Authors' objectives:

Uterine fibroids affect at least 30 percent of women during their reproductive years. Symptoms associated with fibroids have a significant impact on quality of life. Fibroids are the leading indication for hysterectomy and result in more than $2 billion in annual hospital charges. This report presents an assessment of the literature on the benefits, risks, and costs of the management of symptomatic and asymptomatic uterine fibroids in women aged 20 to 55.

Authors' results and conclusions: The overall quality of the literature on the management of fibroids is poor. Inconsistency in reporting the severity of symptoms, uterine and fibroid anatomy, and response to treatments prevented meaningful comparison of studies for most questions. The researchers found almost no evidence to support the effectiveness of commonly recommended medical treatments. However, there was consistent evidence from randomized trials that preoperative use of gonadotropin-releasing hormone agonist therapy reduces estimated blood loss and may facilitate the surgical approach by reducing uterine size; the clinical significance of these effects is unclear. Prospective studies consistently show that the outcomes of hysterectomy up to 2 years after surgery are favorable for most symptomatic women, although up to 12 percent of women develop new symptoms after surgery. Placing these results in the context of other treatments, such as myomectomy, medical therapy, or no intervention, is impossible because of significant differences in the severity of preintervention disease. There are almost no data to allow estimation of the overall costs of fibroids to the economy. Research priorities should include methodologically rigorous studies of the effectiveness of nonsurgical treatments and development of standard measures of disease severity.

Authors' recommendations: The available evidence on the management of uterine fibroids is of poor quality. Patients, clinicians, and policymakers do not have the data they need to make truly informed decisions about appropriate treatment. Given the prevalence of this condition and its substantial impact on women's lives, obtaining these data should be a high research priority.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/utersumm.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)