EVIDENCE-BASED DIAGNOSIS AND TREATMENT OF UTERINE FIBROIDS

Abstract

Summary. Aim. Analyze (using scientific databases and evidence-based guidelines, up to 5 years old, applying PRISMA methodology) diagnostic and treatment methods for uterine fibroids, commonly used by physicians and summarize them to propose the most reliable and effective ones. Methods. PubMed and Cochrane databases were analyzed, according to PRISMA recommendations. Selected articles in English, up to 5 years old, using keywords: “uterine fibroid diagnosis”, “uterine fibroid treatment and management”. Results. 59 articles, which met criteria, were selected. Diagnosis of fibroids is based on a comprehensive history, laboratory tests and widely used US method, yet the gold standard for differential diagnosis is MRI. Possible treatment methods – LNG-IUS, combined pills, UPA, GnRH analogues, suitable for first line treatment or as preparation for surgical intervention, whenever >3 cm or multiple uterine fibroids are diagnosed – laparoscopic, laparotomic myomectomy, hysteroscopic resection, RFVTA procedure is also possible. Possible effectiveness of HIFU, robot-assisted technologies require further research. Conclusions. The diagnosis and treatment of uterine fibroids depends on a variety of
factors. Diagnosis of fibroids is based on a case history, laboratory tests, applied US, yet gold standard for differential diagnosis – MRI. Fertility-preserving treatment methods –
conservative drug treatment, minimally invasive methods – AIFU, RFVTA, GAE. The most effective surgical methods are hysteroscopic, laparoscopic myomectomy, RFVTA has
similar effectiveness.