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Which is the best fertility-sparing treatment for uterine fibroids? Review of literature


MOJ Women's Health
Bardi, G. Pezzetti, A. Chiesa, G. Gangarossa, A. Iliakis, C. Di Cesare Cristina, P. Rosaschino

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Abstract

Uterine fibroids are benign tumors of the smooth muscle cells of the uterus that are the most common benign tumors in women during their reproductive years. The etiopathogenesis is multifactorial but we know that mainly estrogen and progesterone induce UF formation and growth. UF vary greatly in size, location, and symptoms: most tumors are largely asymptomatic, but they may also cause a wide range of severe and chronic symptoms that impact negatively with familiar and social relationships. UF might cause infertility. Their adverse effects on pregnancy because distort the endometrial cavity and thin the endometrium. In fact the negative action of fibroids on fertility is mainly due to produce numerous cytokines and growth factors that produce an endometrial inflammation that, with an altered local hormonal environment, may impede embryo-implantation. The type of treatment may depend on the location, size and number of UF and it should be related to understanding if the therapy improves the reproductive capacity of the woman. In this review of the literature we evaluate the various therapeutic possibilities that we have available if we decide to treat UF to improve the fertile capacity of the woman who wishes to have children. We will exclude medical therapy, which is predominantly birth control, although in recent years new substances are being studied, such as vitamin D and epigallocatechin gallate, which promise interesting therapeutic developments. A proper mention will be made of laparotomy, laparoscopic and hysteroscopic myomectomy, but particular importance will be given to the evaluation of new therapeutic trends such as high-intensity focused ultrasound, also guided by nuclear magnetic resonance, and thermal ablation with radio frequency and microwaves. The embolization of UF will also be addressed, but we know it is contraindicated for women who wish to become pregnant.

Keywords

uterine fibroids, hysteroscopic myomectomy, high-intensity focused ultrasound, radiofrequency myolisis, microwave thermoablation

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