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Use of medical, surgical and complementary treatments among women with fibroids

  • Vanessa L. Jacoby
    Correspondence
    Corresponding author. Tel.: +1 415 514 8299.
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
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  • Alison Jacoby
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
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  • Lee A. Learman
    Affiliations
    Department of Obstetrics and Gynecology, Indiana University School of Medicine, USA
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  • Michael Schembri
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA
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  • Steven E. Gregorich
    Affiliations
    Medicine, University of California, San Francisco, CA, USA

    Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
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  • Rebecca Jackson
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA

    Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
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  • Miriam Kuppermann
    Affiliations
    Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA

    Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

    Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
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Published:September 14, 2014DOI:https://doi.org/10.1016/j.ejogrb.2014.09.004

      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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