Uterine fibroids: modern methods of treatment, advantages and complications

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Abstract

The state of the reproductive system by women with uterine fibroids is considered as a part of this literature review. The main clinical manifestations of myomatous nodes were identified by writing the review: abnormal uterine and heavy menstrual bleeding, infertility, miscarriage, chronic pelvic pain, dysfunction of adjacent organs, which are indications for surgical treatment. It is noted that approximately 30 % of women with uterine fibroids suffer from abnormal uterine bleeding, leading to anemia and reduced quality of life. Chronic pelvic pain significantly reduces the quality of life of patients, worsening their functional and mental state and disrupting sexual function. This review focuses on reproductive problems in women with leiomyoma. Taking into consideration the high prevalence of this nosology and the need to preserve the fertility of patients, the review describes modern methods of treating patients with uterine myoma, including drug therapy surgical treatment and alternative methods. Currently, in order to stop the symptoms of uterine fibroids, as well as for preoperative preparation, conservative therapy is used, which allows to reduce pain, restore hemoglobin levels, reduce intraoperative blood loss and reduce surgery time. Reproductive disorders associated with uterine fibroids, such as infertility, recurrent miscarriage, and adverse obstetric outcomes, are a significant reason to improve organ-preserving therapies or develop new ones. Although hysterectomy is a radical treatment for uterine fibroids, it is unacceptable for patients who have not realized their reproductive function. Therefore, the most justified intervention is myomectomy with various surgical approaches, and as an alternative treatment, uterine artery embolization, radiofrequency ablation or high-intensity focused ultrasound treatment of uterine fibroids. These data allow us to conclude that the high prevalence and versatility of symptoms of uterine fibroids among patients of reproductive age determine the relevance of searching for optimal methods of treatment.

About the authors

Ekaterina Yu. Aleynikova

Peoples’ Friendship University of Russia

Author for correspondence.
Email: ketall@mail.ru
ORCID iD: 0000-0002-1434-0386
Moscow, Russian Federation

