Current treatment for symptomatic uterine fibroids: available evidence and therapeutic dilemmas

This Review offers an evaluation of current treatments for symptomatic uterine fibroids, including uterine artery embolisation, MRI-guided high-intensity focused ultrasound, laparoscopic radiofrequency ablation, transcervical radiofrequency ablation, ulipristal acetate, and oral gonadotropin-releasing hormone antagonists with add-back therapy. Placing these therapies within the IDEAL (Idea, Development, Exploration, Assessment, And Long-Term Follow-Up) framework and the clinical phases of drug development framework, we highlight key gaps in the evidence such as the lack of head-to-head comparisons with standard care, scarce long-term data, and inadequate consideration of real-world fibroid and patient characteristics. We provide a clear overview, assess the strength of the available evidence, and propose a practical flowchart to help clinicians navigate treatment decisions, ensuring the best care for women with symptomatic fibroids at various stages of therapy development. Insight into these matters equips both patient and clinician with essential information to support the process of shared and fully informed decision making. Importantly, this Review also identifies knowledge gaps that contribute to the specification of the fibroid research agenda.