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Selective estrogen receptor modulators (SERMs) for uterine leiomyomas
X Lingxia1, W Taixiang, C Xiaoyan
1West China Hospital, Sichuan University, Clinical Medicine, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041. kitty_xlx@yahoo.com.cn
Background:
Uterine fibroids are benign tumors that arise from individual smooth muscle cells of the uterus. Selective estrogen receptor modulators (SERMs) are ER ligands that act as estrogens in some tissues, while blocking estrogen action in others. There have been many clinical studies of various SERMs for uterine fibroid. However, their effectiveness is controversial.
Objectives:
To evaluate the evidence for the effectiveness and safety of selective estrogen receptor modulators in women with uterine fibroids.
Search Strategy:
We searched The Cochrane Library, MEDLINE, the Register of Chinese trials developed by the Chinese Cochrane Centre, and the Chinese Med Database, Chinese Biomedical Disc (CBMDisc 1978 to July 2004); VIP (1989 to October 2005)); China National Knowledge Infrastructure (CNKI 1994 to 2003) in October 2005. We hand searched a number of journals, and searched reference lists, databases of ongoing trials and the Internet.
Selection Criteria:
We included randomized controlled studies of selective estrogen receptor modulators versus other forms of medical therapy or placebo in women in the reproductive age (18 to 45 years old) with confirmed uterine fibroid.
Data Collection And Analysis:
Two review authors independently extracted data and assessed trial quality. As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarized the data in a narrative format.
Main Results:
Three studies involving 215 participants were included, trial size varied from 25 to 100. Comparison interventions included no treatment, Poly vitamins, and leuprolide acetate depot plus raloxifene versus leuprolide plus placebo tablet. There was a tendency towards fibroid reduction with selective estrogen receptor modulators (SERMs), although this was not significant in all studies. All three studies mentioned adverse reactions but no detailed data were acquired in the included studies.
Authors' Conclusions:
There is no evidence from the limited number of studies that SERMs reduce the size of fibroids or improve clinical outcomes. Further studies are required to establish evidence of benefit of SERMs in treating women with uterine fibroids.
Insights
Selective estrogen receptor modulators (SERMs) show a tendency for uterine fibroid reduction, but evidence for effectiveness and safety is limited. More research is needed to confirm benefits for women with uterine fibroids.
Area of Science:
- Gynecology
- Pharmacology
- Oncology
Background:
- Uterine fibroids are common benign uterine smooth muscle tumors.
- Selective estrogen receptor modulators (SERMs) have variable estrogenic and anti-estrogenic effects.
- Previous studies on SERMs for uterine fibroids yielded controversial results.
Purpose of the Study:
- To evaluate the effectiveness and safety of SERMs for treating uterine fibroids.
- To synthesize evidence from randomized controlled trials on SERM efficacy.
Main Methods:
- Comprehensive literature search across multiple databases including Cochrane Library, MEDLINE, and Chinese databases.
- Inclusion of randomized controlled studies comparing SERMs with placebo or other medical therapies.
- Narrative data synthesis due to heterogeneity and quality limitations of included studies.
Main Results:
- Three studies with 215 participants were included.
- A trend towards fibroid size reduction with SERMs was observed, but not statistically significant in all cases.
- Adverse reactions were reported but lacked detailed data.
Conclusions:
- Limited evidence suggests SERMs do not significantly reduce uterine fibroid size or improve clinical outcomes.
- Further high-quality research is necessary to establish the therapeutic benefits of SERMs for uterine fibroids.
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