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Overview of treatment of uterine leiomyomas (fibroids)

Elizabeth A Stewart, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Uterine leiomyomas (fibroids or myomas) are benign tumors. Since histologic confirmation of the clinical diagnosis is not necessary in most cases, and there is both growth and regression of fibroids, asymptomatic uterine leiomyomas can usually be followed without intervention [1]. Women with leiomyomas whose physicians prescribed "watchful waiting" experienced no significant change in symptoms or decline in quality of life, thereby providing some reassurance to women who are asymptomatic or have mild symptoms and choose to avoid intervention [2]. Moreover, evidence-based guidelines support not treating asymptomatic fibroids [3-5].

Prophylactic therapy to avoid potential future complications from myomas or their treatment is not recommended because we don’t have reliable predictors of progression. Possible exceptions include women with significant submucosal leiomyomas who are contemplating pregnancy and women with ureteral compression leading to moderate or severe hydronephrosis. In these women, prophylactic treatment may prevent miscarriage or urinary tract obstruction.

Relief of symptoms (eg, abnormal uterine bleeding, pain, pressure) is the major goal in management of women with significant symptoms [3]. The type and timing of any intervention should be individualized, based upon factors such as [6]:

Type and severity of symptoms

Size of the myoma(s)

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Literature review current through: Nov 2017. | This topic last updated: Nov 30, 2017.
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