Most<unk> s do not require treatment unless they are causing symptoms. After menopause,<unk> s shrink, and it is unusual for them to cause problems. Symptomatic<unk> s can be treated by: * medication to control symptoms (i.e., symptomatic management) * medication aimed at shrinking tumors * ultrasound<unk>  destruction * myomectomy or radiofrequency ablation * hysterectomy *<unk>  artery embolization In those who have symptoms,<unk>  artery embolization and surgical options have similar outcomes with respect to satisfaction. Medication A number of medications may be used to control symptoms. NSAIDs can be used to reduce painful menstrual periods. Oral contraceptive pills may be prescribed to reduce<unk>  bleeding and cramps. Anemia may be treated with iron supplementation. Levonorgestrel intrauterine devices are effective in limiting menstrual blood flow and improving other symptoms. Side effects are typically few as the levonorgestrel (a progestin) is released in low concentration locally. While most levongestrel-IUD studies concentrated on treatment of women without<unk> s a few reported good results specifically for women with<unk> s including a substantial regression of<unk> s. Cabergoline in a moderate and well-tolerated dose has been shown in two studies to shrink<unk> s effectively. The mechanism of action responsible for how cabergoline shrinks<unk> s is unclear. Ulipristal acetate is a synthetic selective progesterone receptor modulator (SPRM) that has tentative evidence to support its use for presurgical treatment of<unk> s with low side-effects. Long-term UPA-treated<unk> s have shown volume reduction of about 70%. In some cases UPA alone is used to relieve symptoms without surgery, and to allow successful pregnancies without<unk>  regrowth. Indeed, in the tumor cells, the molecule blocks the cell proliferation, induces their apoptosis and stimulates the remodeling of the extensive fibrosis by matrix metalloproteinases, hence explaining the long-term benefit. Yet, due to some rare but severe hepatic injuries after UPA treatment, the licence was suspended in 2020 in the EU and voluntary removed in Canada. Danazol is an effective treatment to shrink<unk> s and control symptoms. Its use is limited by unpleasant side effects. Mechanism of action is thought to be antiestrogenic effects. Recent experience indicates that safety and side effect profile can be improved by more cautious dosing. Gonadotropin-releasing hormone analogs cause temporary regression of<unk> s by decreasing estrogen levels. Because of the limitations and side effects of this medication, it is rarely recommended other than for preoperative use to shrink the size of the<unk> s and uterus before surgery. It is typically used for a maximum of 6 months or less because after longer use they could cause osteoporosis and other typically postmenopausal complications. The main side effects are transient postmenopausal symptoms. In many cases the<unk> s will regrow after cessation of treatment, however, significant benefits may persist for much longer in some cases. Several variations are possible, such as GnRH agonists with add-back regimens intended to decrease the adverse effects of estrogen deficiency. Several add-back regimes are possible, tibolone, raloxifene, progestogens alone, estrogen alone, and combined estrogens and progestogens. Progesterone antagonists such as mifepristone have been tested, there is evidence that it relieves some symptoms and improves quality of life but because of adverse histological changes that have been observed in several trials it can not be currently recommended outside of research setting.<unk>  growth has recurred after antiprogestin treatment was stopped. Aromatase inhibitors have been used experimentally to reduce<unk> s. The effect is believed to be due partially by lowering systemic estrogen levels and partially by inhibiting locally overexpressed aromatase in<unk> s. However,<unk>  growth has recurred after treatment was stopped. Experience from experimental aromatase inhibitor treatment of endometriosis indicates that aromatase inhibitors might be particularly useful in combination with a progestogenic ovulation inhibitor.<unk>  artery<unk>  artery embolization (UAE) is a noninvasive procedure that blocks blood flow to<unk> s, causing them to shrink. Long-term outcomes with respect to how happy people are with the procedure are similar to that of surgery. There is tentative evidence that traditional surgery may result in better fertility. One review found that UAE doubles the future risk of miscarriage. UAE also appears to require more repeat procedures than if surgery was done initially. A person will usually recover from the procedure within a few days.<unk>  artery ligation, sometimes also laparoscopic occlusion of<unk>  arteries are minimally invasive methods to limit blood supply of the uterus by a small surgery that can be performed transvaginally or laparoscopically. The principal mechanism of action may be similar like in UAE but is easier to perform and fewer side effects are expected. The 2016 NICE (National Institute of Clinical Excellence – the non governmental public body that publishes guidelines in the use of health technologies and good clinical practice in the United Kingdom) guidelines state UAE/UFE can be offered to women with symptomatic<unk> s<unk> s being usually >30mm in size). Women should be informed that UAE and myomectomy (the surgical removal of<unk> s) may potentially allow them to retain their fertility. Myomectomy Submucosal<unk>  in hysteroscopy Treatment of an intramural<unk>  by laparoscopic surgeryAfter treatment of an intramural<unk>  by laparoscopic surgery Myomectomy is a surgery to remove one or more<unk> s. It is usually recommended when more conservative treatment options fail for women who want fertility preserving surgery or who want to retain the uterus. There are three types of myomectomy: * In a hysteroscopic myomectomy (also called transcervical resection), the<unk>  can be removed by either the use of a resectoscope, an endoscopic instrument inserted through the vagina and cervix that can use high-frequency electrical energy to cut tissue, or a similar device. * A laparoscopic myomectomy is done through a small incision near the navel. The physician uses a laparoscope and surgical instruments to remove the<unk> s. Studies have suggested that laparoscopic myomectomy leads to lower morbidity rates and faster recovery than does laparotomic myomectomy. * A laparotomic myomectomy (also known as an open or abdominal myomectomy) is the most invasive surgical procedure to remove<unk> s. The physician makes an incision in the abdominal wall and removes the<unk> s from the uterus. Laparoscopic myomectomy has less pain and shorter time in hospital than open surgery. Hysterectomy Hysterectomy was the classical method of treating<unk> s. Although it is now recommended only as last option,<unk> s are still the leading cause of hysterectomies in the US. Endometrial ablation Endometrial ablation can be used if the<unk> s are only within the uterus and not intramural and relatively small. High failure and recurrence rates are expected in the presence of larger or intramural<unk> s. Other procedures Radiofrequency ablation is a minimally invasive treatments for<unk> s. In this technique the<unk>  is shrunk by inserting a needle-like device into the<unk>  through the abdomen and heating it with radio-frequency (RF) electrical energy to cause necrosis of cells. The treatment is a potential option for women who have<unk> s, have completed child-bearing and want to avoid a hysterectomy. Magnetic resonance guided focused ultrasound, is a non-invasive intervention (requiring no incision) that uses high intensity focused ultrasound waves to destroy tissue in combination with magnetic resonance imaging (MRI), which guides and monitors the treatment. During the procedure, delivery of focused ultrasound energy is guided and controlled using MR thermal imaging. Patients who have symptomatic<unk> s, who desire a non-invasive treatment option and who do not have contraindications for MRI are candidates for MRgFUS. About 60% of patients qualify. It is an outpatient procedure and takes one to three hours depending on the size of the<unk> s. It is safe and about 75% effective. Symptomatic improvement is sustained for two plus years. Need for additional treatment varies from 16-20% and is largely dependent on the amount of<unk>  that can be safely ablated; the higher the ablated volume, the lower the re-treatment rate. There are currently no randomized trial between MRgFUS and UAE. A multi-center trial is underway to investigate the efficacy of MRgFUS vs. UAE.
Uterine fibroid
Uterine inversion
Leiomyoma
Cervical pregnancy
Endometrioid tumor
Ovarian pregnancy
Pelvic lipomatosis
Endometriosis