Use of combined hormonal contraceptives in women with uterine fibroids: opinions of practitioners

BACKGROUND: Uterine fibroids are increasingly diagnosed in patients of reproductive age. Combined hormonal contraceptives provide reliable protection against unwanted pregnancy and help to reduce or eliminate various clinical manifestations of uterine fibroids. In practice, obstetrician-gynecologists have “barriers” to prescribing combined hormonal contraceptives to patients with uterine fibroids.

AIM: The aim of this work was to study the features of the clinical approach of obstetrician-gynecologists to the management of patients with uterine fibroids interested in combined hormonal contraception.

MATERIALS AND METHODS: The method of voluntary anonymous questioning was applied to 366 obstetrician-gynecologists. The work experience of 62.1% (n = 227) of doctors was 10 years or more. The questionnaire included questions about various aspects of the use of combined hormonal contraceptives for contraception in women with uterine fibroids.

RESULTS: Only every second (47.5%; n = 174) obstetrician-gynecologist correctly assigns uterine fibroids to the first category of acceptability for combined hormonal contraceptives. The presence of an asymptomatic submucous myomatous node (FIGO 1–2) or dysmenorrhea in women with uterine fibroids is considered by 29.0% (n = 106) and 5.7% (n = 21) of obstetrician-gynecologists, respectively, as a contraindication to the use of combined hormonal contraceptives. Every ninth participant (11.4%; n = 42) believes that the presence of uterine fibroids limits the duration of use of combined hormonal contraceptives for contraception to 1–5 years. Almost half (45.6%; n = 167) of the respondents believe that combined hormonal contraceptives have various effects on uterine fibroids (cause regression or growth of fibroids, increase the risk of new fibroids). More than half (53.3%; n = 195) of the respondents are not informed about the reduction in the risk of developing uterine fibroids when using combined hormonal contraceptives for five years or more.

CONCLUSIONS: In the analyzed cohort of experienced obstetrician-gynecologists, we identified their “barriers” to prescribing combined hormonal contraceptives for contraception for women with uterine fibroids. Those are incomplete awareness of the acceptance criteria for combined hormonal contraceptives and insufficient awareness of the lack of effect of combined hormonal contraceptives on the size of existing myomatous nodes and a decrease in the risk of developing uterine fibroids when using combined hormonal contraceptives for five or more years.