no/sham treatment; magnetic resonance-guided focused ultrasound surgery versus other interventions (hysterectomy, myomectomy, hysteroscopic resection, rollerball endometrial ablation, thermal balloon ablation, thermal myolysis with laser); uterine artery embolisation versus no/sham treatment; uterine artery embolisation versus hysterectomy; uterine artery embolisation versus myomectomy; uterine artery embolisation versus other interventions (magnetic resonance-guided focused ultrasound surgery, hysteroscopic resection, rollerball endometrial ablation, thermal balloon ablation, thermal myolysis with laser).

Cite as

Lethaby A, Vollenhoven B. Fibroids (uterine myomatosis, leiomyomas). Systematic review 814. BMJ Clinical Evidence. . 2015 June. Accessed [date].

Latest guidelines

Latest citations

Interventions to reduce haemorrhage during myomectomy for fibroids. ( 02 September 2015 )

Transcervical intralesional vasopressin injection compared with placebo in hysteroscopic myomectomy: a randomized controlled trial. ( 02 September 2015 )