Alina V. Solovyeva

Peoples’ Friendship University of Russia

Email: ketall@mail.ru
ORCID iD: 0000-0001-6711-1563
Moscow, Russian Federation

References

  1. Stewart E, Cookson C, Gandolfo R, Schulze-R ath R. Epidemiology of uterine fibroids: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2017;124(10):1501-1512. doi: 10.1111/1471-0528.14640
  2. Radzinsky VE, Olina AA, Orazov MR, Khamoshina MB, Solovieva AV, Penzhoyan GA, Mingaleva NV, Doronina OK, Savicheva AM, Gonchareva ZL, Knyazev SA, Orekhov RE, Artymuk NV, Novikova VA, Olenev AS. Women’s consultation: a guide / Radzinsky V.E., editor M.: GEOTAR-Media; 2021. 576 p. (In Russian)
  3. Metwally M, Raybould G, Cheong YC, Horne AW. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev.2020;2020(1): CD003857. doi: 10.1002/14651858.CD003857.pub4.
  4. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665-686. doi: 10.1093/humupd/dmw023
  5. Yudha Pratama Putra P, Prameswari AS, Ma’roef M, Musyarrofah A, Nelasari H. Laparoscopic myomectomy versus open myomectomy in uterine fibroid treatment: A meta-analysis. Laparoscopic, Endoscopic and Robotic Surgery. 2021;4(3):66-71. doi: 10.1016/j.lers.2021.08.002
  6. Marsh EE, Al- Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. J Womens Health (Larchmt). 2018;27(11):1359-1367. doi: 10.1089/jwh.2018.7076
  7. Nicolaus K, Bräuer D, Sczesny R, Lehmann T, Diebolder H, Runnebaum IB. Unexpected coexistent endometriosis in women with symptomatic uterine leiomyomas is independently associated with infertility, nulliparity and minor myoma size. Arch Gynecol Obstet. 2019;300(1):103-108. doi: 10.1007/s00404-019-05153-5
  8. Giuliani E, As-S anie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3-9. doi: 10.1002/ijgo.13102
  9. Aguilar HN, Mitchell BF. Physiological pathways and molecular mechanisms regulating uterine contractility. Hum Reprod Update. 2010;16(6):725-744. doi: 10.1093/humupd/dmq016
  10. Radzinsky VE, Orazov MR, Kostin IN. Chronic pelvic pain in gynecological practice. Doctorru. 2019;7:162. doi: 10.31550/1727-2378-2019-162-7-30-35 (In Russian).
  11. Giray B, Esim-B uyukbayrak E, Hallac-Keser S, Karageyim- Karsidag AY, Turkgeldi A. Comparison of Nerve Fiber Density between Patients with Uterine Leiomyoma with and without Pain: a Prospective Clinical Study. Geburtshilfe Frauenheilkd. 2018;78(4):407-411. doi: 10.1055/a-0591-1751
  12. Freytag D, Günther V, Maass N, Alkatout I. Uterine Fibroids and Infertility. Diagnostics. 2021;11(8):1455. doi:10.3390/ diagnostics11081455
  13. Somigliana E, Reschini M, Bonanni V, Busnelli A, Li Piani L, Vercellini P. Fibroids and natural fertility: a systematic review and metaanalysis. Reprod Biomed Online. 2021;43(1):100-110. doi: 10.1016/j.rbmo.2021.03.013
  14. De La Cruz MSD, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100-107.
  15. Bonine NG, Banks E, Harrington A, Vlahiotis A, Moore- Schiltz L, Gillard P. Contemporary treatment utilization among women diagnosed with symptomatic uterine fibroids in the United States. BMC Womens Health. 2020;20:174. doi: 10.1186/s12905-020-01005-6
  16. Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2017(11): CD000547. doi: 10.1002/14651858.CD000547.pub2
  17. Xuan J, Deng G, Liu R, Chen X, Zheng Y. Analysis of medication data of women with uterine fibroids based on data mining technology. Journal of Infection and Public Health. 2020;13(10):1513-1516. doi: 10.1016/j.jiph.2019.07.017
  18. Uterine fibroids. Clinical guidelines. 2020. Ministry of Health of the Russian Federation. 48 p. (In Russian).
  19. Karena ZV, Shah H, Vaghela H, Chauhan K, Desai PK, Chitalwala AR. Clinical Utility of Mifepristone: Apprising the Expanding Horizons. Cureus. 14(8): e28318. doi: 10.7759/cureus.28318.
  20. Kulshrestha V, Kriplani A, Agarwal N, Sareen N, Garg P, Hari S, Thulkar J. Low dose mifepristone in medical management of uterine leiomyoma - An experience from a tertiary care hospital from north India. Indian J Med Res. 2013;137(6):1154-1162.
  21. Dobrokhotova YuE, Ilyina IY., Ibragimova DM, Narimanova MZ Uterine fibroids: alternative methods of treatment. Problems of reproduction. 2018;24(2):83-87. doi: 10.17116/repro201824283-87. (In Russian).
  22. Farris M, Bastianelli C, Rosato E, Brosens I, Benagiano G. Uterine fibroids: an update on current and emerging medical treatment options. Ther Clin Risk Manag. 2019;15:157-178. doi: 10.2147/TCRM. S147318
  23. Middelkoop MA, de Lange ME, Clark TJ, Mol BWJ, Bet PM, Huirne JAF, Hehenkamp WJK. Evaluation of marketing authorization and clinical implementation of ulipristal acetate for uterine fibroids. Hum Reprod. 2022;37(5):884-894. doi: 10.1093/humrep/deac009
  24. Donnez J, Hudecek R, Donnez O, Matule D, Arhendt HJ, Zatik J, Kasilovskiene Z, Dumitrascu MC, Fernandez H, Barlow DH, Bouchard P, Fauser BCJM, Bestel E, Terrill P, Osterloh I, Loumaye E. Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids. Fertility and Sterility. 2015;103(2):519-527.e3. doi: 10.1016/j.fertnstert.2014.10.038
  25. Biscione A, Barra V, Bellone E, Severi FM, Luisi S. Ulipristal acetate on quality of life and sexual function of women with uterine fibromatosis. Gynecological Endocrinology. 2020;36(1):87-92. doi: 10.1080/09513590.2019.1640202
  26. Ekanem E, Talaulikar V. Medical Therapy for Fibroids: What Next for Ulipristal Acetate? Adv Ther. 2021;38(1):137-148. doi: 10.1007/s12325-020-01555-z
