title: Use of medical, surgical and complementary treatments among women with fibroids.
abstract: OBJECTIVE
  To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA. Electronic address: jacobyv@obgyn.ucsf.edu.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Jacoby
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Jacoby
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Learman
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Schembri
authors.affiliation: Medicine, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.affiliation: 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.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.affiliation: 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.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D015670:Acupuncture Therapy; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D004032:Diet; D004414:Dyspareunia / Q000209:etiology; D055356:Endometrial Ablation Techniques; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000150:complications / Q000628:therapy*; D017116:Low Back Pain / Q000209:etiology; D008875:Middle Aged; D059351:Organ Sparing Treatments; D017699:Pelvic Pain / Q000209:etiology; D028321:Plant Preparations / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014592:Uterine Hemorrhage / Q000209:etiology; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000150:complications / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003278:Contraceptives, Oral, Hormonal; D028321:Plant Preparations
keywords: Complementary treatments; Myomectomy; Uterine artery embolization; Uterine fibroids