What are the principles of managing uterine fibroids?

Management is individualised by symptoms, fibroid size/number/location, and the woman's fertility wishes and age:

• Asymptomatic fibroids - usually no treatment (observe)
• Symptomatic - medical therapy for bleeding, then myomectomy (preserve fertility/uterus), uterine artery embolisation, or hysterectomy (definitive, family complete)

Clinical relevance. Management is individualised - observe asymptomatic fibroids; treat symptomatic ones medically then surgically by fertility wishes.

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Principles of managing fibroids

Treatment is tailored to the individual rather than to the fibroids alone.

Key factors

• Symptoms and their severity (bleeding, pressure, pain, subfertility).
• Fibroid size, number, and location (e.g. submucosal vs subserosal).
• The woman's fertility wishes, age, and preferences.

The options by situation

• Asymptomatic - usually observation (no treatment), with reassurance; fibroids regress after the menopause.
• Symptomatic, fertility/uterus to be preserved - medical therapy for bleeding, then myomectomy (or uterine artery embolisation, weighing fertility uncertainty).
• Symptomatic, family complete - hysterectomy (definitive) or uterine artery embolisation.
• Pre-operative GnRH agonists may shrink fibroids and correct anaemia.

Always

• Treat anaemia; counsel about recurrence (after uterus-sparing options) and the small possibility of malignancy with rapid growth.