Clinical Crossroads
Clinician's Corner
January 7, 2009

A 41-Year-Old Woman With Menorrhagia, Anemia, and FibroidsReview of Treatment of Uterine Fibroids

Author Affiliations

Author Affiliation: Dr Van Voorhis is F. K. “Ted” Chapler Professor of Obstetrics and Gynecology and Director of the Reproductive Endocrinology Division at University of Iowa Carver College of Medicine, Iowa City.

JAMA. 2009;301(1):82-93. doi:10.1001/jama.2008.791

Uterine fibroids are common tumors that can cause heavy menstrual bleeding, pelvic pressure symptoms, and reproductive disorders. The incidence of fibroids peaks in the fifth decade of age and they are more common in African American women. Often, fibroids are asymptomatic and require no treatment. However, the case of Ms P, a 41-year-old woman with recurrent uterine fibroids, menorrhagia, anemia, and fatigue who wishes to retain fertility, illustrates the symptoms that require treatment. Evaluation usually begins with a pelvic examination and an ultrasound to determine both the size and location of the fibroids within the uterus. Standard treatment of symptomatic fibroids is surgical removal by myomectomy or hysterectomy, depending in part on the desire for future fertility; new treatment options include uterine artery embolization via interventional radiologic techniques as well as various medical interventions. Several new therapies show promise but are still experimental at this time. The evidence for treatment options for Ms P and symptomatic patients with fibroids in general is discussed.