Medical or surgical management of fibroids? An internet survey of gynecologists' views.

AIM: To assess the attitudes of gynecologists toward symptomatic fibroids and analyze which factors influence their choice of treatment.

MATERIAL AND METHOD: We surveyed the attitude of Belgian gynecologists toward patients' cases. We used a vignette of a woman with symptomatic fibroids and modified 3 factors: her age, her parity and her desire for pregnancy, thereby establishing 12 different cases. We ensured that each gynecologist (n=1437) received one case, chosen randomly, by email. The gynecologists were asked whether and how they would treat the patient.

RESULTS

Replies were received from 337 gynecologists (a 23% response rate). Of the 337, 116 (34%) would prescribe a medical treatment only; in this group, 29% specified acetate ulipristal a selective progesterone receptor modulator (SPRM) and 27% indicated progestins. Of the sample of 337 responders, another 116 (34%) would begin with medical treatment (70% an SPRM) and then proceed to surgery. Of the 337 gynecologists, 75 (22%) would perform surgery only. The preferred surgical treatments were myomectomy (53/75; 71%) and hysterectomy (19/75; 25%) when surgery was suggested as a first step, and myomectomy (91/115; 79%) and hysterectomy (18/115; 16%) when it was preceded by medical treatment. The choice of treatment varied significantly in relation to the 12 vignettes (p<0.01). When we grouped the vignettes there was no significant variation in relation to age or parity, but a there was significant variation (p<0.001) in relation to desire to achieve pregnancy.

CONCLUSION

We observed that, in women with symptomatic fibroids, the desire retain fertility is respected. Moreover, SPRM is increasingly used for symptomatic patients.