Management of Uterine Fibroids

Project Summary Title and Description

Title
Management of Uterine Fibroids
Description
We assessed the evidence about management of uterine fibroids. Specifically, we sought to determine effectiveness of interventions, risks of harm, and whether individual or fibroid characteristics influence outcomes.
Attribution
N/A
Authors of Report
N/A
Methodology description
We included studies published in English from January 1985 to September 2016. We identified randomized clinical trials to assess outcomes and harms of interventions. We used data from trials in a meta-analysis to estimate likelihood and timing of subsequent interventions for fibroids based on initial type of intervention. To describe risk of unrecognized leiomyosarcoma, we included studies that allowed calculation of prevalence of leiomyosarcoma discovered at the time of surgery for masses believed to be fibroids. We also identified publications that indicated operative approach to removal of leiomyosarcoma tissue and included survival data. We extracted data, assessed risk of bias, and rated the strength of the evidence for informing care.
PROSPERO
N/A
DOI
10.26300/mkmx-rk08
Notes
Data entered retrospectively into SRDR. Outcome data, demographics data, and characteristics data files have been uploaded.
Funding Source
N/A

Key Questions

1. Key Question 1: What is the comparative effectiveness (benefits and harms) of treatments for uterine fibroids, including comparisons among these interventions?
2. Key Question 2: Does treatment effectiveness differ by patient or fibroid characteristics (e.g., age, race/ethnicity; symptoms; vascular supply to fibroids; menopausal status; or number, size, type, location, or total volume of fibroids)?
3. Key Question 3: What is the risk of encountering a leiomyosarcoma when morcellation is used for masses believed to be uterine fibroids at the time of myomectomy or hysterectomy?
4. Key Question 4: Does risk of leiomyosarcoma dissemination differ by patient or fibroid characteristics (e.g., age; race/ethnicity; symptoms; menopausal status; imaging characteristics; vascular supply to fibroids; or number, size, type, location, or total volume of fibroids) or surgical approach to morcellation?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Ultrasound guided high intensity focused ultrasound (USgHIFU) ablation for uterine fibroids: Do we need the microbubbles?2015
Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids.2015
Comparison of polyvinyl alcohol microspheres and tris-acryl gelatin microspheres for uterine fibroid embolization: results of a single-center randomized study.2014
Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri.2014
Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy.2014
A case-control study of high-intensity focused ultrasound combined with sonographically guided intratumoral ethanol injection in the treatment of uterine fibroids.2014
Long-term treatment of uterine fibroids with ulipristal acetate ☆.
Enhancing ablation effects of a microbubble-enhancing contrast agent ("SonoVue") in the treatment of uterine fibroids with high-intensity focused ultrasound: a randomized controlled trial.2014
Non spherical polyvinyl alcohol versus gelatin sponge particles for uterine artery embolization for symptomatic fibroids.2013
Minilaparoscopic myomectomy: a mini-invasive technical variant.2013
Treatment of Uterine Myoma with 2.5 or 5 mg Mifepristone Daily during 3 Months with 9 Months Posttreatment Followup: Randomized Clinical Trial.2013
Mifepristone versus placebo to treat uterine myoma: a double-blind, randomized clinical trial.
Safety and effectiveness of different dosage of mifepristone for the treatment of uterine fibroids: a double-blind randomized clinical trial.2013
Efficacy and safety of oral tranexamic acid in women with heavy menstrual bleeding and fibroids.2013
Effect of high-intensity focused ultrasound on sexual function in the treatment of uterine fibroids: comparison to conventional myomectomy.2013
The effect of high-intensity focused ultrasound treatment on immune function in patients with uterine fibroids.2013
The effect of treatment preference and treatment allocation on patients' health-related quality of life in the randomized EMMY trial.2013
Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings.2013
Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy.2012
Treatment of uterine myoma with 5 or 10mg mifepristone daily during 6 months, post-treatment evolution over 12 months: double-blind randomised clinical trial.2012
Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature.2012
Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial.2011
Uterine artery embolization versus myomectomy: impact on quality of life--results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial.2012
Gasless laparoscopy versus conventional laparoscopy in uterine myomectomy: a single-centre randomized trial.2011
Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results.2011
Prospective comparison of laparoscopic uterine artery occlusion plus myomectomy with classic intrafascial supracervical hysterectomy for symptomatic fibroid treatment: differences in post-operative quality-of-life measures.2011
Comparison of the efficacy of the embolic agents acrylamido polyvinyl alcohol microspheres and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: a prospective randomized controlled trial.2011
Polyvinyl alcohol particle size for uterine artery embolization: a prospective randomized study of initial use of 350-500 μm particles versus initial use of 500-700 μm particles.2011
Efficacy and tolerability of CDB-2914 treatment for symptomatic uterine fibroids: a randomized, double-blind, placebo-controlled, phase IIb study.
Evaluation of loop ligation of larger myoma pseudocapsule combined with vasopressin on laparoscopic myomectomy.
Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial.2010
A comparative study of fibroid ablation rates using radio frequency or high-intensity focused ultrasound.2010
Uterine artery embolisation versus hysterectomy for leiomyomas: primary and 2-year follow-up results of a randomised prospective clinical trial.2010
The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids.2010
Uterine artery embolization versus laparoscopic occlusion of uterine arteries for leiomyomas: long-term results of a randomized comparative trial.2009
Comparison of the effect of gonadotropin-releasing hormone agonist and dopamine receptor agonist on uterine myoma growth. Histologic, sonographic, and intra-operative changes.2009
Laparoscopy vs minilaparotomy in women with symptomatic uterine myomas: a prospective randomized study.2009
A randomized, controlled study comparing minilaparotomy versus isobaric gasless laparoscopic assisted minilaparotomy myomectomy for removal of large uterine myomas: short-term outcomes.2009
A randomized, controlled clinical trial comparing the effects of aromatase inhibitor (letrozole) and gonadotropin-releasing hormone agonist (triptorelin) on uterine leiomyoma volume and hormonal status.2010
Mifepristone for the treatment of uterine leiomyomas: a randomized controlled trial.2008
Laparoscopically assisted vaginal hysterectomy versus vaginal hysterectomy for enlarged uterus.2008
A randomized trial of laparoscopic versus laparoscopic-assisted minilaparotomy myomectomy for removal of large uterine myoma: short-term outcomes.2008
Economic evaluation of uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial.2008
CDB-2914 for uterine leiomyomata treatment: a randomized controlled trial.2008
Uterine artery embolization versus occlusion for uterine leiomyomas: a pilot randomized clinical trial.2008
Leiomyoma infarction after uterine artery embolization: a prospective randomized study comparing tris-acryl gelatin microspheres versus polyvinyl alcohol microspheres.2008
Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy--results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial.2008
Tibolone reverses the cognitive effects caused by leuprolide acetate administration, improving mood and quality of life in patients with symptomatic uterine leiomyomas.2008
Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy.2008
Isobaric gasless laparoscopy versus minilaparotomy in uterine myomectomy: a randomized trial.2008
Sexuality and body image after uterine artery embolization and hysterectomy in the treatment of uterine fibroids: a randomized comparison.2007
Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy.2007
Efficacy of tibolone as "add-back therapy" in conjunction with a gonadotropin-releasing hormone analogue in the treatment of uterine fibroids.2008
Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial.2007
A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes.
A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: short-term outcomes.2007
Comparison of the effect of gonadotropin-releasing hormone analog (Diphereline) and Cabergoline (Dostinex) treatment on uterine myoma regression.2007
A randomized, controlled trial of asoprisnil, a novel selective progesterone receptor modulator, in women with uterine leiomyomata.2007
Uterine-artery embolization versus surgery for symptomatic uterine fibroids.2007
Laparoscopic occlusion compared with embolization of uterine vessels: a randomized controlled trial.2007
Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: a randomized controlled trial.2006
Effects of the position of fibroids on fertility.2006
Administration of goserelin acetate after uterine artery embolization does not change the reduction rate and volume of uterine myomas.2006
Uterine artery embolization in the treatment of symptomatic uterine fibroid tumors (EMMY trial): periprocedural results and complications.2006
Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas.2006
