| Treatment Category | Specific Treatment Options | Mechanism of Action | Indications / Patient Selection | Clinical Efficacy | Side Effects / Limitations | MAXO term suggestion |
|---|---|---|---|---|---|---|
| Non-hormonal medical therapy | Tranexamic acid | Antifibrinolytic; reduces menstrual blood loss by inhibiting plasminogen activation | Symptomatic heavy menstrual bleeding (HMB) when uterine preservation desired; useful as symptom-control therapy rather than tumor-directed treatment (pqac-00000010) | Improves fibroid-related abnormal uterine bleeding/heavy menstrual bleeding; does not shrink fibroids (pqac-00000010) | No effect on fibroid size; symptomatic only; thrombotic-risk considerations in selected patients (pqac-00000010) | MAXO: antifibrinolytic therapy |
| Non-hormonal medical therapy | NSAIDs | Reduce prostaglandin-mediated bleeding and pain | Mild-to-moderate bleeding and dysmenorrhea; patients seeking short-term symptom relief (pqac-00000010) | Can reduce pain and some bleeding symptoms, but generally less effective than targeted hormonal suppression for fibroid burden (pqac-00000010) | Symptomatic only; gastrointestinal/renal adverse effects; no fibroid shrinkage (pqac-00000010) | MAXO: nonsteroidal anti-inflammatory drug therapy |
| Hormonal medical therapy | Combined oral contraceptives | Suppress ovulation/endometrial proliferation; reduce menstrual bleeding | Women with bleeding symptoms who desire non-surgical management and contraception (pqac-00000006, pqac-00000007, pqac-00000010) | Helpful for bleeding control; primarily symptom management rather than definitive fibroid treatment (pqac-00000007, pqac-00000010) | Limited effect on fibroid size; estrogen-containing therapy may not suit all patients (pqac-00000010) | MAXO: hormonal therapy |
| Hormonal medical therapy | Progestogens | Endometrial suppression and bleeding control | Selected patients with abnormal uterine bleeding; often short-term or individualized use (pqac-00000007) | May improve bleeding; evidence for fibroid shrinkage is limited (pqac-00000007) | Restricted efficacy for bulk symptoms/size reduction; hormone-related adverse effects (pqac-00000007) | MAXO: progestogen therapy |
| Hormonal medical therapy | Levonorgestrel intrauterine system (LNG-IUS) | Local progestin effect on endometrium, reducing bleeding | Bleeding-predominant symptoms, especially when uterine cavity distortion is not prohibitive (pqac-00000010) | Effective for HMB control in selected women; not a fibroid-eliminating therapy (pqac-00000010) | Expulsion/placement difficulty with cavity distortion; limited effect on bulk symptoms or tumor size (pqac-00000010) | MAXO: intrauterine hormone delivery |
| Hormonal medical therapy | GnRH agonists | Initial pituitary stimulation followed by downregulation, causing hypoestrogenism/hypoprogesteronism | Preoperative bridge therapy, short-term bleeding control, temporary fibroid shrinkage, anemia optimization before surgery (pqac-00000007, pqac-00000010) | Well-established temporary reduction in bleeding and fibroid size; useful as bridge to surgery (pqac-00000001, pqac-00000007, pqac-00000010) | Menopausal symptoms, bone loss with prolonged use, rebound growth after discontinuation (pqac-00000007, pqac-00000010) | MAXO: gonadotropin-releasing hormone agonist therapy |
| Hormonal medical therapy | Oral GnRH antagonists | Direct pituitary GnRH blockade suppressing ovarian steroid production | Symptomatic fibroids with HMB; uterus-sparing medical management; useful when a reversible oral option is preferred (pqac-00000010) | Effective modern option for reducing bleeding and improving symptoms; part of contemporary conservative management (pqac-00000010) | Hypoestrogenic adverse effects; may require add-back strategies; treatment effect is not curative (pqac-00000010) | MAXO: gonadotropin-releasing hormone antagonist therapy |
| Hormonal medical therapy | Selective progesterone receptor modulators (SPRMs), e.g. ulipristal acetate | Modulate progesterone receptor signaling, reducing bleeding and fibroid growth | Historically used for intermittent long-term bleeding and size control in selected women (pqac-00000007, pqac-00000009, pqac-00000010) | Good results reported for bleeding control and fibroid size reduction; response may vary with MED12 status (pqac-00000007, pqac-00000009) | Regulatory/safety limitations in many regions, including liver toxicity concerns; access restricted (pqac-00000007, pqac-00000010) | MAXO: selective progesterone receptor modulator therapy |
| Hormonal medical therapy | Aromatase inhibitors | Lower local/systemic estrogen synthesis | Selected refractory cases or off-label individualized management (pqac-00000010) | May improve symptoms in some patients; evidence base narrower than GnRH-based approaches (pqac-00000010) | Hypoestrogenic effects; not standard first-line treatment (pqac-00000010) | MAXO: aromatase inhibitor therapy |
| Surgical therapy | Myomectomy (hysteroscopic, laparoscopic, open/laparotomic, mini-laparotomic, robotic) | Physical removal of fibroids with uterine preservation | Symptomatic patients desiring fertility preservation or uterine conservation; approach depends on number, size, and location of myomas (pqac-00000007, pqac-00000006) | Effective symptom relief while preserving uterus; review data showed comparable average pregnancy rates between minimally invasive and open approaches (~29.7% vs ~28.5%) (pqac-00000007) | Recurrence risk persists; operative bleeding/adhesions; more invasive than medical/radiologic options (pqac-00000007) | MAXO: myomectomy |
