Modern management of fibroids

Uterine fibroids are common benign tumours that occur in women of reproductive age. They are frequently associated with symptoms that impact on quality of life and require treatment. Up until mid-1990s, this was usually surgical with either hysterectomy or myomectomy being performed. Although myomectomy conserves the uterus, it is associated with complications that might not enhance the chance of pregnancy and for those concerned about fertility, alternatives are being developed. The most widely used of these is uterine artery embolization (UAE), which is a very successful treatment in terms of treating symptoms such as heavy menstrual bleeding but the impact on fertility is, as yet, unclear. Other exciting developments are high intensity focussed ultrasound and MRI guided focussed ultrasound. These allow a more directed approach. However, these techniques require sophisticated equipment which is not yet generally available.New medical treatments are being evaluated – the most popular currently are the progesterone receptor modulators that induce amenorrhoea and a degree of fibroid shrinkage whilst having minimal effect on ovarian function. One has recently been licensed for short term use in the UK and Europe and it is hoped that longer term use will be possible in the future.This review summarizes the information available on these techniques and also provides suggestions for further reading.