NDLI: Therapeutic management of uterine fibroid tumors: updated French guidelines.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Marret, Henri Fritel, Xavier Ouldamer, Lobna Bendifallah, Sofiane Brun, Jean-Luc De Jesus, Isabelle Derrien, Jean Giraudet, Géraldine Kahn, Vanessa Koskas, Martin Legendre, Guillaume Lucot, Jean Philippe Niro, Julien Panel, Pierre Pelage, Jean-Pierre Fernandez, Hervé
Organization	CNGOF (French College of Gynecology and Obstetrics)
Description	Country affiliation: France Author Affiliation: Marret H ( Service de gynécologie, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnelé, 37044 Tours, France. marret@med.univ-tours.fr)
Abstract	The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids. When pregnancy is desired, whether or not infertility is being treated by assisted reproductive technology, hysteroscopic resection in one or two separate procedures of submucosal fibroids less than 4 cm in length is recommended, regardless of whether they are symptomatic. Interstitial, also known as intramural, fibroids have a negative effect on fertility but treating them does not improve fertility. Myomectomy is therefore indicated only for symptomatic fibroids; depending on their size and number, and may be performed by laparoscopy or laparotomy. Physicians must explain to women the potential consequences of myomas and myomectomy on future pregnancy. For perimenopausal women who have been informed of the alternatives and the risks, hysterectomy is the most effective treatment for symptomatic fibroids and is associated with a high rate of patient satisfaction. When possible, the vaginal or laparoscopic routes should be preferred to laparotomy for hysterectomies for fibroids considered typical on imaging. Because uterine artery embolization is an effective treatment with low long-term morbidity, it is an option for symptomatic fibroids in women who do not want to become pregnant, and a validated alternative to myomectomy and hysterectomy that must be offered to patients. Myolysis is under assessment, and research on its use is recommended. Isolated laparoscopic ligation of the uterine arteries is a potential alternative to uterine artery embolization; it also complements myomectomy by reducing intraoperative bleeding. It is possible to use second-generation techniques of endometrial ablation to treat submucosal fibroids in women whose families are complete. Subtotal hysterectomy is a possible alternative to total hysterectomy for fibroid treatment, given that by laparotomy the former has a lower complication rate than the latter, while by laparoscopy, these rates are the same. In each case, the patient is informed about the benefit and risk associated with each therapeutic option.
File Format	HTM / HTML
ISSN	03012115
Issue Number	2
Volume Number	165
e-ISSN	18727654
Journal	European Journal of Obstetrics & Gynecology and Reproductive Biology
Language	English
Publisher	Elsevier
Publisher Date	2012-12-01
Publisher Place	Ireland
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Obstetrics Discipline Gynecology Leiomyoma Therapy Uterine Neoplasms Female Humans Hysterectomy Methods Informed Consent Drug Therapy Surgery Perimenopause Pregnancy Ultrasonography Uterine Artery Embolization Uterine Hemorrhage Uterine Myomectomy Uterus Blood Supply Journal Article Practice Guideline Review
Content Type	Text
Resource Type	Article
Subject	Reproductive Medicine Obstetrics and Gynecology

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Uterine artery embolization for postpartum hemorrhage.

Treatment of uterine leiomyoma: how to choose a therapeutic method?

Failure of conservative management in postpartum haemorrhage: uterine necrosis and hysterectomy after angiographic selective embolization with gelfoam.

The role of preventive uterine artery occlusion during laparoscopic myomectomy: a review of the literature.

Acute rectal ischemia following failed uterine artery embolization and emergency hysterectomy for postpartum hemorrhage.

Impact of previous uterine artery embolization on fertility.

Indications and alternatives to hysterectomy.

Management of uterine fibroids in pregnancy: recent trends.

Subsequent pregnancy after two uterine artery embolizations.

Therapeutic management of uterine fibroid tumors: updated French guidelines.

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