Abstract：
Uterine fibroids (UFs) are the most common female benign pelvic tumors, affecting >60% of patients aged 30-44 years. Uterine fibroids are asymptomatic in a large percentage of cases and may be identified incidentally using a transvaginal ultrasound or a magnetic resonance imaging scan. However, in approximately 30% of cases, UFs affect the quality of life and women\'s health, with abnormal uterine bleeding and heavy menstrual bleeding being the most common complaints, along with iron deficiency (ID) and ID anemia. Medical treatments used for UFs-related abnormal uterine bleeding include symptomatic agents, such as nonsteroidal antiinflammatory drugs and tranexamic acid, and hormonal therapies, including combined oral contraceptives, gonadotropin-releasing hormone agonists or antagonists, levonorgestrel intrauterine systems, selective progesterone receptor modulators, and aromatase inhibitors. Nevertheless, few drugs are approved specifically for UF treatment, and most of them manage the symptoms. Surgical options include fertility-sparing treatments, such as myomectomy, or nonconservative options, such as hysterectomy, especially in perimenopausal women who are not responding to any treatment. Radiologic interventions are also available: uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound, and radiofrequency ablation. Furthermore, the management of ID and ID anemia, as a consequence of acute and chronic bleeding, should be taken into account with the use of iron replacement therapy both during medical treatment and before and after a surgical procedure. In the case of symptomatic UFs, the location, size, multiple UFs, or coexistent adenomyosis should guide the choice with a shared decision-making process, considering long- and short-term treatment goals expected by the patient, including pregnancy desire or wish to preserve the uterus independently of reproductive goals.
摘要：
子宫肌瘤（UFs）是最常见的女性良性盆腔肿瘤，影响超过60％的30-44岁的患者。UF在很大一部分病例中无症状，可以通过阴道超声或磁共振偶然识别。然而,在大约30%的病例中，UF会影响生活质量(QoL)和女性健康，子宫出血异常（AUB）和月经大出血（HMB）是最常见的主诉，以及缺铁（ID）和ID贫血（IDA）。用于UF相关AUB的药物治疗包括对症药物，如非甾体抗炎药和氨甲环酸，和荷尔蒙疗法，包括联合口服避孕药，促性腺激素释放激素（GnRH）激动剂或拮抗剂，左炔诺孕酮宫内节育系统，选择性孕酮受体调节剂和芳香化酶抑制剂。然而，很少有药物被批准专门用于UFs治疗，其中大多数可以控制症状。手术选择包括保留生育能力的治疗，比如子宫肌瘤切除术,或非保守的选择,作为子宫切除术，尤其是围绝经期妇女对任何治疗都没有反应。放射学干预措施也可用：子宫动脉栓塞术，高强度聚焦超声或磁共振引导聚焦超声，射频消融.此外，ID和IDA的管理，由于急性和慢性出血，在药物治疗期间以及手术前后都应考虑使用铁替代疗法。在有症状的UFs的情况下，位置,尺寸,多个UF或共存的子宫腺肌病应该以共同的决策来指导选择，考虑到患者预期的长期和短期治疗目标，包括怀孕的愿望或希望独立于生殖目标而保留子宫。
