Management of uterine fibroids: an update of the evidence.
Level 1 - systematic review of randomized trials
Systematic review of comparative and observational studies
What was done
The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center conducted a systematic review updating evidence on uterine fibroid management, evaluating incidence, prevalence, treatment outcomes, comparative effectiveness, modifiers, and costs. Searches spanned MEDLINE, Embase, and Cochrane Collaboration databases for English-language articles published from February 2000 through August 2006. Case series with fewer than 100 participants and cohort studies with fewer than 40 participants were excluded. A total of 107 studies met inclusion criteria and underwent quality assessment.
What was found
Of the 107 included studies, 3 were rated good quality, 56 fair, and 48 poor. Cumulative incidence of uterine fibroids by age 50 reached 70% to 80%, with higher risk at younger ages in Black women. Preoperative medical management reduced fibroid volume but lacked adequate evidence showing improvements in major operative outcomes. Weak evidence supported hysteroscopic treatment of submucous fibroids for women desiring pregnancy. Studies of uterine artery embolization (UAE) reported shorter procedure times and hospital stays compared to other procedures, but complication rates showed inconsistent directions of effect and longer-term outcomes were missing. No well-conducted U.S. trials directly compared common interventions (including hysterectomy, myomectomy, or expectant management) regarding treatment objectives, while treatment costs continued to rise.
Why it matters
Despite fibroids affecting the majority of women by age 50, clinicians and patients lack high-quality comparative trial data to evaluate the relative risks, benefits, and long-term outcomes of major medical and surgical interventions.
Limits
The evidence base is dominated by low-quality research, with only 3 of 107 studies rated good quality. Direct head-to-head trials in U.S. populations, evaluations of expectant management, tracking of fibroid recurrence or regrowth, and long-term safety and fertility outcomes were largely absent from the literature.
Cited by
- supports Approximately 80 percent of women will develop uterine fibroids by age 50.