Management of uterine leiomyomata: What do we really know?

OBJECTIVE: To systematically review the literature on the surgical and nonsurgical management of uterine leiomyomata. DATA SOURCES: Published literature in English on the management of uterine leiomyomata published from 1975 through 2000 was identified in MEDLINE, CINAHL, CancerLit, EMBASE, HealthSTAR, and the Cochrane Database of Systematic Reviews. Search terms included "leiomyomata," "fibroids," "hysterectomy," and "myomectomy." STUDY SELECTION: Study designs considered included controlled trials, prospective trials with historical controls, prospective or retrospective cohort studies, and series with at least 20 cases. Original research studies or relevant reviews were included if the study population included women with uterine leiomyomata, and data were provided relevant to one or more of nine prespecified research questions. TABULATION, INTEGRATION, AND RESULTS: Inconsistency in reporting of severity of symptoms, uterine anatomy, and response to therapy prevented meaningful comparison of studies in most cases, and prevented performance of meta-analysis in all cases. This was true of both surgical and nonsurgical treatments. CONCLUSION: The available evidence on die management of uterine leiomyomata is of poor quality. Patients, clinicians, and policymakers do not have the data needed to make informed decisions about appropriate treatment. Given the prevalence of this condition and its substantial impact on women's lives, obtaining these data should be a high research priority. (C) 2002 by The American College of Obstetricians and Gynecologists.