Published in IJCP
American Family Physician
Uterine Fibroids: Diagnosis and Treatment
March 11, 2019 | Maria Syl D. De La Cruz, Edward M. Buchanan
Uterine fibroids are common benign neoplasms, with a higher prevalence in older women and in those of African descent.
Many are discovered incidentally on clinical examination or imaging in asymptomatic women. Fibroids can cause abnormal
uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain,
constipation, and dyspareunia. Ultrasonography is the preferred initial imaging modality. Expectant management is
recommended for asymptomatic patients because most fibroids decrease in size during menopause. Management should
be tailored to the size and location of fibroids; the patient’s age, symptoms, desire to maintain fertility, and access to
treatment; and the experience of the physician. Medical therapy to reduce heavy menstrual bleeding includes hormonal
contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs. Gonadotropin-releasing hormone agonists or
selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are
approaching menopause. Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic
resonance–guided focused ultrasound surgery.