The facts about fibroids. Presentation and latest management options

Uterine fibroids, which eventually develop in more than 50% of women, are usually asymptomatic, but they can cause many different symptoms and complications that challenge clinicians. For example, they can complicate pregnancy, mask the diagnosis of ovarian neoplasms, and confuse the management of menopause by causing abnormal uterine bleeding. The best noninvasive method of diagnosis is ultrasonography. Progestogens may be used to suppress menorrhagia, but use of these agents to treat fibroids is not routine. Gonadotropin-releasing hormone (GnRH) agonist analogues offer a promising medical approach to the treatment of fibroids; they have been shown to decrease fibroid size and to decrease uterine bleeding. Thus they may allow deferment of surgical treatment in selected patients (thereby preserving fertility) or decrease the risks involved when surgery is necessary. Further study is needed to assess the long-term effects of GnRH analogues on bone density, cholesterol levels, and risk of coronary artery disease. Surgical treatment is primarily by hysterectomy, unless myomectomy is indicated because of reproductive considerations.