Uterine Fibroids: Modern Treatment Approaches and New Perspectives

Introduction: What are Uterine Fibroids?

Uterine fibroids, or leiomyomas, are one of the most common benign tumors of the female reproductive system. They develop from the smooth muscle cells of the uterine wall and can vary in size from microscopic to large masses that significantly increase the volume of the organ. Estimates suggest that fibroids occur in 70-80% of women by age 50, although not everyone experiences symptoms. Clinical manifestations may include heavy and prolonged menstrual bleeding, lower abdominal pain, pelvic pressure, frequent urination, constipation, and even infertility or pregnancy complications. The choice of treatment for uterine fibroids depends on numerous factors, such as the size and number of fibroid nodes, their location, the patient's age, the desire to preserve fertility, and the severity of symptoms.

Fibroid Diagnostics: The Key to Effective Treatment

Accurate diagnosis is the first and most crucial step in choosing an appropriate treatment strategy. The primary method is pelvic ultrasound (ultrasonography), which makes it possible to determine the presence, size, number, and location of fibroid nodes. In some cases, a more detailed evaluation may require magnetic resonance imaging (MRI), especially when planning surgery or when atypical forms of fibroids are suspected.

Conservative and Medical Treatment

Conservative therapy aims to reduce symptoms and slow the growth of fibroids, as well as to prepare for surgical treatment. It is frequently used in women with small fibroids, mild symptoms, or during the premenopausal period. Medical methods include:

• Hormonal medications: Gonadotropin-releasing hormone (GnRH) agonists can temporarily reduce the size of fibroids by inducing an artificial menopausal state. Selective progesterone receptor modulators are also used to reduce bleeding and fibroid volume.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Used to relieve pain and reduce heavy menstrual bleeding.
• Iron supplements: Prescribed to correct anemia caused by chronic blood loss.

Maintaining hormonal balance is extremely important for women's health, especially during periods requiring special attention, such as during pregnancy, where disorders like hyperthyroidism require careful monitoring [1].

Minimally Invasive Treatment Methods for Fibroids

These methods are becoming increasingly popular due to their lower invasiveness, shorter recovery period, and the ability to preserve the uterus.

• Uterine Artery Embolization (UAE): This is an interventional radiology procedure in which special particles (emboli) are injected via a catheter into the uterine arteries, blocking the blood supply to the fibroid nodes. Deprived of nutrients, the nodes decrease in size and undergo necrosis. The principle of embolization, aimed at blocking the blood supply to pathological tissues, is used in various fields of medicine to improve treatment outcomes, such as in chronic subdural hematomas [3].
• MRI-guided Focused Ultrasound Ablation (FUS ablation, HIFU): A method in which high-intensity focused ultrasound is used to heat and destroy fibroid tissue without incisions.
• Radiofrequency Ablation (RFA): A procedure in which a thin electrode generating radiofrequency energy is inserted into the fibroid node, leading to the heating and destruction of the fibroid tissue.

Surgical Treatment: When Surgery is Inevitable

Surgical intervention is considered in cases where conservative and minimally invasive methods are ineffective, in the presence of large fibroids, rapid growth, pronounced symptoms, or suspicion of malignant transformation.

• Myomectomy: Removal of only the fibroid nodes while preserving the uterus. This method is preferred for women planning a pregnancy. It can be performed laparoscopically, hysteroscopically (for submucosal nodes), or via laparotomy.
• Hysterectomy: Removal of the uterus. This is a radical method considered for multiple, large fibroids, severe symptoms when other methods are impossible or undesirable, and in women not planning a pregnancy.

Innovations and Prospects in Fibroid Treatment

Medical science is constantly evolving, offering new approaches to the diagnosis and treatment of various diseases. Modern medicine actively utilizes complex mathematical models and population-based selection methods to accurately calculate treatment parameters and evaluate drug kinetics in tissues, which optimizes therapeutic approaches [2, 5]. In addition to medical and surgical methods, non-pharmacological strategies can be applied in a comprehensive health approach, such as manual therapy to relieve certain types of pain [4]. Ongoing research into the mechanisms of disease development, such as cardiovascular pathologies, facilitates the search for new therapeutic targets and the development of effective drugs [6, 7]. These general trends in medicine also influence the development of approaches to treating uterine fibroids, stimulating the search for more effective and safer methods.

Conclusion: An Individualized Approach is the Key to Success

Choosing the optimal treatment strategy for uterine fibroids is always an individual decision made by the physician together with the patient. It is based on a careful assessment of the clinical presentation, examination data, reproductive plans, and the woman's personal preferences. Modern medicine offers a wide range of effective methods to achieve the best outcomes and significantly improve the quality of life of patients with uterine fibroids.

References

1. [1] Management of hyperthyroidism during pregnancy and lactation. (European Journal of Endocrinology, 2011) https://pubmed.ncbi.nlm.nih.gov/21389085/
2. [2] Non-linear mixed-effects modelling and population-based model selection for ¹³¹I kinetics in benign thyroid disease. (EJNMMI Physics, 2025) https://pubmed.ncbi.nlm.nih.gov/40198532/
3. [3] Enhancing Outcomes in Subdural Hematoma: The Role of Middle Meningeal Artery Embolization. (Cardiology in Review, 2025) https://pubmed.ncbi.nlm.nih.gov/40265887/
4. [4] Manual Therapy Approach to the Extraocular Muscles in Migraine Treatment: A Preliminary Study. (Advances in Experimental Medicine and Biology, 2022) https://pubmed.ncbi.nlm.nih.gov/35147929/
5. [5] ¹³¹I therapy for benign thyroid disease: flexible single-time-point dosimetry using population-based model selection with non-linear mixed-effects modelling. (EJNMMI Physics, 2025) https://pubmed.ncbi.nlm.nih.gov/41082032/
6. [6] Mitoquinone Prevents Cardiac Dysfunction by Normalizing Mitochondrial ROS and Calcium Handling in Acute Myocardial Infarction. (Acta Physiologica (Oxford, England), 2026) https://pubmed.ncbi.nlm.nih.gov/42432986/
7. [7] Sennoside A Ameliorates Myocardial Fibrosis After Myocardial Infarction by Binding to KDM4B and Regulates IRX2 Expression. (Cardiovascular Drugs and Therapy, 2026) https://pubmed.ncbi.nlm.nih.gov/42412153/
8. [8] Preventive migraine treatment in mitochondrial diseases: a case report of erenumab efficacy and literature review. (Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2022) https://pubmed.ncbi.nlm.nih.gov/36097203/

Disclaimer: The information presented in this article is for informational purposes only and cannot be used for self-diagnosis or self-treatment. Before making any decisions regarding your health, be sure to consult a qualified medical specialist.