Abstract
BackgroundUterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence.PurposeTo determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence.Study SelectionTwo authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013.Data ExtractionTwo authors independently extracted data from identified studies.Data SynthesisA Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence—Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated.Results and LimitationsA total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes.ConclusionsThere is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed.
Highlights
Uterine fibroids are benign tumours of the uterus known as leiomyomas
Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials. gov until December 2013
A total of 75 RCT met the inclusion criteria, 47 of which were included in the network metaanalysis
Summary
Uterine fibroids are benign tumours of the uterus known as leiomyomas. Malignant transformation is rare. The prevalence of uterine fibroids varies between 5% and 65% depending on age, ethnicity, geographical region and quality of imaging techniques [1,2,3,4,5]. They can occur as single or multiple focal fibroids or can be diffuse [5, 6]. Classification and subclassification by fibroid position and size is important Such factors have clinical and research implications. Medical treatment aims to control symptoms in order to replace or delay surgery This may improve the outcome of surgery and prevent recurrence
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