Contemporary Management of Uterine Fibroids

Background: Uterine fibroids (leiomyomas) are the most common benign tumors in women of reproductive age and represent a significant cause of abnormal uterine bleeding, pelvic pain, infertility, and reduced quality of life. Contemporary management has evolved toward individualized, uterus-sparing approaches, incorporating pharmacological and minimally invasive strategies alongside traditional surgical methods. Methods: This narrative review was conducted based on a comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science databases for studies published between January 2010 and December 2025. The search strategy combined Medical Subject Headings (MeSH) and free-text terms related to uterine fibroids and their management. Eligible studies included clinical trials, systematic reviews, and meta-analyses focusing on pharmacological, minimally invasive, and surgical treatments in adult women. The review was prepared in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) recommendations to improve methodological transparency and quality of reporting. Results: A total of 97 studies were included in the qualitative synthesis. Minimally invasive techniques, including uterine artery embolization (UAE), radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU), demonstrate high efficacy in symptom control and improvement of quality of life, with shorter recovery times and lower complication rates compared to conventional surgery. However, their impact on fertility remains variable and requires careful patient selection. Pharmacological therapies, particularly GnRH analogues and antagonists, effectively reduce bleeding and fibroid volume, although their long-term use is limited by side effects. Conclusions: The management of uterine fibroids should be individualized, taking into account symptom severity, fibroid characteristics, patient age, and reproductive plans. Minimally invasive and pharmacological treatments represent effective alternatives to surgery in appropriately selected patients, while surgical approaches remain essential in advanced or refractory cases. Future research should focus on optimizing personalized treatment strategies and evaluating long-term outcomes, particularly regarding fertility and recurrence.