While many patients with mild/moderate symptoms can be managed using various pharmacological treatments, previously patients presenting with moderate/severe symptoms would progress to a point where surgical or radiological interventions would have been required. The main driver for the decision to undertake fibroid surgery is due to the severity of symptoms including uterine bleeding, discomfort, and pain. The size of the uterus and fibroids affects the decision to perform surgery, and which type of surgery is chosen.
Surgical interventions include hysterectomy, or in women who wish to preserve their fertility, the more conservative option is myomectomy.
While myomectomy is a preferable option for women who desire to preserve fertility, it has a higher risk of post-operative pyrexia (fever), pelvic haematoma formation and post-operative adhesions, and may need to be repeated if fibroids reappear. Other less invasive procedures which have been developed include Uterine Artery Embolisation (UAE), and, in women where the dominant symptom is bleeding, fibroid size is relatively small, and fertility is not an issue, endometrial ablation.
Surgery for treatment of uterine fibroids is rarely performed as an emergency procedure, and waiting several months before proceeding to surgery is the standard in European countries for many patients.
An array of various therapies is available to manage uterine fibroids. These fall into two main categories46: pharmacological therapies and surgical treatments.