  27. Donnez J, Taylor HS, Stewart EABradley L, Marsh E, Archer D, Al-Hendy A, Petraglia F, Watts N, Gotteland JP, Bestel E, Terrill P, Loumaye E, Humberstone A, Garner E. Linzagolix with and without hormonal add-back therapy for the treatment of symptomatic uterine fibroids: two randomised, placebo-controlled, phase 3 trials. Lancet. 2022;400(10356):896-907. doi: 10.1016/S0140-6736(22)01475-1.
  28. Keam SJ. Linzagolix: First Approval. Drugs. 2022;82(12):1317 doi: 10.1007/s40265-022-01753-9
  29. Hajhashemi M, Ansari M, Haghollahi F, Eslami B. The effect of vitamin D supplementation on the size of uterine leiomyoma in women with vitamin D deficiency. Caspian J Intern Med. 2019;10(2):125-131. doi: 10.22088/cjim.10.2.125
  30. Arjeh S, Darsareh F, Asl ZA, Azizi Kutenaei M. Effect of oral consumption of vitamin D on uterine fibroids: A randomized clinical trial. Complement Ther Clin Pract. 2020;39:101159. doi: 10.1016/j.ctcp.2020.101159
  31. Vysotsky MM, Kuranov II, Nevzorov OB. Indicators of reproductive health after surgical treatment of uterine fibroids. Akusherstvo I Ginekologiya Sankt- Peterburga. 2017;(3): 50-53. (In Russian).
  32. Davis MR, Soliman AM, Castelli- Haley J, Snabes MC, Surrey ES. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Womens Health (Larchmt). 2018;27(10):1204-1214. doi: 10.1089/jwh.2017.6752
  33. Van Dongen H, Emanuel MH, Smeets MJ, Trimbos B, Jansen FW. Follow-up after incomplete hysteroscopic removal of uterine fibroids. Acta Obstet Gynecol Scand. 2006;85(12):1463-1467. doi: 10.1080/00016340600984647
  34. Trebunskikh AS, Tselkovich LS, Balter RB, Ibragimova AR, Ivanova TV. Comparative analysis of the state of health of women with various types of treatment of uterine fibroids. Sovremennaya Nauka: Aktual’nyye problemy teorii i praktiki. Seriya: Yestestvennyye i tekhnicheskiye nauki. 2022;(5):197-202. doi: 10.37882/2223-2966.202 2.05.32. (In Russian).
  35. Herrmann A, Torres-de la Roche LA, Krentel H, Cezar C, de Wilde MS, Devassy R, De Wilde RL. Adhesions after Laparoscopic Myomectomy: Incidence, Risk Factors, Complications, and Prevention. Gynecol Minim Invasive Ther. 2020;9(4):190-197. doi: 10.4103/GMIT.GMIT_87_20
  36. Orlando M, Kollikonda S, Hackett L, Kho R. Non-hysteroscopic Myomectomy and Fertility Outcomes: A Systematic Review. J Minim Invasive Gynecol. 2021;28(3):598-618.e1. doi: 10.1016/j.jmig.2020.10.006
  37. Jeldu M, Asres T, Arusi T, Gutulo MG. Pregnancy Rate after Myomectomy and Associated Factors among Reproductive Age Women Who Had Myomectomy at Saint Paul’s Hospital Millennium Medical College, Addis Ababa: Retrospective Cross-S ectional Study. Int J Reprod Med. 2021;2021:6680112. doi: 10.1155/2021/6680112
  38. Shue S, Radeva M, Falcone T. Comparison of Long- Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed. J Minim Invasive Gynecol. 2018;25(6):1002-1008. doi: 10.1016/j.jmig.2018.01.016
  39. Kupatadze D.D., Safronova M.M. Ultrasound examination of changes in the myometrium after conservative myomectomy in order to predict the course of pregnancy and the choice of various methods of delivery. Luchevaya diagnostika i terapiya. 2021;3(12):87-92. do i:10.22328/2079-5343-2021-12-3-87-92. (In Russian).
  40. Guseva OI, Yaroslavtseva MG. Spontaneous uterine rupture during pregnancy after laparoscopic surgery. Prenatal’naya Diagnostika. 2016;15(4):333-337. (In Russian).
  41. Khorolsky VA, Novikova VA. Organ-preserving treatment of uterine fibroids as a stage of personalized preconception preparation. Lecheniye I Profilaktika. 2022;12(1):26-39. (In Russian).
  42. Taheri M, Galo L, Potts C, Sakhel K, Quinn SD. Nonresective treatments for uterine fibroids: a systematic review of uterine and fibroid volume reductions. International Journal of Hyperthermia. 2019;36(1):294-300. doi: 10.1080/02656736.2018.1564843
  43. Melkozerova OA, Shchedrina ID, Grishkina AA, Chistyakova GN, Bragin EE. The effect of focused ultrasound energy during ablation of uterine fibroids under the control of magnetic resonance imaging on endometrial receptivity in patients of reproductive age. Voprosy Ginekologii, Akusherstva I Perinatologii. 2020;19(4):28-38. doi: 10.20953/1726-1678-2020-4-28-38. (In Russian).
  44. Garza- Leal JG. Long- Term Clinical Outcomes of Transcervical Radiofrequency Ablation of Uterine Fibroids: The VITALITY Study. J Gynecol Surg. 2019;35(1):19-23. doi: 10.1089/gyn.2018.0051
  45. Wallace K, Zhang S, Thomas L. Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids. Fertility and Sterility. 2020;113(3):618-626. doi: 10.1016/j.fertnstert.2019.10.028
  46. Vermeulen CKM, Veen J, Adang C, van Leijsen SAL, Coolen ALWM, Bongers MY. Pelvic organ prolapse after laparoscopic hysterectomy compared with vaginal hysterectomy: the POP-UP study. Int Urogynecol J. 2021;32(4):841-850. doi: 10.1007/s00192-020-04591-z
  47. Semyatov SM, Leffad ML. Рrediction of infertility in patients with uterine leiomyoma. RUDN Journal of Medicine. 2022;26(4):396- 403. doi: 10.22363/2313-0245-2022-26-4-396-403. [Semiatov S.M., Leffad M.L. Рrediction of infertility in patients with uterine leiomyoma // Вестник Российского университета дружбы народов. Серия: Медицина. 2022. Т. 26. No 4. С. 396-403. doi: 10.22363/2313-0245-20 22-26-4-396-403].

Copyright (c) 2023 Aleynikova E.Y., Solovyeva A.V.

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