Prognosis
Medical
Many currently available medical therapies for the treatment of symptomatic uterine fibroids are effective for shrinking the size of fibroids, thereby significantly ameliorating fibroid-related symptoms. However, long-term use of these agents in premenopausal patients is not recommended because of serious adverse effects with prolonged use. They can, however, be effectively employed preoperatively to reduce fibroid size and reduce menstrual-associated anemia prior to surgical intervention.[82]
On cessation of medical therapy, regrowth of fibroids to pretreatment size occurs relatively quickly (within 12 weeks in the case of gonadotropin-releasing hormone agonists, for example) and symptoms return.[65] Medical therapies may also be usefully employed in perimenopausal patients in order to bridge the gap to naturally occurring frank menopause with accompanying spontaneous amelioration of fibroid-related symptoms in many cases.[72]
Surgical
Uterine-sparing surgeries such as myomectomy and uterine artery embolization have been shown to be effective in treating fibroid-related symptoms such as heavy menstrual bleeding and those related to uterine bulk. In a collection of five studies involving 285 patients undergoing myomectomy for heavy menstrual bleeding, 81% showed reduction or complete resolution of heavy bleeding following surgery.[23]
There is some evidence in the literature that uterine cavity-distorting uterine fibroids can contribute to infertility and pregnancy complications such as preterm labor, abruptio placentae, breech presentation, and cesarean section.[9] Unfortunately, there is some risk of recurrence of fibroids (up to 25%), which does not vary by type of surgery.[82] In an examination of seven studies among patients undergoing myomectomy, a reduction in miscarriage from 41% to 19% was found following surgery.[121] Similar findings were noted in a retrospective study where patients were evaluated prior to undergoing abdominal myomectomy for fibroids that did not involve or distort the uterine cavity. In addition to a reduction in first-trimester fetal loss, second-trimester loss was reduced from 17% to none following surgery.[165]
Another study comparing clinical outcome following myomectomy and uterine artery embolization (UAE) between 3 and 5 years following surgery showed a 28% rate of further invasive therapy for recurrent symptoms in the UAE group.[73] There is insufficient evidence comparing different interventions for fibroids.[82]
Hysterectomy remains the most successful treatment of symptomatic uterine fibroids among women not desiring uterine preservation due to its efficacy in permanently ameliorating fibroid-related symptoms.[166]
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