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A Systematic Review of Minimally Invasive Treatments for Uterine Fibroid-Related Bleeding

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Abstract

Newer minimally invasive techniques provide treatment options for symptomatic uterine fibroids while allowing uterus preservation. The objective of this review was to analyze the efficacy of uterine-preserving, minimally invasive treatment modalities in reducing fibroid-related bleeding. A comprehensive search was conducted of PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases from inception to July 2020. English-language publications that evaluated premenopausal women with fibroid-related bleeding symptoms before and after treatment were considered. Randomized controlled trials were assessed for bias with the established Cochrane Risk of Bias Tool 2.0 and observational studies were assessed for quality under the New Castle-Ottawa Scale guidelines. Eighty-four studies were included in the review, including 10 randomized controlled trials and 74 observational studies. Six studies on myomectomy demonstrated overall bleeding symptom improvement in up to 95.9% of patients, though there was no significant difference between mode of myomectomy. Forty-one studies on uterine artery embolization reported significant reduction of fibroid-related bleeding, with symptomatic improvement in 79 to 98.5% of patients. Three studies suggested that embolization may be superior to myomectomy in reducing fibroid-related bleeding. Six studies reported that laparoscopic uterine artery occlusion combined with myomectomy led to greater reduction of bleeding than myomectomy alone. Fifteen studies demonstrated significantly reduced bleeding severity after radiofrequency ablation (RFA). Additional research is needed to establish the superiority of these modalities over one another. Long-term evidence is limited in current literature for magnetic resonance-guided focused ultrasound surgery, cryomyolysis, microwave ablation, and laser ablation.

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Data Availability

The data that support the findings of this study were derived from the following resources available in the public domain: PubMed, Embase, PsycINFO, ClinicalTrials.gov, Scopus, and Cochrane Library databases.

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Authors and Affiliations

  1. Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

    Jiahui Zhang

  2. Department of Obstetrics and Gynecology, Saint Joseph Hospital Denver, Denver, CO, USA

    Virginia-Arlene Go

  3. Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jaime Friel Blanck

  4. Division of Reproductive Sciences & Women’s Health Research, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Bhuchitra Singh

Authors
  1. Jiahui Zhang
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  2. Virginia-Arlene Go
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  3. Jaime Friel Blanck
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  4. Bhuchitra Singh
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BS conceived of the presented idea and supervised the findings of this work. JB searched databases for review articles. JZ interpreted the data and wrote the manuscript with help from AG and BS. All authors discussed the results and contributed to the final manuscript.

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Correspondence to Bhuchitra Singh.

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Zhang, J., Go, VA., Blanck, J.F. et al. A Systematic Review of Minimally Invasive Treatments for Uterine Fibroid-Related Bleeding. Reprod. Sci. 29, 2786–2809 (2022). https://doi.org/10.1007/s43032-021-00722-z

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