Uterine Fibroids: Rapid Evidence Review

Uterine fibroids are the most common benign tumor in women. Most fibroids are asymptomatic, but presenting symptoms include those associated with increased uterine size (eg, abdominal distension, urinary frequency or urgency, constipation), abnormal uterine bleeding, pelvic pain, and infertility. The initial evaluation of fibroids should include a full gynecologic history with abdominal, speculum, and bimanual pelvic examinations. Initial imaging of choice is the combination of transvaginal and transabdominal ultrasonography. Pelvic magnetic resonance imaging with contrast may further characterize the extent of disease and guide treatment. Treatment choices are determined by fibroid size and location with preferences for uterine and fertility preservation. Pharmacotherapy is used to control heavy or abnormal uterine bleeding and includes combined and progestin-only oral contraceptives; 52-mg levonorgestrel-releasing intrauterine devices; nonsteroidal anti-inflammatory drugs; tranexamic acid; and hormonal therapies, such as gonadotropin-releasing hormone antagonists and gonadotropin-releasing hormone agonists. Surgical and interventional options reduce bulk symptoms, reduce bleeding, and may preserve or improve fertility. Surgical and interventional radiologic options include hysterectomy, myomectomy, uterine artery embolization, radiofrequency ablation, and high-intensity focused ultrasonography. Treating vitamin D deficiency may reduce fibroid tumor size or halt progression.