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.
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