**Warning:**	The NCBI web site requires JavaScript to function. 	more...

An official website of the United States government

**The .gov means it's official.**							Federal government websites often end in .gov or .mil. Before							sharing sensitive information, make sure you're on a federal							government site.						

**The site is secure.**							The **https://** ensures that you are connecting to the							official website and that any information you provide is encrypted							and transmitted securely.						

Log in

#### Account

                          - Dashboard
                          - Publications
                          - Account settings
                          - Log out

Access keysNCBI HomepageMyNCBI HomepageMain ContentMain Navigation

# Bookshelf

## 

                -  Browse Titles 
                -  Advanced 
                -  Help 
                -  Disclaimer 

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

                        - This publication is provided for historical reference only and the information may be out of date.

**This publication is provided for historical reference only and the information may be out of date.**

< PrevNext >

# Management of Uterine Fibroids

*Evidence Reports/Technology Assessments, No. 154*

Investigators: Meera Viswanathan, PhD, Katherine Hartmann, MD, PhD, Nikki McKoy, BS, Gretchen Stuart, MD, Nicole Rankins, MD, Patricia Thieda, MS, Linda J Lux, MPA, and Kathleen N Lohr, PhD.

Agency for Healthcare Research and Quality (US)2007 Jul

                            - Copyright and        Permissions

Bookshelf Copyright Notice

## Structured Abstract

#### Objectives:

The RTI International-University of North Carolina at				Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically updated				evidence on the management of uterine fibroids, specifically incidence and				prevalence of fibroids, treatment outcomes, comparisons of treatment, modifiers of				outcomes, and costs.

#### Data Sources:

We searched MEDLINE®, Cochrane				Collaboration resources, and Embase.

#### Review Methods:

We included studies published in English from February				2000 through August 2006. We excluded studies with low sample size (based on study				design, cases series < 100 and cohorts < 40) or lack of relevance to				uterine fibroids. Of 107 included studies, 3 were good quality, 56 fair, and 48				poor.

#### Results:

The cumulative incidence by age 50 is 70 percent to 80				percent; black women are more likely to get fibroids at younger ages. Appearance of				new fibroids and growth of existing fibroids after treatment are poorly studied.				Trials of preoperative medical management indicate that treatment reduces fibroid				volume but do not provide sufficient evidence of improvement in important operative				outcomes. When women are treated for reasons other than symptom relief, such as when				pregnancy is desired, weak evidence supports treating submucous fibroids via				hysteroscopy.

No well-conducted trials in U.S. populations directly compared treatment options,				including the option of expectant management, or followed women to determine whether				the intervention met their treatment objectives. Common procedures such as				hysterectomy and myomectomy, including choice among types of myomectomy, still				cannot be meaningfully compared. Studies comparing uterine artery embolization (UAE)				with other procedures reported procedure time and length of stay favoring UAE, but				inconsistency of the direction of effect for complications and absence of key				information on longer-term outcomes suggest that this evidence base is inadequate to				comment on the relative risks and benefits of UAE versus hysterectomy or myomectomy.

Costs of fibroid treatment, despite shorter average lengths of stay, are rising.

#### Conclusions:

The dearth of high-quality evidence supporting the				effectiveness of most interventions for uterine fibroids is remarkable, given how				common this problem is. The current state of the literature does not permit				definitive conclusions about benefit, harm, or relative costs to help guide women's				choices. Significant research gaps include well-conducted trials in U.S. populations				that directly compare interventions on short- and, especially, long-term outcomes,				studies on therapeutics for medical management, and information on treatment				decisions for women who desire a pregnancy.

## Contents

                          - Expand All
                          - Collapse All

                        - Preface
                        - Executive Summary
                        - 1. Introduction                           - Risk Factors for Uterine Fibroids
                          - Management of Uterine Fibroids
                          - Key Questions and Analytic Framework
                          - Analytic Framework for the Management of Uterine Fibroids
                          - Production of This Evidence Report
                          - Uses of This Report
                        - 2. Methods                           - Literature Review Methods
                          - Literature Synthesis
                          - Strength of Available Evidence
                          - External Peer Review
                        - 3. Results                           - KQ 1: Incidence and Prevalence of Uterine Fibroids
                          - KQ 2: Outcomes of Interventions for Relief of Symptoms Related to Uterine					Fibroids
                          - Pharmaceutical Management: Results
                          - KQ 4: Costs of Fibroid Treatment
                        - 4. Discussion                           - Principal Findings
                          - Limitations of the Evidence Base and This Review
                          - Future Research Directions
                          - Conclusions
                        - Appendix A. Exact Search Strings
                        - Appendix B. Sample Data Abstraction Forms
                        - Appendix C. Evidence Tables
                        - Appendix D. List of Excluded Studies
                        - Appendix E. List of Peer Reviewers
                        - References

                          - Expand All
                          - Collapse All

Prepared for: Agency for Healthcare Research and                            Quality, U.S. Department of Health and Human Services.1             Contract No. 290-02-0016. Prepared by: RTI International-University of North Carolina Evidence-based Practice Center, Research Triangle Park, North Carolina.

