Uterine Fibroids: Diagnosis and Treatment

Am Fam Physician. 2017 Jan 15;95(2):100-107.

Abstract

Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent. Many are discovered incidentally on clinical examination or imaging in asymptomatic women. Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia. Ultrasonography is the preferred initial imaging modality. Expectant management is recommended for asymptomatic patients because most fibroids decrease in size during menopause. Management should be tailored to the size and location of fibroids; the patient's age, symptoms, desire to maintain fertility, and access to treatment; and the experience of the physician. Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs. Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Female
  • Humans
  • Leiomyoma / diagnosis*
  • Leiomyoma / diagnostic imaging
  • Leiomyoma / surgery
  • Leiomyoma / therapy
  • Middle Aged
  • Ultrasonography
  • Uterine Neoplasms / diagnosis*
  • Uterine Neoplasms / diagnostic imaging
  • Uterine Neoplasms / surgery
  • Uterine Neoplasms / therapy