[Frontiers in Bioscience E5, 12-22, January 1, 2013]

Advances in management of uterine myomas

Nirmala Duhan

Department of Obstetrics and Gynecology, Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India


1. Abstract
2. Introduction
3. Expectant management
4. Medical therapy
4.1. Antifibrinolytics
4.2. Non steroidal anti-inflammatory
4.3. Oral contraceptive pills
4.4. Progestogens
4.5. Danazole
4.6. Levonorgestrel intrauterine device (LNG-IUD)
4.7. Gonadotropin releasing hormone analogues (GnRHa)
4.8. Aromatic inhibitors
4.9. Mifepristone
4.10. CDB-2914
5. Surgical management
5.1. Hysterectomy
5.2. Abdominal myomectomy
5.3. Hysteroscopic myomectomy
5.4. Vaginal myomectomy
5.5. Laparoscopic/robotically assisted laparoscopic myomectomy
5.6. Magnetic resonance-guided focused ultrasound surgery (MRgFUS)
5.7. Uterine artery embolization (UAE)
5.8. Endometrial ablation
5.9. Myolysis
5.10. Uterine artery ligation
6. Conclusion
7. References


Uterine myomas, the most common benign solid pelvic tumors in women, occur in twenty percent of them in reproductive years and form the most common indication for hysterectomy. Various factors affect the choice of the best treatment modality for a given patient. Asymptomatic myomas may be managed by careful follow up. Medical therapy should be tried as a first line of treatment for symptomatic myomas while surgical treatment should be reserved only for appropriate indications. Myomectomy would be preferred over hysterectomy in those wishing subsequent childbearing. Preoperative GnRH-analogue treatment reduces the myoma size and vascularity but may render the capsule more difficult to resect. Poor surgical risk women with large symptomatic myomas or those wishing to avoid major surgical procedures may be offered uterine artery embolization. Serial follow-up for growth and symptoms may be appropriate for asymptomatic perimenopausal women. The present article reviews the available therapeutic modalities for uterine myomas.