Pain and return to daily activities after uterine artery embolization and hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial.2006
Abdominal vs vaginal hysterectomy: a comparative study of the postoperative quality of life and satisfaction.2006
Spherical polyvinyl alcohol versus tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a limited randomized comparative study.2005
Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial.2006
Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial.2005
Twelve-month safety and efficacy of low-dose mifepristone for uterine myomas.2005
Gonadotropin-releasing hormone agonist with or without raloxifene: effects on cognition, mood, and quality of life.2004
Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study.2004
Raloxifene prevents the growth of uterine leiomyomas in premenopausal women.2004
Low-dose mifepristone for uterine leiomyomata.2003
Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial.2003
Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study.2002
Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial.2002
Effectiveness of combined GnRH analogue plus raloxifene administration in the treatment of uterine leiomyomas: a prospective, randomized, single-blind, placebo-controlled clinical trial.2002
Raloxifene administration in premenopausal women with uterine leiomyomas: a pilot study.
Impact of different hormone replacement therapy regimens on the size of myoma uteri in postmenopausal period: tibolone versus transdermal hormonal replacement system.2002
Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus.2002
Comparison of two procedures for laparoscopic-assisted vaginal hysterectomy of large myomatous uteri.2002
Addition of laparoscopic uterine nerve ablation to laparoscopic bipolar coagulation of uterine vessels for women with uterine myomas and dysmenorrhea.2001
Effects of raloxifene treatment on uterine leiomyomas in postmenopausal women.2001
The role of tamoxifen in the treatment of symptomatic uterine leiomyomata -- a pilot study.2001
Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy.2001
Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study.2001
Thermal balloon ablation in myoma-induced menorrhagia under local anesthesia.2001
A prospective randomized study comparing endocrinological and clinical effects of two types of GnRH agonists in cases of uterine leiomyomas or endometriosis.2000
Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy.2000
Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids.2000
A randomized study of the effects of tibolone and transdermal estrogen replacement therapy in postmenopausal women with uterine myomas.2000
Goserelin acetate to avoid hysterectomy in pre-menopausal women with fibroids requiring surgery.1999
A clinical trial of the effects of tibolone administered with gonadotropin-releasing hormone analogues for the treatment of uterine leiomyomata.1998
Effect of tibolone on postmenopausal women with myomas.1997
Two-step gonadotropin-releasing hormone agonist treatment of uterine leiomyomas: standard-dose therapy followed by reduced-dose therapy.1996
Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome.1996
Sustained benefits of leuprolide acetate with or without subsequent medroxyprogesterone acetate in the nonsurgical management of leiomyomata uteri.1995
Long-term medical therapy for leiomyomata uteri: a prospective, randomized study of leuprolide acetate depot plus either oestrogen-progestin or progestin 'add-back' for 2 years.1994
A prospective, randomized trial of gonadotropin-releasing hormone agonist plus estrogen-progestin or progestin "add-back" regimens for women with leiomyomata uteri.1993
An evaluation of the effect of gonadotropin-releasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebo-controlled, crossover trial.1993
Efficacy of a low-dose leuprolide acetate depot in the treatment of uterine leiomyomata in Japanese women.1992
Treatment of leiomyomata uteri with leuprolide acetate depot: a double-blind, placebo-controlled, multicenter study. The Leuprolide Study Group.1991
Intranasal buserelin versus surgery in the treatment of uterine leiomyomata: long-term follow-up.1991
Luteinizing hormone-releasing hormone analog therapy of uterine fibroid: analysis of results obtained with buserelin administered intranasally and goserelin administered subcutaneously as a monthly depot.1990
A randomized, placebo-controlled, double-blind study evaluating the efficacy of leuprolide acetate depot in the treatment of uterine leiomyomata.1989
A randomized, double-blind trial of a gonadotropin releasing-hormone agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri.1988
Comparison of levonorgestrel-releasing intrauterine device with oral progestins in heavy menstrual bleeding (HMB) cases with uterine leiomyoma (LNG-IUD and oral progestin usage in myoma uteri).2014

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