Uterine fibroids are the most common pelvic tumours and the most common benign tumours in women. Usually diagnosed late in a woman’s reproductive life, fibroids are present in up to 40% of women older than 40 years. Fibroid-related symptoms are often divided into menstrual symptoms, such as heavy bleeding, or bulk-related symptoms that result from the enlargement of the uterus. Common symptoms include abnormal uterine bleeding, pelvic pressure and pain, infertility, recurrent pregnancy loss, and decreased quality of life. Medications or surgical interventions may be needed to treat fibroids. Hysterectomy is a definitive solution for many women; however, alternatives that preserve fertility and avoid invasive surgery do exist. The less-invasive uterine-preserving alternatives include myomectomy, uterine artery embolization or occlusion (UAE or UAO), myolysis, and endometrial ablation. Each carries its own safety and effectiveness profile, and the treatment of fibroids must be individualized depending on such factors as symptoms, size and location of fibroids, age, desire for future pregnancy or preservation of the uterus, the availability of therapy, physician experience, and patient preference.

To help guide decisions about the treatment of fibroids, this study systematically reviews the clinical and cost-effectiveness of interventions for symptomatic uterine fibroids that preserve the uterus and are available in Canada, compared with each other or with hysterectomy. Medications have been excluded from this comparison, but do provide an alternative option for short-term therapy.

Contents

• Acronyms and Abbreviations
• Executive Summary
• Context and Policy Issues
• Research Questions
• Key Findings
• Methods
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Data Extraction Strategy
  • Critical Appraisal of Individual Studies
  • Data Analysis Methods
• Results
  • Quantity of Research Available
• Clinical Review
  • Study Characteristics
  • Critical Appraisal of Individual Studies
  • Data Analyses and Synthesis
• Economic Review
  • Study Characteristics
  • Critical Appraisal of Individual Studies
  • Results
• Discussion
  • Summary of Evidence
  • Limitations
• Conclusions and Implications For Decision- Or Policy-Making
• References
• Appendix 1 Literature Search Strategy
• Appendix 2 Selection of Included Studies
• Appendix 3 Included Studies For Clinical Evidence
• Appendix 4 Excluded Studies for Clinical Review
• Appendix 5 Clinical Evidence — Study Characteristics and patient baseline characteristics
• Appendix 6 Clinical Evidence — Critical Appraisal of Studies
• Appendix 7 Clinical Evidence — Study Results
• Appendix 8 Economic Evidence — Study Characteristics
• Appendix 9 Economic Evidence – Critical Appraisal of Studies
• Appendix 10 Economic Evidence — Study Results

Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec. The views expressed herein are those of CADTH and do not necessarily reflect the views of our funders.

Suggested citation:

Uterine-preserving interventions for the management of symptomatic uterine fibroids: a systematic review of clinical and cost-effectiveness. Ottawa: CADTH; 2016 Jan. (CADTH Rapid Response report: systematic review).

Disclaimer: This report is a review of existing public literature, studies, materials, and other information and documentation (collectively the “source documentation”) that are available to CADTH. The accuracy of the contents of the source documentation on which this report is based is not warranted, assured, or represented in any way by CADTH, and CADTH does not assume responsibility for the quality, propriety, inaccuracies, or reasonableness of any statements, information, or conclusions contained in the source documentation.

CADTH takes sole responsibility for the final form and content of this report. The statements and conclusions in this report are those of CADTH and not of reviewers.

This document is prepared by the Rapid Response Service, an information service of the Canadian Agency for Drugs and Technologies in Health (CADTH). The service is provided to those involved in planning and providing health care in Canada. This Rapid response is based on a comprehensive and systematic search of the literature available to CADTH at the time of preparation. The intent is to provide a systematic review of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. This response has been peer-reviewed by content experts. The information in this document is intended to help Canadian health care decision-makers make well-informed decisions and thereby improve the quality of health care services. Rapid responses should be considered along with other types of information and health care considerations. This report should not be used as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process, or as a substitute for professional medical advice. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness, particularly in the case of new and emerging health technologies for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation or the document to ensure that its contents are accurate, complete, and up to date as of the date of the date of publication, CADTH does not make any guarantee to that effect. CADTH does not guarantee and is not responsible for the quality, currency, propriety, accuracy, or reasonableness of any statements, information, or conclusions contained in the source documentation. CADTH is not responsible for any errors or omissions or injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the information in this document or in any of the source documentation.