Myomectomy technique, morcellation safety, newer oral medical treatments.
This page is written for clinicians and referrers and is not advice for individual patients. If you are a patient, the plain-language page is Fibroids .
Each week the literature is searched for new papers on fibroids, screened to the few that meet the evidence bar, and each one is verified on PubMed before it is summarised. I read every entry and give one verdict: whether the paper changes what I tell patients or do in theatre, supports current practice, or leaves it unchanged. Papers appear here newest first, grouped by the week they were found, with the study design, the main result and its effect size, and the reason for the verdict. Abstracts are not reproduced; the summaries are my own.
Digest of 5 November 2026
Search window 30 October 2026 to 5 November 2026
Across 23 randomised trials of fibroid treatments, safety was similar, and women needed another procedure less often after myomectomy than after embolisation
PRISMA systematic review with two Bayesian network meta-analyses of 23 randomised trials (2,055 women), searched to July 2026, comparing uterine artery embolisation with hysterectomy, myomectomy, focused ultrasound, microwave ablation and laparoscopic uterine artery occlusion, and comparing embolic agents.
Finding
Technical success and major complications did not differ across strategies in the Bayesian analysis; frequentist analysis gave slightly higher technical success for hysterectomy than embolisation (RR 1.09, 95% CI 1.02 to 1.17). Myomectomy had lower reintervention than embolisation (OR 0.21, 95% CrI 0.10 to 0.40). Results for embolic agents were imprecise and not reproduced in the frequentist analysis (for example higher reintervention with polyvinyl alcohol particles, OR 5.3, 1.4 to 28).
Supports current practicemoderate evidence
Adds durability to the reasons he prefers myomectomy, without changing who is offered what.
What it means
If a woman is weighing embolisation against myomectomy, this supports telling her that embolisation is about as safe in the short term but more often needs a second procedure.
Conflicts of interest: Funding is not stated in the abstract.
Reviewed by Mr Jan, .
Removing retained products with a hysteroscopic tissue removal device: nearly always complete, about 1 in 20 had new adhesions, and no proof it beats standard methods
Systematic review and meta-analysis (PROSPERO CRD420251247904), searched to January 2026, of four studies of hysteroscopic morcellation for retained products of conception: two randomised trials, one prospective and one retrospective study.
Finding
Complete removal 95.0% (95% CI 92.2 to 97.7), additional procedures 6.6% (2.5 to 10.6), new intrauterine adhesions 5.2% (0.4 to 10.0), intraoperative complications 7.5% (3.4 to 11.6) and postoperative complications 3.4% (1.1 to 5.6). Mean procedure time 11.18 minutes (I2 98.8%). In natural frequencies, about 1 woman in 20 developed new adhesions.
No changeweak evidence
A descriptive pooled estimate with no comparator, which does not change how retained products are managed.
What it means
Retained products after birth or miscarriage are a common route into Asherman's, so a figure for new adhesions is worth having when he talks about prevention.
Conflicts of interest: Funding is not stated in the abstract.
Reviewed by Mr Jan, .
Fibroids and miscarriage in a London early pregnancy unit: more miscarriages with fibroids, but no independent link after allowing for age
Prospective observational study over 15 months at a London tertiary early pregnancy unit: 416 women with singleton pregnancies under 10 weeks, 104 with fibroids and 312 controls, all scanned systematically.
Finding
Miscarriage was 22.9% with fibroids against 14.6% without (unadjusted OR 1.74, 95% CI 0.98 to 3.10; adjusted OR 1.49, 0.82 to 2.70). Each additional fibroid raised the odds (OR 1.17, 1.01 to 1.37). Second-trimester pain was more common with fibroids (OR 2.92, 1.43 to 5.97); bleeding did not differ.
Supports current practicemoderate evidence
An underpowered UK study consistent with his focus on cavity-distorting fibroids, not a reason to change advice.
What it means
A woman with fibroids in early pregnancy can be told that age probably matters more than the fibroids, though a small effect, especially with several fibroids, cannot be ruled out.
Conflicts of interest: Funding is not stated in the abstract.
Reviewed by Mr Jan, .
Digest of 29 October 2026
Search window 23 to 29 October 2026
Focused ultrasound treatment of fibroids is followed by a small fall in AMH, with no change in antral follicle count
Systematic review and single-arm meta-analysis of ten studies (two randomised trials and eight case series, 667 women) to January 2026 measuring ovarian reserve before and 3 to 24 months after high-intensity focused ultrasound (HIFU) for fibroids or adenomyosis.
Finding
AMH fell slightly after HIFU (MD -0.12 ng/mL, 95% CI -0.20 to -0.04, I2 0%), and similarly in fibroid-only studies (MD -0.13, -0.22 to -0.05); antral follicle count did not change (2 studies, 140 women; MD -0.05, -0.28 to 0.19). There were too few data for an adenomyosis-specific estimate.
No changeweak evidence
A small, uncontrolled AMH fall that does not change advice on fibroid treatment.
What it means
If a patient asks about HIFU instead of myomectomy, she can be told the effect on egg reserve appears small, but the evidence cannot show it is safe for fertility.
Conflicts of interest: Funding is not stated in the abstract.
Reviewed by Mr Jan, .
Digest of 19 October 2026
Search window 13 to 19 October 2026
Uterine rupture in pregnancy after myomectomy is about 0.3%, higher when the cavity was entered: systematic review
Systematic review (MEDLINE, Embase, Web of Science, Cochrane Library; two reviewers) of 31 studies published between April 2013 and October 2023, covering 13,381 pregnancies after a myomectomy; the cavity-entry comparison rests on 380 women.
Finding
Uterine rupture during pregnancy or labour occurred in 0.30% (40/13,381; 95% CI 0.21-0.41), about 3 in every 1,000 pregnancies. It was more frequent when the cavity had been entered at the myomectomy (3/44, 6.82%) than when it had not (4/336, 1.19%), OR 6.07, p = 0.04. The type of myomectomy (laparoscopic, open or robotic) did not significantly influence the risk, the studies gave insufficient data to estimate the risk in a trial of labour, and no other consistent risk factor was found.
Supports current practicemoderate evidence
Confirms the rupture figure used in counselling, supports recording cavity entry in the operation note for the obstetric team, and gives no reason to steer patients away from laparoscopic or robotic myomectomy.
What it means
For a woman planning a pregnancy after a myomectomy, the womb tearing is rare: about 3 in every 1,000 pregnancies, with no difference between keyhole, robotic and open operations.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Every paper on this site's evidence pages is also available as open data at /evidence/papers.json. The search and screening rules are on the evidence index.
Last reviewed .Reviewed by Mr Haider Jan, Consultant Gynaecologist.
For patients: Fibroids
The plain-language page on what the condition is, how I assess it and the choices, written for the women I see.
