Medical treatment for uterine fibroids: Does current evidence mandate a change in clinical guidelines?

L. Puşcaşiu

Abstract: Current medical practice has seen, in the last two decades, a change of paradigm due to the appearance and growth of evidence based medicine. Although there have been numerous, and many times justified, critiques regarding this type of medical practice, currently, evidence based medicine has become the norm, not the exception, at a global level. The uterine fibroid represents the most frequent benign tumor in women of child reproductive age, its prevalence being estimated between 20 and 40%. As such, it represents a pathology which is often seen in all gynecology services worldwide. The principal treatment for these tumors is represented by hysterectomy, these procedure also being most frequently for uterine fibroids. Also, uterine fibroids are the most frequent indication for hysterectomy. An American study from 2012 showed that uterine fibroids have an annual incidence estimated at 0.92% in the United States of America and that 94% of women diagnosed will have at least one diagnostic or therapeutic procedure in the year following the diagnostic. Using these data, the authors of the study estimate that the annual direct and indirect costs in the USA are between 5.89 and 34.37 billion dollars, using the 2010 value of the dollar. An important part of these costs is represented by the absence from the workplace (7.8 billion dollars). As such, the economic impact of uterine fibroids is actually higher than the cost for managing breast, colon or ovarian cancer, reaching around half the costs for treating diabetes mellitus. Although uterine fibroids present such a high prevalence, possible complications and a steep cost, there were only a handful of studies which allowed an evaluation of the efficacy of different treatments. Recommendations with a clear scientific value have been hard to formulate due to this problem. Donnez et al., cited in an editorial from the prestigious “New England Journal of Medicine”, written by Stewart, present two randomized clinical trials which were done to gain a better grasp on the drugs used in the treatment of uterine fibroids. The editorialist concludes that the studies finally present strong evidence for the treatment of uterine fibroids, representing a step forward in the medical therapy of these tumors.
Keywords: Uterine Fibroids, SPRM, leuprolide acetate, safety profile, ulipristal acetate