New Horizons in Fibroid Management

AbstractPurpose of ReviewReview of the latest advances in the treatment of uterine fibroids. Addressing conservative management, medical therapy, interventional radiological procedures (non-surgical alternatives or non-excisional procedures) and conservative or radical endoscopic or open surgery (myomectomy, hysterectomy).Recent FindingsNewer medical therapy relied on the use of selective progesterone receptor modulators (SPRMs) (Esmya/UPA) for management of heavy menstrual bleeding (HMB) associated with fibroids. However, the drug is currently under investigation for a link with hepatic damage associated with its use. Other SPRMs currently showing promise include vilaprisan and telapristone. New medical therapy also includes oral small molecule GnRH antagonists such as Relugolix, Elagolix and Lizagolix which are undergoing phase 2 and 3 trials and have shown promise. The new NICE guidance on HMB also suggests limited effectiveness of pharmacological methods in fibroids>  3 cm and therefore referral to an expert with possible consideration of surgery as a first-line treatment. Non-excisional procedures include the use of uterine artery embolisation which is currently being compared to myomectomy and its effect on the quality of life in the FEMME study. With regar d to excisional therapies, controversy still surrounds the use of laparoscopic power morcellators (LMPs). A white paper has been issued by the US FDA in December 2017 on the matter, and a PneumoLiner still rema...
Source: Current Obstetrics and Gynecology Reports - Category: OBGYN Source Type: research