Uterine fibroids: does the current paradigm of treatment require modernization?

DOI

https://dx.doi.org/10.18565/aig.2023.308

Levakov S.A., Kaviladze M.G., Guseynova Sh.T.
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia

Uterine fibroids are common monoclonal tumors of the uterus. Fibroids have components of both smooth muscle and fibroblasts, in addition to a significant amount of fibrous extracellular matrix, and all of them contribute to the pathogenetic process. Fibroids are extremely heterogeneous in their pathophysiology, size, localization and clinical symptoms. They partially refer to a number of diseases, which have aspects of malignant behavior in some cases, but are generally benign. The risk factor for fibroids is associated with race: black women have a higher risk of developing fibroids at an earlier age than white patients, and they also have more severe forms of the disease. In clinical practice, one-third to one-half of all hysterectomies are performed due to fibroids; there is also a significant morbidity and increased health care costs for women of reproductive age. In fact, modern treatment of uterine fibroids includes mainly surgical and interventional methods: about three quarters of all methods of fibroid treatment are hysterectomies. However, there are clinical innovations in the use of progesterone receptor modulators as drug therapy. To date, the information about the genetic subgroup that leads to the formation of fibroids is quite relevant; it can contribute to further understanding of the clinical heterogeneity of this disease and lead to individual treatment. This information is extremely important, as currently there is no high-quality evidence which can be used to base therapeutic decisions.
Conclusion. The prospects for the clinical treatment of uterine fibroids should change dramatically in the next decade, therefore, the current paradigm of treatment requires modernization. The direction for further research is clear: it is necessary to move towards determining predictors of the fibroid prognosis and developing individual therapy, which can be followed by early intervention, as well as strategies for primary and secondary prevention.

Authors’ contributions: Levakov S.A. – developing the concept and design of the study; Kaviladze M.G., Guseynova Sh.T. – collection and analysis of literary data, writing and editing the text.
Conflicts interest: The authors declare that there are no conflicts of interest.
Funding: The study has not been sponsored.
For citation: Levakov S.A., Kaviladze M.G., Guseynova Sh.T. Uterine fibroids: does the current paradigm of treatment require modernization?
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (3): 35-48 (in Russian)
https://dx.doi.org/10.18565/aig.2023.308

uterine fibroids

hysteroscopy

hysteroresectoscopy

uterine artery embolization

laparoscopy

laparotomy

conservative myomectomy

hysterectomy

FUS-MRI

fertility

reproductive function

Full text (in Russian)

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Received 29.12.2023

Accepted 19.03.2024

Sergey A. Levakov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, N.V. Sklifosovsky ICM, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(495)609-14-00, levakoff@yandex.ru,
https://orcid.org/0000-0002-4591-838X
Mariami G. Kaviladze, PhD student, Teaching Assistant of the Department of Obstetrics and Gynecology, N.V. Sklifosovsky ICM, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), +7(495)609-14-00, 119991, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7 (495) 609-14-00,
mariam-kaviladze@mail.ru, https://orcid.org/0000-0003-0221-5673
Shirin T. Guseynova, student of N.V. Sklifosovsky ICM, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University),
+7(495)609-14-00, 119991, Russia, Moscow, Trubetskaya str., 8, bld. 2, +7(495)609-14-00, guseinova.shirin@mail.ru, https://orcid.org/0009-0008-6967-7497
Corresponding author: Mariami G. Kaviladze, mariam-kaviladze@mail.ru

Uterine fibroids: does the current paradigm of treatment require modernization?

Levakov S.A., Kaviladze M.G., Guseynova Sh.T.

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