Symptomatic uterine fibroids – targeted pharmacotherapy Consensus of an expert meeting

Abstract

On 14 December 2016, independent and hospital-based gynaecologists gathered in Frankfurt am Main for an expert meeting with a view to developing a consensus paper on the treatment of uterine fibroids (leiomyomas) in gynaecological practice. Attention was paid in particular to the new aspects of targeted pharmacotherapy.

The experts reached consensus on the requisite diagnostic examinations, and devised an algorithm for managing symptomatic uterine fibroids in premenopausal and perimenopausal women. The central decision in the treatment algorithm is the question whether there is a desire to preserve the uterus. Prior to performing hysterectomy in an anaemic patient not wanting to preserve the uterus, preoperative treatment with UPA is worthwhile. If there is an indication for surgery combined with the desire to preserve the uterus, it is necessary to consider from the surgeon’s perspective, how useful it would be to undertake preoperative treatment with UPA. In particular, this applies to hysteroscopic resection. Preoperative treatment may also be worthwhile prior to laparoscopy and laparotomy procedures if there are large or multiple fibroids as per FIGO 2.

In case of secondary anaemia or fibroids in an unfavourable location, especially in patients who wish to have children, e.g. close to the tubes or cervix, preoperative pharmacological treatment with UPA may also be indicated. The surgery can thus be optimised and in patients wishing to have children it will prove less detrimental.

In general, in the management of fibroids, it is preferable to take a causal approach early on by employing targeted pharmacological treatments. Combined oral contraceptives, progestins and LNG-IUS therefore are not advantageous in such a situation. Flexible interval therapy with UPA, ideally beginning with two 12-week courses of treatment separated by a treatment-free interval of approximately two months, offers an alternative to surgical and interventional radiological procedures.

As experts says, the use of targeted, long-term pharmacological treatments can help reduce the need for surgery on uterine fibroids and also lower the number of hysterectomies, in particular, and in the long term improve patient quality of life.