Surgical and radiological management of uterine fibroids in the UK.
OBJECTIVE
Uterine fibroids remain the most common benign gynaecological pathology and a frequent reason for gynaecological referral and treatment. The range of available treatments is currently undergoing a minor revolution with the introduction of nonsurgical therapies, but their role remains to be established.


RESULTS
Arguably the most significant change in recent years has been the availability of uterine artery embolization as a form of nonsurgical management. A survey of UK gynaecologists, however, has shown that the option of embolization is only utilized by just over half the respondents. Instead, conventional surgery such as hysterectomy and myomectomy remain the mainstay of nonsymptomatic treatment. In the absence of gross uterine enlargement, vaginal hysterectomy is feasible and safe. Fewer hysterectomies, however, are being done and more women are undergoing myomectomy, with almost 50% of UK consultant gynaecologists carrying out hysteroscopic myomectomy and just over 10% laparoscopic myomectomy.


CONCLUSIONS
Greater utilization of less invasive endoscopic or vaginal procedures for the management of uterine fibroids seems a reasonable target. In the longer term, it is likely that the various nonsurgical techniques which shrink fibroids and thereby reduce symptoms will have an increasingly important role in the treatment of this common condition.
Chapman
Lynne
L
Minimally Invasive Therapy Unit & Endoscopic Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK.
Magos
Adam
A
D004621:Embolization, Therapeutic; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D010535:Laparoscopy; D053685:Laser Therapy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000098:blood supply
D007987:Gonadotropin-Releasing Hormone