Study summary · research use only
Fibroids (uterine myomatosis, leiomyomas)
Plain-language summary
Paraphrased from the published abstract below — not a verdict on whether anything works.
This systematic review of human clinical evidence on uterine fibroids reports prevalence of 5% to 77% depending on diagnostic method, with possible presentations including menorrhagia, pain, infertility, or recurrent pregnancy loss, and risk factors including obesity, nulliparity, and no long-term oral contraceptive use; fibroids were noted to tend to shrink or fibrose after menopause. Searching Medline, Embase, the Cochrane Library, and other databases through June 2009, the review identified 54 systematic reviews, RCTs, or observational studies, graded using GRADE methodology, addressing medical treatment alone, preoperative medical treatment, and surgical treatment. It presents evidence on gonadorelin analogues, hysterectomy, focused ultrasound, laparoscopic and abdominal myomectomy, endometrial ablation techniques, thermal myolysis, and uterine artery embolisation.
Abstract
Between 5% and 77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, 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. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: medical treatment alone; preoperative medical treatments for women scheduled for surgery; and surgical treatments in women with fibroids? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (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). We found 54 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: gonadorelin analogues (with progestogen, raloxifene, tibolone, or combined oestrogen-progestogen), hysterectomy (plus oophorectomy), hysteroscopic resonance-focused ultrasound, laparoscopic myomectomy, laparoscopically assisted vaginal hysterectomy, rollerball endometrial ablation, thermal balloon ablation, thermal myolysis with laser, total abdominal hysterectomy, total abdominal myomectomy, total laparoscopic hysterectomy, total vaginal hysterectomy, and uterine artery embolisation.
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