An expert consensus on the medical management of uterine fibroids and complementing surgical management with focus on low dose mifepristone

Abstract

The aim of this consensus guideline is to provide clinicians with an understanding of the clinical significance of uterine fibroids and the best evidence available on treatment modalities with a focus on low dose mifepristone as an option for patients who need symptom relief preoperatively or postoperatively. Methods: The areas of clinical practice considered in formulating this consensus statement shared by gynecologists during the meeting were organized into four key themes, namely screening and diagnosis of fibroids, medical management of fibroids, role of low dose mifepristone in the medical management of fibroids, and complimenting surgical management of fibroids with low dose mifepristone. Results: Medical and surgical procedures were analyzed in the therapy of uterine fibroids. Novel medical approaches with low dose mifepristone (25 mg) were explored and found to establish an effective new therapy. Mifepristone may be used as a pre-operative adjunct to reduce the size of fibroids. Post-operative use of mifepristone can be typically initiated at a low dose of 25 mg. Ultrasound examinations were suggested to monitor the uterine fibroids. Mifepristone is safe even when used for a prolonged duration. Mifepristone has low cumulative incidence of fibroid recurrence after surgery, and provides faster recovery of reproductive function. Conclusion:Implementation of this consensus statement should optimize the decision-making process of women and their physician in assessment of treatment for uterine fibroids, having considered the disease process and available treatment options, and evaluated the risks and anticipated benefits. New options now exist, with mifepristone, a progesterone receptor antagonist proven to treat fibroid symptoms effectively. These recommendations can improve the quality of care for women with uterine fibroids utilizing the best available evidence and best clinical practices.