Future Directions for the Treatment of Leiomyomas WILLIAM H. CATHERINO, MD, PHD PROFESSOR AND CHAIR-RESEARCH, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY UNIFORMED SERVICES UNIVERSITY NATIONAL INSTITUTES OF HEALTH Objectives At the completion of this lecture, you will: u Understand the benefits and drawbacks of surgical intervention u Understand the benefits and drawbacks of minimally invasive interventions u Understand the benefits and drawbacks of medical interventions Please email
[email protected] with any ?s Disclosures u Consultant: Abbvie, Allergan, Bayer u Research grant: Allergan u Wife, Scientific Director: EMD Serono Please email
[email protected] with any ?s Best Studied Therapies for Fibroids Surgical Radiologic Medical ______ >100 years of study Hysterectomy Open myomectomy GnRH agonists 25-34 years of study SERMs: Tamoxifen Endometrial Ablation GnRH agonists 20-24 years of study SERMs: Raloxifene Laparoscopic myomectomy Uterine artery embolization Retinoic acid 10-19 years of study SERMs: Letrozole, genestein Uterine artery obstruction SPRMs: Mifepristone, asoprisnil, ulipristal Robotic myomectomy GnRH antagonists 5-9 years of study Cryomyolysis MRI-guided high frequency u/s SPRMs: Telepristone Laparoscopic ablation Please email
[email protected] with any ?s Surgical Intervention Scientific Study Into Various Fibroid Treatments Minimally Invasive Surgical Interventions Interventions Medical Interventions 180 80 20 135 60 15 90 40 10 45 20 5 0 2008 2010 2012 2014 2016 0 0 2008 2010 2012 2014 2016 20082009 2010201120122013 201420152016 hysterectomy Laparoscopic myomectomy UAE Ulipristal Leuprolide Hysteroscopic myomectomy Endometrial ablation Mifepristone Levonorgestrel Open myomectomy Radiofrequency ablation Letrozole Cetrorelix Robotic myomectomy MRI-Guided HiFU Triptorelin Vilaprisan Hysterectomy Decreasing Over Time Please email
[email protected] with any ?s Laparoscopic Myomectomy • Shorter inpatient stay (52hrs vs.