Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis

Abstract

Despite the substantial heterogeneity of the study population, this meta-analysis provides valuable information on relative treatment efficacy of various uterine-sparing interventions for fibroids, which is relevant when counseling patients in daily practice. Furthermore, this study demonstrates that long-term data, particularly for the newest uterine-sparing interventions, are urgently needed.

Epidemiology and management of uterine fibroids

“…For the latter reason, the procedure is not recommended for women with prior extensive abdominal/pelvic surgeries or abdominal scarring. The rates of re‐intervention following MRgFUS are higher (30.5%) compared with myomectomies or UAE . Data on successful pregnancies after MRgFUS are rare and need further investigation …”

“…Additionally, presence of five or more fibroids, pedunculated, gadolinium non‐enhanced or very large fibroids (>10 cm), post‐menopausal status, and severe adenomyosis are contraindications to this procedure. Following MRgFUS, approximately 71% of women reported an improvement of symptoms at 6 months . Although rare, reversible pelvic neuropathy and local skin burns are the main risks associated with MRgFUS.…”

“…Following MRgFUS, approximately 71% of women reported an improvement of symptoms at 6 months. 17,34 Although rare, reversible pelvic neuropathy and local skin burns are the main risks associated with MRgFUS. For the latter reason, the procedure is not recommended for women with prior extensive abdominal/pelvic surgeries or abdominal scarring.…”

“…The rates of re-intervention following MRgFUS are higher (30.5%) compared with myomectomies or UAE. 34 Data on successful pregnancies after MRgFUS are rare and need further investigation. 34…”

Evaluation and Management of Abnormal Uterine Bleeding

“…In comparing treatments, reintervention risk after 36 months was 1.2% for abdominal myomectomy, 7.4% for UAE, 34.7% for highintensity focused ultrasound (includes both MRI and ultrasound guided), and 3.2% for hysteroscopic myomectomy. 31 Oral SPRMs seem to be promising as medical therapy that lowers bleeding and decreases leiomyoma size; 1 SPRM is available outside of the United States. 26,29 Additional long-term medical treatments are anticipated in the future.…”