Therapeutic management of uterine fibroid tumors: updated French guidelines

Service de gynécologie, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnelé, 37044 Tours, France.
European journal of obstetrics, gynecology, and reproductive biology (Impact Factor: 1.63). 08/2012; 165(2). DOI: 10.1016/j.ejogrb.2012.07.030
Source: PubMed

ABSTRACT The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids.


Available from: Guillaume Legendre, Jun 03, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surgical myomectomy is currently regarded as the standard conservative treatment for patients who wish to preserve their fertility. However, it presents two main problems: the intra- and postoperative risk of bleeding and the risk of recurrence of leiomyomas. Preventive occlusion of uterine arteries was described during laparoscopic myomectomy as one of the procedures addressing these issues.
    Archives of Gynecology and Obstetrics 11/2014; 291(4). DOI:10.1007/s00404-014-3546-4 · 1.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20%-25% of the worldwide population. No currently approved medical treatment is able to completely eliminate fibroids. Surgery, particularly hysterectomy, predominates as the treatment strategy of choice, even though it is associated with risks and complications and causes infertility. Until recently, gonadotropin-releasing hormone agonists were the only available drugs for the preoperative treatment of fibroids. However, ulipristal acetate (UPA), an oral selective progesterone receptor modulator, was recently licensed in Europe for the same indication. Recent studies have demonstrated the efficacy and safety of UPA in the medical management of fibroids before surgery, with a better tolerability profile than leuprolide acetate. Analyzing the literature, we identified new management strategies involving UPA and surgery, considering advantages of both medical and surgical therapy. The advent of UPA will undoubtedly modify the surgical approach to fibroids, but the heterogeneity of these possible indications now requires various original clinical studies to identify the optimal indications for UPA in patients with symptomatic fibroid(s).
    International Journal of Women's Health 01/2015; 7:321-30. DOI:10.2147/IJWH.S50016
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chinese medicine is commonly used and covered by health insurance to treat symptoms of uterine fibroids in Taiwan. This retrospective cohort study compared the consumption of conventional western medicine and medical cost between Chinese medicine (CM) users and nonusers among patients with uterine fibroids. We extracted 44,122 patients diagnosed with uterine fibrosis between 1996 and 2010 from the National Health Insurance reimbursement database, which is a population-based database released by a government-run health insurance system. Multivariate linear regression models were used to find association between using Chinese medicine and the consumption of conventional medicine, and between using Chinese medicine and medical cost. The total fibroid-related conventional western medicine consumed by CM users was less than that by nonusers (β = -10.49, P < 0.0001). Three categories of conventional medicines, including antianemics (-3.50 days / year /patient, P < 0.0001), hemostatics (- 1.89 days / year / patient, P < 0.0001), and hormone-related agents (-3.13 days / year / patient, P < 0.0001), were used less in patients who were CM users. Moreover, although using CM increased 16.9 USD per patient in CM users annually (P < 0.0001), the total annual medical cost for treating fibroid was 5610 USD less in CM users than in nonusers (P < 0.0001). Our results suggested that CM reduced the consumption of conventional medicine, and might be a potential therapeutic substitute for conventional western medicines to treat uterine fibroids with low cost.
    BMC Complementary and Alternative Medicine 04/2015; 15(1):129. DOI:10.1186/s12906-015-0645-0 · 1.88 Impact Factor