Treatment	Description	Advantages	Disadvantages	Fertility preserved?
Gonadotropin- releasing hormone agonists	Preoperative treatment to decrease size of tumors before hysterectomy, myomectomy, or myolysis	Decreases blood loss and operative and recovery time	Long-term treatment associated with high cost, menopausal symptoms, and bone loss; increased recurrence risk with myomectomy	Dependent on subsequent procedure
Hysterectomy	Surgical removal of the uterus (transabdominal, transvaginal, or laparoscopic)	Definitive treatment for women who do not wish to preserve fertility Vaginal procedure associated with less blood loss, pain, and fever and greater patient satisfaction compared with abdominal procedure	Surgical risks	No
Myolysis	In situ destruction of tumors by heat, laser, or cryotherapy	Ease and rapidity of procedure; minimal blood loss; rapid recovery time	Delay in reduction of uterine size; unknown risk of recurrence; prolonged vaginal bleeding	Unknown
Myomectomy	Surgical or endoscopic excision of tumors	Resolution of symptoms with preservation of fertility; perioperative morbidity similar to that with hysterectomy	Fibroid recurrence rate of 15 to 30 percent at five years; success of procedure determined by number and extent of tumors	Yes
Uterine artery embolization	Interventional radiologic procedure to occlude uterine arteries	Minimally invasive; avoids surgery; short hospital stay (24 to 36 hours)	Symptom recurrence of more than 17 percent at 30 months; risk of extended hospitalization for postprocedure pain	No (limited experience)