#### Suggested citation:

Viswanathan, M, Hartmann, K, McKoy, N, Stuart, G, Rankins, N, Thieda, P, Lux, L,				Lohr, KN. Management of Uterine Fibroids: An Update of the Evidence. Evidence				Report/Technology Assessment No. 154 (Prepared by RTI International-University of				North Carolina Evidence-based Practice Center under Contract No. 290-02-0016. AHRQ				Publication No. 07-E011. Rockville, MD: Agency for Healthcare Research and Quality.				July 2007.

This report is based on research conducted by the RTI-UNC Evidence-based Practice				Center (EPC) under contract to the Agency for Healthcare Research and Quality				(AHRQ), Rockville, MD (Contract No. 290-02-0016). The findings and conclusions in				this document are those of the author(s), who are responsible for its content, and				do not necessarily represent the views of AHRQ. No statement in this report should				be construed as an official position of AHRQ or of the U.S. Department of Health and				Human Services.

The information in this report is intended to help clinicians, employers,				policymakers, and others make informed decisions about the provision of health care				services. This report is intended as a reference and not as a substitute for				clinical judgment.

This report may be used, in whole or in part, as the basis for the development of				clinical practice guidelines and other quality enhancement tools, or as a basis for				reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human				Services endorsement of such derivative products may not be stated or implied.

**None of the investigators has any affiliations or financial involvement that					conflicts with the material presented in this report.**

                        - 1
                        - 
540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Copyright Notice

Bookshelf ID: NBK38746

< PrevNext >

Share

### Views

                    - PubReader
                    - Print View
                    - Cite this Page Viswanathan M, Hartmann K, McKoy N, et al. Management of Uterine Fibroids: An Update of the Evidence. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Jul. (Evidence Reports/Technology Assessments, No. 154.)

### Other titles in these collections

                    - AHRQ Evidence Reports
                    - Health Services/Technology Assessment Text                            (HSTAT)

### Similar articles in PubMed

                    - The management of uterine leiomyomas. [J Obstet Gynaecol Can. 2015] The management of uterine leiomyomas.*Vilos GA, Allaire C, Laberge PY, Leyland N, SPECIAL CONTRIBUTORS.**J Obstet Gynaecol Can. 2015 Feb; 37(2):157-178.*
                    - The management of uterine leiomyomas. [J Obstet Gynaecol Can. 2003] The management of uterine leiomyomas.*Lefebvre G, Vilos G, Allaire C, Jeffrey J, Arneja J, Birch C, Fortier M, Wagner MS, Clinical Practice Gynaecology Committee, Society for Obstetricians and Gynaecologists of Canada.**J Obstet Gynaecol Can. 2003 May; 25(5):396-418; quiz 419-22.*
                    - A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study. [Health Technol Assess. 2008] A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study.*Hirst A, Dutton S, Wu O, Briggs A, Edwards C, Waldenmaier L, Maresh M, Nicholson A, McPherson K.**Health Technol Assess. 2008 Mar; 12(5):1-248, iii.*
                    - Review Uterine artery embolization for symptomatic uterine fibroids. [Cochrane Database Syst Rev. 2014] Review Uterine artery embolization for symptomatic uterine fibroids.*Gupta JK, Sinha A, Lumsden MA, Hickey M.**Cochrane Database Syst Rev. 2014 Dec 26; 2014(12):CD005073. Epub 2014 Dec 26.*
                    - Review Uterine artery embolization as a treatment option for uterine myomas. [Obstet Gynecol Clin North Am. ...] Review Uterine artery embolization as a treatment option for uterine myomas.*Marshburn PB, Matthews ML, Hurst BS.**Obstet Gynecol Clin North Am. 2006 Mar; 33(1):125-44.*
See reviews...See all...

### Recent Activity

ClearTurn OffTurn On
                      - Management of Uterine Fibroids Management of Uterine Fibroids 
                      - Sickle Cell Disease: Screening, Diagnosis, Management, and Counseling in Newborn... Sickle Cell Disease: Screening, Diagnosis, Management, and Counseling in Newborns and Infants 
                      - Strategies To Support Quality-based Purchasing Strategies To Support Quality-based Purchasing 
                      - Value of the Periodic Health Evaluation Value of the Periodic Health Evaluation 
                      - Effects of Soy on Health Outcomes Effects of Soy on Health Outcomes 

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on
See more...

TwitterFacebookLinkedInGitHubNCBI Insights Blog

Connect with NLM
                      - Twitter
                      - Facebook
                      - Youtube

National Library of Medicine8600 Rockville Pike							Bethesda, MD 20894

Web PoliciesFOIAHHS Vulnerability Disclosure

HelpAccessibilityCareers

-  NLM 
-  NIH 
-  HHS 
-  USA.gov