With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice?

Uterine fibroids are the most common benign uterine tumors. This review examines the different management strategies, involving mainly surgery, and evaluates them in the light of new developments with selective progesterone receptor modulators. On the one hand, hysteroscopic and laparoscopic (or minilaparotomic) myomectomy is the treatment of choice in women who wish to preserve their uterus, and hysterectomy has long been considered the standard surgical approach in symptomatic women who no longer wish to conceive. On the other hand, recent studies have demonstrated the efficacy of ulipristal acetate in the medical management of myomas. Analyzing the respective advantages of both medical and surgical therapy, we propose new guidelines for the management of fibroids that take into account the most important symptoms (bleeding, infertility) and the age of the patients.