Uterine fibroids, or leiomyoma, are benign tumors of the uterus that may cause severe pain, bleeding, and infertility (1). Fibroids affect a woman's quality of life, as well as her fertility and obstetrical outcomes. Fibroids affect approximately 35-77% of reproductive age-women (2-4), although the real prevalence is much higher since many fibroids may be asymptomatic. Nearing age 50, this likelihood may increase to 70-80% depending on the patient's ethnicity (3). Of particular note, Peddada et al. (5) found that fibroid growth rates declined for white women over 35 years old, but did not decline for black women of the same age. Fibroids are a public health concern and have been estimated to cost the U.S. health care system up to $34.4 billion dollars per year (6).
In this review, we examine the medical and surgical therapies that women and their providers may choose to treat uterine fibroids, paying particular attention to pregnancy rates and obstetrical outcomes. When selecting a treatment, individual patient preferences should be taken into account, such as desire for future childbearing. The fibroid location, size, and number are essential considerations.
Aside from traditional surgical therapies such as hysterectomy and myomectomy, minimally invasive gynecologic surgeries (MIGS), Uterine Artery Embolization (UAE), and Magnetic Resonance guided Focused Ultrasound (MRgFUS) are increasing in popularity. The preliminary data using these newer therapies are encouraging. However, patients should be counseled that any uterus-sparing technique has the potential for fibroid recurrence.