Management of Uterine Fibroids. Volume 2. Evidence Tables and Bibliography.Evidence Report/Technology Assessment Number 34

摘要

This report presents an assessment of the literature published from 1975 through2000 on the benefits, risks, and costs of the management of symptomatic and asymptomatic uterine fibroids in women aged 20 to 55. Supplemental data were collected from the Nationwide inpatient Sample and from Duke University Medical Center. 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. There was almost no evidence to support the effectiveness of commonly recommended medical treatments. However, evidence from randomized trials indicates that preoperative use of gonodotropin-releasing hormone (GnRH) agonist therapy reduces estimated blood loss and may facilitate surgery by reducing uterine size; however, 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. Priorities for future research should include methodologically rigorous studies of the effectiveness of nonsurgical treatments and development of standard measures of disease severity.