| Surgical therapy | Hysterectomy | Definitive removal of uterus, eliminating fibroids | Women with severe symptoms, no fertility desire, recurrent disease, or failure of conservative options; often considered definitive therapy (pqac-00000007, pqac-00000010) | Most definitive symptom control; fibroid recurrence eliminated because uterus removed (pqac-00000007, pqac-00000010) | Loss of fertility; surgical morbidity; longer recovery than some minimally invasive approaches (pqac-00000007) | MAXO: hysterectomy |
| Minimally invasive / interventional | Uterine artery embolization (UAE) / uterine artery occlusion | Devascularization leading to ischemic shrinkage of fibroids | Symptomatic women seeking uterus-sparing, non-excisional treatment; generally not first choice when future fertility is a major goal (pqac-00000007, pqac-00000010) | Improves bleeding and bulk symptoms in many patients; accepted radiologic option in modern care pathways (pqac-00000007, pqac-00000010) | Post-embolization pain, reintervention/recurrence risk, uncertain reproductive implications relative to myomectomy (pqac-00000007, pqac-00000010) | MAXO: uterine artery embolization |
| Minimally invasive / interventional | High-intensity focused ultrasound (HIFU) / MR-guided focused ultrasound | Thermal ablation of fibroid tissue | Selected women with accessible fibroid anatomy seeking noninvasive uterus-sparing treatment (pqac-00000007, pqac-00000010) | Can reduce symptoms and fibroid volume; post-treatment MRI parameters can predict regrowth/reintervention risk (pqac-00000010) | Not suitable for all fibroid locations/sizes; residual fibroid regrowth can occur; access/expertise dependent (pqac-00000010) | MAXO: focused ultrasound ablation |
| Minimally invasive / interventional | Radiofrequency ablation / myolysis | Thermal destruction of fibroid tissue | Symptomatic fibroids in patients preferring minimally invasive, uterus-preserving treatment (pqac-00000007, pqac-00000010) | Effective symptom-directed minimally invasive option in selected patients (pqac-00000007, pqac-00000010) | Long-term recurrence and fertility data less extensive than for myomectomy; anatomy-dependent feasibility (pqac-00000007) | MAXO: radiofrequency ablation |
| Minimally invasive / interventional | Endometrial ablation | Destruction of endometrium to reduce bleeding | Bleeding-predominant symptoms in carefully selected women not seeking fertility; not a tumor-directed therapy (pqac-00000007) | May reduce bleeding symptoms but does not treat intramural/subserosal tumor burden (pqac-00000007) | Not appropriate for future fertility; limited if cavity distortion is substantial (pqac-00000007) | MAXO: endometrial ablation |
| Supportive care | Iron replacement therapy | Repletes iron stores in iron deficiency/iron deficiency anemia from chronic bleeding | Women with fibroid-related HMB, iron deficiency, or anemia before/after surgery and during medical management (pqac-00000010) | Improves consequences of chronic blood loss and perioperative readiness; important adjunct rather than fibroid-directed therapy (pqac-00000010) | Does not treat underlying fibroids; oral GI intolerance or IV infusion logistics may limit use (pqac-00000010) | MAXO: iron supplementation |
| Experimental / emerging | Vitamin D | Proposed antiproliferative/anti-fibrotic effects; deficiency is a reported risk factor | Investigational or adjunctive setting; biologic rationale strengthened by epidemiologic association with deficiency (pqac-00000007, pqac-00000011) | Promising preclinical and prior xenograft evidence noted in model reviews, but not established standard clinical therapy (pqac-00000011) | Insufficient evidence for routine standalone treatment of symptomatic leiomyoma (pqac-00000011) | MAXO: vitamin supplementation |
| Experimental / emerging | Targeted/precision approaches linked to molecular subtype (e.g., MED12-informed response prediction) | Treatment selection based on tumor driver biology and pathway dependence | Future personalized management, particularly for mutation-stratified hormonal response (pqac-00000009) | Emerging evidence suggests MED12 status may influence response to GnRH agonists and ulipristal acetate (pqac-00000009) | Not yet routine clinical standard; requires broader validation and accessible molecular testing (pqac-00000009) | MAXO: precision medicine intervention |
| Experimental / emerging | Novel agents under investigation | Various pathways including progesterone signaling, ECM remodeling, and other molecular targets | Patients with unmet need for fertility-preserving, long-term, non-surgical options (pqac-00000007, pqac-00000001) | Reviews describe multiple promising investigational therapies, but few are yet approved specifically for fibroids (pqac-00000007, pqac-00000010) | Evidence still evolving; many therapies remain investigational or regionally unavailable (pqac-00000007, pqac-00000010) | MAXO: investigational pharmacotherapy |


*Table: This table summarizes current and emerging treatment options for uterine leiomyoma, including mechanisms, appropriate patient selection, expected efficacy, limitations, and suggested MAXO-aligned intervention labels. It is useful for comparing conservative, surgical, and interventional management strategies in one view.*