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Practical therapeutics RCTs regarding the benefits and/or harms of the use of these drugs for treating uterine fibroids. A systematic review concluded that current evidence does not support or refute the use of herbal preparations for treatment of uterine fibroids due to insufficient studies with large sample sizes and of high quality. 10,55 Conclusions Many uterine fibroids are asymptomatic and require no intervention. While myomectomy and hysterectomy have been the traditional definitive treatments for symptomatic uterine fibroids, not all women wish to have surgery and many want to retain their uterus. Non-surgical treatment options for symptomatic fibroids include pharmacologic as well as radiologically guided interventions. The range of medical treatments includes tranexamic acid, non-steroidal anti- inflammatory drugs, contraceptive steroids, GnRH analogues, aromatase inhibitors and progesterone receptor modulators. However, it is important to remember that these medical options may not always be a definitive form of treatment and symptoms may return when treatment is stopped. 56 References 1 Wise LA et al. Age-specific incidence rates for self-reported uterine leiomyomata in the Black Women’s Health Study. Obstetrics Gynecol 2005;105:563–8. 2 Talaulikar VS, Manyonda I. Progesterone and progesterone receptor modulators in the management of symptomatic uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2012;165(2):135–40. 3 Wilson EA, Yang F, Rees ED. Estradiol and progesterone binding in uterine leiomyomata and in normal uterine tissue. Obstetrics Gynecol 1980;55:20–4. 4 Tamaya T, Fujimoto J, Okada H. Comparison of cellular levels of steroid receptors in uterine leiomyomas and my Y]][KXH[YXXB[[]XH NN N͍ $KH\\T][ H[Y] \\]Y]و\[ZXšY[[]XY[Έ\ [^\]H܈X]BY[X[YY[ˈYY Nx$ Y[X[U][ Hx$ܙ\ۜHYHوBݙ[ ܘ[[^[ZXܛ][][ۈ܈X]BY[X[YY[ˈ[H؜][X LŇ NNKLx$˂Y\][ YXXH[Y]Hٛܘ[[^[ZX˜XY[Y[]X]HY[X[YY[[XYˈY[&\X[ ۙ[ H LNM$ ˂[[HZHPˈYXXHو[^[ZXXY[HX]Y[وY[\]X[ۋY[[ۘ[X]HY[X[YY[ΈH\[X]X]Y]˂XH؜][X[ LLNLx$˂H]XHKX]\]Z\ˈۋ\\Y[[KZ[[[X]ܞHY܈X]HY[X[YY[ˈ[H]X\H\] LN L0\^S0^][SPTˈSPT][ۂ][Y[X[Y[Y[و]\[HXY˂X]\]\ˈ MJ JNL $MLHZ[][ ܘ[۝X\]H\H[]\[HZ[^[X\\ΈHY]KX[[\\\Yۈܝ[\x$۝YY\ˈ\[X][\XXY]\KB؜] L̎Lx$ L[[ܚY\[\X[R˂\\]]XY[HX] [Y[و[\X]X]\[HXYˈ^\[\XX\ LM x$ KL[]X[[HYܘ]YH[^HYYX[X[Y[Y[و]\[HXY]YY\\\ۙHX]]H \ݙ\JNB[YK؜][YX ̍N8$ MXY][ [YXX[YXوY[\ۂ]\[H^[XH[YNH]X]H۝YYH\\[]ۘY[\[X\[šܛ[ۙHYۚ\ \[X؜] LN̎ $ MH[Z[Z[T][ \[܂\[\[X\[[]]\[H\[\܂]\[HXYˈ[H]X\H\] L̎ NM M[\\][ [Y]X[[ܜB\[ۙ\H\Hو]ۛܙ\[[X\[š[]]\[H]X\ˈ[[YX]NN Nx$ KM\[HH][ [Z\Y\\]]HX[قH]ۛܙ\[[]]\[H\[H[ܙ]\\ۙH܈X]Y[وY[]X›Y[ܜYXK؜][YX NNNL NNL$ N݈][ ]ۛܙ\[[X\[B[]]\[H\[H܈HX]Y[قY[ܜYXH[ ܈K\]Y[\Y[\]\[BYY[\X]Y]]\[HZ[^[XK]\۝X\\X[\H LNM 8$˂NHܚ\[HH][ YXXHوH]ۛܙ\[ B[X\[[]]\[H\[H[]\[HZ[^[XK[[YX؜] LLMx$ \\\H][ H [[۝ۋX\\]]BY[ۈYY[ٚ[\]H]ۛܙ\[[]]\[H\[HHH]][][ۈ\[™\[\[Y[YY[]\K]\؜][X\[ LMLΌM͸$ HX\[][ YXو]ۛܙ\[ \[X\[’UT[\\ۙHX\܈[[]܈BLLMۈ]\[HZ[^[X\ˈ۝X\[ۂ NNx$L ˂X\[][ YXوH]ۛܙ\[ B[X\[[]]\[H\[HۈY\][ۈ[\\[H[Y]][K[H\X[ۂ NML $ ]^ZH][ ۔[[YHX]Y[YܙB\\X\X[ۈوX]X\^[X\ΈBX]K[Z^Y ][X[HYK\[\[ LMMM$K]XHK[ݙ[\KKB\]]H۔[[YH\\HYܙB\\X^H܈^[YX^H܈]\[HXY˂[H]X\H\] N N M ˂H[ZH[][Z\[HSKX[[ۙHK۔Yۚ\Έ^H]HHXH[H[\X[Y[Y[وXY\X\O؜][YX[XH L͌ JNL $L ]XHK[ݙ[\KYXXHقK[\]]HۘY[ܛ[ۙH[X\[˜[[Y\܈Y[]]\[HXY[\Y[\\X^H܈^[YX^NB\[X]X]Y]ˈ LJ L NLM$L ]XHQK[ݙ[[]Y[KX\Y\Xܛ[ۘ[\\Y\܂[Y[]\[Y[]XYˈ\X\[؜][YX ̌ $K\H][ \\ۙH[\\ۙBX\܈[[]܈[]\[HZ[^[XHܛ [X\[ X\ۈ ]\ YK[][ۘ[\X\[]\[H[K[\\[N[]Y\  H]SK[X[][]Hو\\ۙHX\܂[[]ܜ[Z\YXۈH[Y]][K\[؜][X ŇNN8$̍ \H][ \\]]HYXوB\\ۚ[  HۈY\][ۋ\\[B^\[ۈوܛXܜ[[\Y]\[BZ[^[XH[[ܛX[^[Y]X[[˂\H M \ N8$˂H[YH][ [ ]\HXYXX[ۜق\\ۙHX\܈[[]ܜ[HY[][ۂو]\[HZ[^[XHܛ [Z[\YY L̎8$˂̈H[][ H[Y] \\\\Y[قYYX[X]Y[܈]\[HZ[^[X\ˈYY ̍NNx$KZ\[\][ YHZY\\ۙH܂]\[HZ[^[X]K؜][X L N $L \[HZ\[\ Y[[HˈYXقZY\\ۙH܈[\X]XZ[^[X]Hۂ]X[]HوYH[]\[H^K؜][X LL x$˂H\ۙ[\]H][ ZY\\ۙH܈BX]Y[و]\[HZ[^[X\ΈH[Z^Y۝YX[ ؜][X LLL x$͈͋\[H][ ZY\\ۙH܈]\[HXY˂[H]X\H\] L]YŒMN N ͎ ˂YZH][ YXوH]\\ۙBX\܈[[]܈M L ۈXY^H[]\[HYY[ˈ؜][X ΌM˂[\ވ][ X]Y[و]\[BZ[^[X\]Hݙ[[X]H\\ۙBX\܈[[]܈ JH ˈ[X[\ L NXX ͋H[\ވ][ YXوHݙ[[X]B\\ۙHX\܈[[]܈ JH\\ۚ[ۈYY[]\[XX]Z[^[X]K[X[\ LŇx$PK ][Q][ LLM܈]\[BZ[^[X]HX]Y[H[Z^Y۝YX[ ؜][X LLNLLx$͋ HY[X[][ YXXH[\X []HقLLMX]Y[܈[\X]X]\[BXYΈH[Z^Y XKX[ XXB۝Y \HRXYK\[\[ LNMJ ͍B̊NLx$̋ ۛ^][PTHYHܛ\ [\\[X]]H\\XX܈XYX]Y[YܙB\\K[YY L͍ x$̌ ۛ^][PTHYHܛ\ [\\[X]]H\\]\YHX]]H܈]\[BXYˈ[YY L͍ x$̋ ܛHK]H \\ۙHX\܂[[]ܜ[H[Y]][N[\[ۜ\]Y[\ˈ[H\\]H L΂M$ H]]\][ HX[Hو[Y]X[]H[XYH\\ۙHX\܂[[]ܜˈ[] ̌NNLx$ ZH][ Hݙ[\[YYHܘ[۝X\]H[܈Y[][X[KXKX[ [Z^Y۝YX[قZY\\ۙH[\[[ۛH[]ۛܙ\[ K[H\ ̌ 8$͋ Z\][ YXوۙ\HX]Y[]YHZY\\ۙHۈH[Y]][K[B\ Nx$ ۛ^][ ۙ]\HX]Y[و]\[BXY][\\[X]]K\[\[ ML J NMMKM˙Lx$N Hۛ^][ YXXH[Y]Hو\X]Y\Hو[\\[X]]H[]\[HXYˈ\[\[ MNL NLNKL˙L˂Lۛ^][ ۙ]\HYYX[X[Y[Y[و]\[HXY][\\[X]]K\[\[ ML J JNMKLM˂LH^XH][ \\Y\و NYۘ[Y\Y\[\\[X]]HX]Y[܈]\[HXYˈ\[\[ ML JNM 8$KL[0\[][ X[ۈو\X]\H[X]܈܂X]Y[و]\[HZ[^[XH[\[Y[]\[]Y[ˈ\[\[ NLJ JN 8$˂Lۙ][ \X]\H[X]ܜ܈]\[BXYˈ[H]X\H\] LL ML KM[][ [X]H\[X\܂[[]ܜ T\H܈]\[HZ[^[X\˂[H]X\H\] LML L ˂MH]H][ \[\\][ۜ܈]\[BXYˈ[H]X\H\] L LL