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# Management of Uterine Fibroids

*Evidence Reports/Technology Assessments, No. 34*

Evan R Myers, MD, MPH, Matthew W Barber, MD, Grace M Couchman, MD, Santanu Datta, MBA, MS, Rebecca N Gray, Dphil, Tara Gustilo-Ashby, MD, Jane T Kolimaga, MS, and Douglas C McCrory, MD, MHSc.

Agency for Healthcare Research and Quality (US)2001 Jul

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## Structured Abstract

#### Objective:

                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.

#### Search Strategy:

                Published literature on the management of uterine fibroids was identified in                    MEDLINE, CINAHL, CancerLit, EMBASE, HealthSTAR, and the Cochrane Library for                    1975 through 2000. Medical subject headings terms used included "leiomyoma,"                    "fibroids," "hysterectomy," and "myomectomy."

#### Selection Criteria:

                Empirical study designs considered included controlled trials, prospective trials                    with historical controls, prospective or retrospective cohort studies, and                    medium to large case series. Studies of these types and review articles were                    included if the study population included women with uterine fibroids and data                    were provided on one or more of the key research questions. Studies were                    excluded if the article did not present original research or a relevant review,                    the patient population did not include women with uterine fibroids, or the study                    design was a single case report or small case series with fewer than 20                    subjects.

#### Data Collection and Analysis:

                Paired reviewers independently screened each abstract and article. Two reviewers                    also performed the data abstraction. Included studies were graded for internal                    and external validity. Supplemental data were collected from the Nationwide                    Inpatient Sample and from Duke University Medical Center.

#### Main Results:

                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.

#### Conclusions:

                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.

## Contents

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                        - Preface
                        - Summary
                        - 1. Introduction                           - Background
                          - Scope and Purpose
                          - Prevalence and Incidence of Uterine Fibroids
                          - Biology of Fibroids
                          - Burden of Illness
                          - Patient Populations
                          - Practice Settings
                          - Target Audiences
                        - 2. Methodology                           - Topic Assessment and Refinement
                          - Literature Search and Selection
                          - Data Abstraction
                          - Quality Scoring
                          - Quality Control Procedures
                          - Supplemental Data Sources
                          - Data Synthesis
                        - 3. Results                           - Question 1: What are the risks and benefits of hysterectomy and myomectomy in					the treatment of symptomatic and asymptomatic fibroids?
                          - Question 2: What are the risks associated with single versus multiple					myomectomies?
                          - Question 3: Who are appropriate candidates for each procedure?
                          - Question 4: What is the incidence of need for additional treatment after					myomectomy or other uterus-sparing interventions?
                          - Question 5: Does additional treatment result in significantly increased					morbidity?
                          - Question 6: What are the risks and benefits of nonsurgical treatment?
                          - Question 7: What are the costs associated with effective surgical and					nonsurgical treatments?
                          - Question 8: Do risks and benefits differ for women according to race,					ethnicity, age, interest in future childbearing, and so forth?
                          - Question 9: What are the effects of surgical management of uterine fibroids,					especially hysterectomy, on the aging process?
                        - 4. Decision Model                           - Approach
                          - Clinical Scenario
                          - Methods
                          - Results
                          - Methodological Issues
                          - Summary
                        - 5. Conclusions                           - Research Implications
                          - Limitations of the Current Literature
                          - Limitations of the Report
                          - Suggested Strategies for Using This Report
                        - 6. Future Research                           - Improving Comparability Across Studies
                          - Improving Knowledge About the Effectiveness of Medical Therapies
                          - Improving Knowledge About Long-Term Outcomes
                          - Improving Knowledge About Basic Epidemiology and Use of Health Services
                          - Improving Knowledge About the Economics of Fibroids
                        - Abbreviations and Acronyms Used in This Report
                        - References
                        - Evidence Tables
                        - Bibliography

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Director: David B Matchar, MD.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department                of Health and Human Services.1                 Contract No. 290-97-0014.                Prepared by: Duke Evidence-based                    Practice Center, Durham, NC.

#### Suggested citation:

Myers ER, Barber MW, Couchman GM, et al. Management                    of uterine fibroids (Evidence Report/Technology Assessment No. 34, contract                    290-97-0014 to the Duke Evidence-based Practice Center). AHRQ Publication No.                    01-E052. Rockville, MD: Agency for Healthcare Research and Quality. July                    2001.

On December 6, 1999, under Public Law 106-129, the Agency for Health Care Policy and                Research (AHCPR) was reauthorized and renamed the Agency for Healthcare Research and                Quality (AHRQ). The law authorizes AHRQ to continue its research on the cost,                quality, and outcomes of health care and expands its role to improve patient safety                and address medical errors.

This report may be used, in whole or in part, as the basis for development of                clinical practice guidelines and other quality enhancement tools, or 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.

The authors of this report are responsible for its content. Statements in the report                should not be construed as endorsement by the Agency for Healthcare Research and                Quality or the U.S. Department of Health and Human Services of a particular drug,                device, test, treatment, or other clinical service.

                        - 1
                        - 
2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Copyright Notice

Bookshelf ID: NBK33644

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                    - Cite this Page Myers ER, Barber MW, Couchman GM, et al. Management of Uterine Fibroids. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 Jul. (Evidence Reports/Technology Assessments, No. 34.)

### Other titles in these collections

                    - AHRQ                    Evidence Reports
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