A Systematic Review of Minimally Invasive Approaches to Uterine Fibroid Treatment for Improving Quality of Life and Fibroid-Associated Symptoms

Joshua M Morris; Angela Liang; Katarina Fleckenstein; Bhuchitra Singh; James Segars

doi:10.1007/s43032-022-01120-9

A Systematic Review of Minimally Invasive Approaches to Uterine Fibroid Treatment for Improving Quality of Life and Fibroid-Associated Symptoms

Reprod Sci. 2023 May;30(5):1495-1505. doi: 10.1007/s43032-022-01120-9. Epub 2022 Nov 18.

Authors

Joshua M Morris^#¹, Angela Liang^#², Katarina Fleckenstein³, Bhuchitra Singh⁴, James Segars⁵

Affiliations

¹ Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
² Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
³ Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA.
⁴ Division of Reproductive Science and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, 21205, USA.
⁵ Division of Reproductive Science and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, 21205, USA. jsegars2@jhmi.edu.

^# Contributed equally.

PMID: 36401073
DOI: 10.1007/s43032-022-01120-9

Abstract

Improvement in symptom severity and quality of life (QoL) are critical concerns for women with fibroids as they evaluate treatment options. This systematic review analyzed available evidence regarding minimally invasive approaches to fibroid treatment and compared validated QoL and fibroid-associated symptom scores before and after treatment. A comprehensive search was conducted using PubMed, Embase, Cochrane Library, and Scopus from January 1990 to July 2020. English-language publications were included if they evaluated associations between minimally invasive approaches to fibroid treatment and QoL or fibroid-associated symptoms, and they used validated questionnaires before and after treatment. QoL or fibroid-associated symptom scores were compared and summarized for each minimally invasive approach. Thirty-seven studies were ultimately included in this review: 26 evaluating individual approaches and 11 which were comparative studies of minimally invasive approaches and surgical interventions. Radiofrequency ablation (RFA) and ultrasound-guided sclerotherapy (USGS) significantly improved overall QoL. Uterine artery embolization (UAE) and ultrasound-guided high-intensity frequency ultrasound (US-HIFU) improved overall QoL to a similar extent as surgical interventions. Twenty-eight studies assessed fibroid-associated symptoms with the Uterine Fibroid Symptoms Quality of Life Questionnaire (UFS-QoL). UAE, magnetic resonance imaging-guided high-intensity frequency ultrasound (MR-HIFU), US-HIFU, RFA, and percutaneous microwave ablation (PMWA) significantly decreased Symptom Severity Score by a range of 21 to 39 points (out of 100) at 6 months. Minimally invasive approaches to treat fibroids were effective alternatives to surgical interventions for improving quality of life, fibroid-associated symptoms, and pain. Outcomes among minimally invasive approaches were similar, presenting patients with numerous options for fibroid treatment.

Keywords: Fibroids; Minimally invasive; Pain; Quality of life; Uterine leiomyoma.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Leiomyoma* / pathology
Leiomyoma* / surgery
Quality of Life
Treatment Outcome
Ultrasonography
Uterine Neoplasms* / surgery