Uterine myoma treatment – alternatives to surgery (literature review)

Abstract

Uterine leiomyomas, also known as fibroids, are benign, hormone-sensitive neoplasms originating from the smooth muscle cells of the myometrium. Leiomyomas are the most common benign neoplasms in the female reproductive system, diagnosed in up to 70% of women by the age of 50. Despite being benign, leiomyomas can lead to significant morbidity, impacting the quality of life due to symptoms such as heavy menstrual bleeding and pelvic pain. While surgical treatment remains a golden standard, there is increasing demand for non-surgical treatment alternatives. This literature review was done to evaluate non-invasive and minimally invasive treatment options for uterine leiomyomas, comparing their effectiveness with surgical treatment options. Non-hormonal medications, such as non-steroidal anti-inflammatory drugs and tranexamic acid, can reduce heavy menstrual bleeding, however, they have no effect on leiomyoma size. Hormonal therapies, including combined oral contraceptives (COC) and levonorgestrel intrauterine devices (LNG-IUD), are widely used as symptomatic therapy but similarly do not reduce leiomyoma size. Gonadotropin-releasing hormone (GnRH) receptor agents are effective in reducing fibroid size but have limitations in terms of long-term use and side effects. Selective progesterone receptor modulators (SPRM) have demonstrated efficacy in affecting both heavy menstrual bleeding and fibroid size, however long-term safety is a concern. Minimally invasive procedures, including uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), and radiofrequency ablation (RFA), are alternatives to surgery with fewer complications and shorter recovery times. Additionally, these procedures offer uterus preservation and are associated with reduced morbidity. HIFU, guided by either ultrasound or magnetic resonance imaging, and RFA have shown promising results in symptom relief and fibroid shrinkage, particularly for women of reproductive age who wish to preserve fertility. However, recurrence of symptoms and fibroid regrowth remain challenges. This literature review highlights the importance of an individualised approach to leiomyoma treatment, balancing the effectiveness and risks of non-surgical and surgical treatment options, especially in cases where fertility preservation is desired. Further research is needed to establish long-term outcomes for non-surgical treatment of uterine leiomyomas.