Advances in management of uterine myomas

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.