Uterine fibroids: a narrative review of epidemiology and management, with a focus on uterine artery embolization.

Background and Objective: Uterine fibroids (UFs) are the most common benign tumors in women. Despite advances in non-operative technologies, hysterectomy remains the main treatment modality. This review summarizes current minimally invasive treatment options with emphasis on uterine artery embolization (UAE) and its relation to epidemiology and pathophysiology of the disease. Methods: A literature search was conducted using PubMed to compile the most up-to-date research in the field of UFs. The results have been presented as a narrative review. Key Content and Findings: UFs occur in about 25-50% of women with approximately $34 billion direct and indirect annual costs in the United States. Risk factors including black ethnicity, genetic predisposition, and early menarche have been identified in the studies. Medical management is often the first line approach. The newer generation of drugs, selective progesterone receptor modulators (SPRM), have improved treatment outcomes compared to older therapies. Hysterectomy remains the definitive treatment. Uterine-preserving therapies such as myomectomy and magnetic resonance-guided high-intensity ultrasound (MRgHIUS) can preserve fertility. Similarly, UAE offers a unique approach which eliminates the potential surgical side effects with similar outcome profiles. Post-embolization infertility remains the main concern that has been reported in up to 40% of the treated patients in studies with mixed data. Patient selection, pre-procedural evaluation, and anatomical considerations play important roles in procedural outcomes. Conclusions: UAE is a treatment option for UFs. Appropriate patient selection strategies can be achieved by a close collaboration between obstetrician and gynecologists and interventional radiologists and would result in effective fibroid treatment while preserving the uterus.