Clinical management of uterine fibroids in women of reproductive age

Abstract

Fibroids are the most common human tumors affecting approximately 40% of women of reproductive age. The prevalence rises with age, and pregnancy seems to have a protective effect. Fibroids change uterine anatomy and function, thus, can be a cause of infertility. Since reproductive plans are shifted

to the fourth decade of life in developed countries, uterine fibroids have become an emerging issue of reproductive health. Their high prevalence and benign characteristics imply that treatment is reserved mainly for symptomatic cases, and personalized to individual needs and expectations. The main symptoms include: heavy menstruation, tension, and infertility due to miscarriage and premature labor. The precise evaluation of the myoma number, size, localization, vascularisation, and their classification according to the FIGO and the Funaki classification system are invaluable for personalized treatment. Conservative treatment is targeted towards the maintenance and improvement of uterine function and is a method of first choice in women of reproductive age. Different treatment modalities vary by diverse invasiveness and effectiveness. Conservative methods include laparoscopic myomectomy and hysteroscopic resection. Novel, minimally-- or non-invasive methods are radiological embolization and ultrasonographic termoablation (HIFU), the latter not even requiring skin incision. The implementation of ultrasound beams that transfer energy, remotely increases fibroid temperature. Treatment causes coagulation and concomitant aseptic necrosis. Symptoms alleviate afterwards. Current literature shows that HIFU has the best obstetrical outcomes compared to other methods. Knowledge of the influence of fibroids on fertility and the possibilities of contemporary therapeutic modalities enables treatment optimization of. Careful personalization warrants therapy effectiveness and safety. 

Key words: fibroid, fertility, embolization, thermoablation, HIFU