title: EMAS position statement: management of uterine fibroids.
abstract: BACKGROUND
  Uterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract.
  
  
  OBJECTIVE
  The aim of this position statement is to provide and critically appraise evidence on the management of women with uterine fibroids.
  
  
  METHODS
  Literature review and consensus of expert opinion.
  
  
  CONCLUSIONS
  Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth. Fibroid-associated symptoms include heavy menstrual bleeding and pain or pelvic discomfort. The association between infertility and fibroids increases with age. Fibroids do not increase the risk of malignant uterine disease and leiomyosarcomas are extremely rare (less than one in 1000). It is unknown at present whether leiomyosarcoma represents de novo growth or malignant transformation from benign uterine fibroids. Treatment options for symptomatic fibroids include pharmacologic, surgical and radiologically guided interventions. The range of medical treatments allows flexible management of fibroid-related symptoms; the options include tranexamic acid, non-steroidal anti-inflammatory drugs, contraceptive steroids, gonadotropin-releasing hormone analogs, antiprogesterone, and selective progesterone receptor modulators. However, these medical options do not remove the tumors and symptoms may return when treatment is stopped. Surgical and radiologically guided procedures may be tailored to age, general health, and individual patient wishes. Hysterectomy is the most effective treatment, although in some cases myomectomy may be sufficient to control symptoms. Alternatives to surgery include uterine artery embolization, myolysis and ablation by high-intensity focused ultrasound (guided with magnetic resonance imaging or ultrasound). The choice of treatment depends on fibroid size, the underlying symptoms and their severity and the woman's desire for subsequent fertility and pregnancy, as well as efficacy and need for repeated interventions.
authors: Department of Obstetrics and Gynecology, Zaragoza University, Faculty of Medicine, Lozano Blesa University Hospital, Domingo Miral s/n, Zaragoza 50009, Spain. Electronic address: faustino.perez@unizar.es.
authors: Faustino R
authors: FR
authors: Pérez-López
authors: Department of Obstetrics and Gynecology, Zaragoza University, Faculty of Medicine, Lozano Blesa University Hospital, Domingo Miral s/n, Zaragoza 50009, Spain.
authors: Lía
authors: L
authors: Ornat
authors: Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Hospital, Bucharest, Romania.
authors: Iuliana
authors: I
authors: Ceausu
authors: Breast Clinic and Menopause Clinic, University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
authors: Herman
authors: H
authors: Depypere
authors: Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa School of Medicine, Valikonagi Cad. No: 93/4, Nisantasi 34365, Istanbul, Turkey.
authors: C Tamer
authors: CT
authors: Erel
authors: Second Department of Obstetrics and Gynecology, National and Capodestrian University of Athens, Greece.
authors: Irene
authors: I
authors: Lambrinoudaki
authors: Department of Medicine, Cardiology Unit and Head Centre for Gender Medicine, Karolinska Institutet and Karolinska University Hospital, Thorax N3:06, SE 17176 Stockholm, Sweden.
authors: Karin
authors: K
authors: Schenck-Gustafsson
authors: Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy.
authors: Tommaso
authors: T
authors: Simoncini
authors: Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, F-31059 Toulouse Cedex 09, France.
authors: Florence
authors: F
authors: Tremollieres
authors: Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
authors: Margaret
authors: M
authors: Rees
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003657:Decision Making; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007889:Leiomyoma / Q000188:drug therapy / Q000628:therapy*; D010347:Patient Care Planning; D017699:Pelvic Pain / Q000209:etiology; D011372:Progestins / Q000627:therapeutic use; D015642:Radiology, Interventional / Q000379:methods; D011980:Receptors, Progesterone / Q000037:antagonists & inhibitors; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000209:etiology; D063186:Uterine Myomectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000628:therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000933:Antifibrinolytic Agents; D011372:Progestins; D011980:Receptors, Progesterone; D007987:Gonadotropin-Releasing Hormone
keywords: Fibroids; Gn-RH analogs; High-intensity focused ultrasound; Hysterectomy; Myomectomy; Ulipristal; Uterine artery embolization