Abstract
Objective
To examine the use of medical management, uterus-preserving surgery (UPS), and complementary
treatments among women with uterine fibroids.
Study design
Prospective cohort study of 933 premenopausal women ages 31–54 years with symptomatic
fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention
Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of
fibroid treatments was determined through annual interviews. Linear regression models
were used to compare changes in fibroid-related symptoms among women who underwent
UPS versus those who did not undergo surgery.
Results
Participants were racially and ethnically diverse, with a mean age of 43 years. During
study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%)
had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative
treatments were commonly used, including exercise (45%), diet (34%), herbs (37%),
and acupuncture (16%): participants reported significant symptom improvement and few
side effects with these interventions. In multivariable linear regression models,
women who did not undergo surgery during the study reported improvement in dyspareunia
(p < .001), pelvic pain (p < .001), and menstrual cramps (p < .001). However, women who underwent UPS reported greater overall resolution of “pelvic
problems” compared with women who did not have surgical treatment (difference in change
score 1.18 on a four-point Likert scale, p < .001).
Conclusion
UPS are effective treatments for women with fibroids, but many women use hormonal
or complementary treatments and report significant symptom improvement without surgical
intervention.
Keywords
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References
- Role, epidemiology, and natural history of benign uterine mass lesions.Clin Obstet Gynecol. 2005; 48: 312-324
- Uterine myomas: an overview of development, clinical features, and management.Obstet Gynecol. 2004; 104: 393-406
- Fibroids and reproductive outcomes: a systematic literature review from conception to delivery.Am J Obstet Gynecol. 2008; 198: 357-366
- Obstetric outcomes in women with sonographically identified uterine leiomyomata.Obstet Gynecol. 2006; 107: 376-382
- Clinical symptomatology of uterine leiomyomas.Clin Obstet Gynecol. 2001; 44: 364-371
- Management of uterine fibroids: an update of the evidence.Evid Rep Technol Assess (Full Rep). 2007; : 1-122
- Recurrence of leiomyomata after myomectomy.Hum Reprod Update. 2000; 6: 595-602
- Predictors of leiomyoma recurrence after myomectomy.Obstet Gynecol. 2005; 105: 877-881
- Abdominal myomectomy: results of a simple operative technique.Fertil Steril. 1996; 65: 41-51
- Changes in rates of hysterectomy and uterine conserving procedures for treatment of uterine leiomyoma.Am J Obstet Gynecol. 2007; 196 ([e1–5; discussion e5–6]): e5-e6
- Myomectomy: recurrence after removal of solitary and multiple myomas.Obstet Gynecol. 1969; 34: 200-203
- The fibroid growth study: determinants of therapeutic intervention.J Womens Health (Larchmt). 2009; 18: 725-732
- Uterine myomas and factors associated with hysterectomy in premenopausal women.Am J Obstet Gynecol. 1997; 176 ([discussion 7–9]): 1213-1217
- Effect of noncancerous pelvic problems on health-related quality of life and sexual functioning.Obstet Gynecol. 2007; 110: 633-642
- Predictors of hysterectomy use and satisfaction.Obstet Gynecol. 2010; 115: 543-551
- Natural history of uterine polyps and leiomyomata.Obstet Gynecol. 2002; 100: 3-7
- Growth of uterine leiomyomata among premenopausal black and white women.Proc Natl Acad Sci USA. 2008; 105: 19887-19892
- Use of oral contraceptives and uterine fibroids: results from a case-control study.Br J Obstet Gynaecol. 1999; 106: 857-860
- Risk factors for uterine fibroids: reduced risk associated with oral contraceptives.Br Med J (Clin Res Ed). 1986; 293: 359-362
- Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study.Am J Epidemiol. 2004; 159: 113-123
- Progestin-releasing intrauterine systems and leiomyoma.Contraception. 2007; 75: S130-S133
- The use of herbs and dietary supplements in gynecology: an evidence-based review.J Midwifery Womens Health. 2006; 51: 402-409
- Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey.J Am Med Assoc. 1998; 280: 1569-1575
- Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials.Reprod Toxicol. 2003; 17: 137-152
- Complementary and alternative medications for women's health issues.Nutr Clin Pract. 2009; 24: 589-608
- A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata.Fertil Steril. 1998; 70: 432-439
Article Info
Publication History
Published online: September 14, 2014
Accepted:
September 3,
2014
Received in revised form:
August 28,
2014
Received:
May 8,
2014
Identification
Copyright
© 2014 Published by Elsevier Inc.
