title: Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials.
abstract: BACKGROUND
  Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence.
  
  
  OBJECTIVE
  To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence.
  
  
  METHODS
  Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013.
  
  
  METHODS
  Two authors independently extracted data from identified studies.
  
  
  RESULTS
  A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated.
  
  
  CONCLUSIONS
  A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes.
  
  
  CONCLUSIONS
  There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed.
authors.affiliation: University College London, Division of Surgery & Interventional Science, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom.
authors.forename: Kurinchi S
authors.initials: KS
authors.lastname: Gurusamy
authors.affiliation: University College London, Division of Surgery & Interventional Science, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom.
authors.forename: Jessica
authors.initials: J
authors.lastname: Vaughan
authors.affiliation: Sydney Centre for Reproductive Health Research, Family Planning New South Wales, Sydney, NSW 2131, Australia.|University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Fraser
authors.affiliation: University College London, Division of Surgery & Interventional Science, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom.
authors.forename: Lawrence M J
authors.initials: LM
authors.lastname: Best
authors.affiliation: University College London, Division of Surgery & Interventional Science, 9th Floor, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom.
authors.forename: Toby
authors.initials: T
authors.lastname: Richards
mesh_terms: D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014594:Uterine Neoplasms / Q000188:drug therapy*