Uterine fibroids (also known as fibroids) are the most common solid tumors of the female pelvis and are the leading cause of hysterectomy. Because hysterectomy is the only treatment option that is definitively effective and reduces the recurrence of fibroids, it remains the most common form of treatment. Many patients who wish to preserve their reproductive function or who wish to keep their uterus even if it has been completed, seek an alternative treatment to hysterectomy. Uterine fibroids are common, vary greatly in size, and can present as subplasmic, interstitial, submucosal, tipped, and multisite. Symptoms and treatment options are determined by the size and number of fibroids and the location of their growth. A simple, inexpensive, and safe long-term drug treatment option is still lacking, and most symptomatic patients still require surgical treatment. Medication Oral contraceptives can control bleeding symptoms without causing further growth of fibroids. However, the results of studies on progestin treatment of fibroids are more complex. Therefore, close monitoring of fibroids or uterine volume is recommended when oral contraceptives are used to treat fibroids. Epidemiological studies also suggest that combination oral contraceptives and progestin alone may reduce the risk of fibroids developing into clinically significant symptoms. The levonorgestrel intrauterine delayed-release system (Mannorrhea) causes the least systemic effects and acts locally on the endometrium, making it a very effective treatment for excessive menstrual flow. However, there is a higher incidence of IUD removal and spotting vaginal bleeding due to discomfort in these patients. Gonadotropin-releasing hormone agonists – GnRHa – Daphylline, Inhibiton, Leuprolide, etc. After three months of treatment with GnRHa most patients will experience amenorrhea and 35-65% of patients will have a reduction in the size of their uterine fibroids. The FDA approved leuprolide acetate in combination with iron as preoperative treatment for anemic patients, which is most effective in patients with large fibroids. the effect of GnRHa is transient, with the fibroids gradually returning to their previous size within a few months after treatment is stopped. Moreover, the severe menopausal symptoms caused by the drug and the side effects of low estrogen on bone density limit its use. It is recommended that GnRHa should not be used for more than 6 months without concomitant counter-additive therapy. If treatment lasts longer than 6 months, low-dose steroid hormone counter-add-on therapy should be used to reduce ongoing bone loss and control vasodilatory symptoms. Progestin Modulators —- Mifepristone The most widely studied modulating progestin complex is mifepristone. Recent studies have shown it to have no role in the control of uterine fibroid symptoms. High doses of mifepristone have been reported to reduce uterine fibroid volume by 26% to 74%. Compared to its analogues, the recurrence of fibroids after interruption of mifepristone treatment is slower. Amenorrhea is a common symptom during mifepristone use, occurring in up to 90% of cases, with more stable bone mineral density and improved pelvic compression symptoms. Potential side effects of mifepristone include excessive endometrial hyperplasia without atypical hyperplasia (14-28%) and transient elevated transaminase levels (4%), requiring monitoring of liver function. Uterine artery embolization Uterine artery embolization for uterine fibroids is primarily performed by interventional radiologists. Uterine arteries are embolized by transcutaneous femoral artery puncture, resulting in vascular dissection and local tissue degeneration of the uterine fibroids. Uterine artery embolization is performed with polyvinyl alcohol gelatin microsphere pellets, which can also be supplemented with metal coils for vascular ligation to occlude them. The rate of reoperation in patients with uterine artery embolization after 5 years of follow-up was found to be 20% (13.7% for hysterectomy, 4.4% for myomectomy, and approximately 1.6% for repeat embolization), and the rate of failure of symptom control was 25%. Based on the long-term and short-term results of uterine artery embolization, uterine artery embolization is a safe and effective treatment modality for patients who wish to preserve the uterus after appropriate selection. Patients who wish to undergo uterine artery embolization should be thoroughly evaluated by an obstetrician/gynecologist, taking into account the patient’s fertility requirements, thus helping to have optimal collaboration with the interventional radiologist to ensure appropriate treatment. Focused Ultrasound Surgery This non-invasive treatment uses high-intensity ultrasound waves that act directly within the localized fibroids. The ultrasound energy passes through the soft tissue and produces well-defined protein degeneration, unavoidable cell damage and coagulative necrosis. Adverse events include excessive menstrual flow, even requiring blood transfusions; persistent pain and bleeding; hospitalization for nausea; and pain in the legs and hips caused by ultrasound treatment of the sciatic nerve in the distal region (which eventually resolves). The cohort study showed that improvement in symptoms at 12 and 24 months of treatment was related to whether treatment was complete, with adverse events decreasing with experience. Given that safety and efficacy have only been confirmed in short-term return studies, long-term follow-up studies are needed to confirm whether the minimally invasive benefits of MRI-mediated focused ultrasound persist beyond 24 months. The maximum volume for treating uterine fibroids is being explored.