title: Medical or surgical management of fibroids? An internet survey of gynecologists' views.
abstract: OBJECTIVE
  To assess the attitudes of gynecologists toward symptomatic fibroids and analyze which factors influence their choice of treatment.
  
  
  METHODS
  We surveyed the attitude of Belgian gynecologists toward patients' cases. We used a vignette of a woman with symptomatic fibroids and modified 3 factors: her age, her parity and her desire for pregnancy, thereby establishing 12 different cases. We ensured that each gynecologist (n=1437) received one case, chosen randomly, by email. The gynecologists were asked whether and how they would treat the patient.
  
  
  RESULTS
  Replies were received from 337 gynecologists (a 23% response rate). Of the 337, 116 (34%) would prescribe a medical treatment only; in this group, 29% specified acetate ulipristal a selective progesterone receptor modulator (SPRM) and 27% indicated progestins. Of the sample of 337 responders, another 116 (34%) would begin with medical treatment (70% an SPRM) and then proceed to surgery. Of the 337 gynecologists, 75 (22%) would perform surgery only. The preferred surgical treatments were myomectomy (53/75; 71%) and hysterectomy (19/75; 25%) when surgery was suggested as a first step, and myomectomy (91/115; 79%) and hysterectomy (18/115; 16%) when it was preceded by medical treatment. The choice of treatment varied significantly in relation to the 12 vignettes (p<0.01). When we grouped the vignettes there was no significant variation in relation to age or parity, but a there was significant variation (p<0.001) in relation to desire to achieve pregnancy.
  
  
  CONCLUSIONS
  We observed that, in women with symptomatic fibroids, the desire retain fertility is respected. Moreover, SPRM is increasingly used for symptomatic patients.
authors.affiliation: Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, 322 rue Haute, 1000 Brussels, Belgium.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pazzaglia
authors.affiliation: Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, 322 rue Haute, 1000 Brussels, Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: Praet
authors.affiliation: Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, 322 rue Haute, 1000 Brussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: Vandromme
authors.affiliation: Department of Obstetrics & Gynaecology, CHU Saint-Pierre, Université Libre de Buxelles, Vrije Universiteit Brussel, 322 rue Haute, 1000 Brussels, Belgium. Electronic address: serge_rozenberg@stpierre-bru.be.
authors.forename: Serge
authors.initials: S
authors.lastname: Rozenberg
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D005260:Female; D059247:Fertility Preservation; D019538:Health Care Surveys; D006801:Humans; D007044:Hysterectomy; D020407:Internet; D007889:Leiomyoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009649:Norpregnadienes / Q000627:therapeutic use*; D011247:Pregnancy; D011372:Progestins / Q000627:therapeutic use*; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
chemical_list: D009649:Norpregnadienes; D011372:Progestins; C555622:ulipristal acetate
keywords: Decision taking; SPRM; Survey; Uterine fibroids; Uterine myoma