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Katon JG, Bossick A, Carey C, Christy A, Doll K, Gatsby E, Gray KE, Lynch KE, Moy E, Owens S, Washington DL, Callegari LS. Racial Disparities in Uterine Fibroid Treatment Among Veterans Using VA Health Care. Womens Health Issues 2023; 33:405-413. [PMID: 37105835 DOI: 10.1016/j.whi.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Uterine fibroids are common, nonmalignant tumors that disproportionately impact Black patients. We aimed to examine Black and White differences in receipt of any treatment and type of first treatment in the Department of Veterans Affairs, including effect modification by severity as approximated by anemia. METHODS We used Department of Veterans Affairs administrative data to identify 5,041 Black and 3,206 White veterans with symptomatic uterine fibroids, identified by International Classification of Diseases, 9th edition, Clinical Modification, codes, between fiscal year 2010 and fiscal year 2012 and followed in the administrative data through fiscal year 2018 for outcomes. Outcomes included receipt of any treatment, hysterectomy as first treatment, and fertility-sparing treatment as first treatment. We stratified all analyses by age (<45, ≥45 years old), used generalized linear models with a log link and Poisson error distribution, included an interaction term between race and anemia, and used recycled predictions to estimate adjusted percentages for outcomes. RESULTS There was evidence of effect modification by anemia for receipt of any treatment but not for any other outcomes. Across age and anemia sub-groups, Black veterans were less likely to receive any treatment than White veterans. Adjusted racial differences were most pronounced among veterans with anemia (<45 years, Black-White difference = -10.3 percentage points; 95% confidence interval, -15.9 to -4.7; ≥45 years, Black-White difference = -20.3 percentage points; 95% confidence interval, -27.8 to -12.7). Across age groups, Black veterans were less likely than White veterans to have hysterectomy and more likely to have a fertility-sparing treatment as their first treatment. CONCLUSIONS We identified significant Black-White disparities in receipt of treatment for symptomatic uterine fibroids. Additional research that centers the experiences of Black veterans with uterine fibroids is needed to inform strategies to eliminate racial disparities in uterine fibroid care.
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Affiliation(s)
- Jodie G Katon
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development (HSR&D), Seattle, Washington; Department of Health Systems and Population Health, University of Washington, Seattle, Washington.
| | - Andrew Bossick
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development (HSR&D), Seattle, Washington; Henry Ford Healthcare System, Detroit, Michigan
| | - Cathea Carey
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development (HSR&D), Seattle, Washington
| | - Alicia Christy
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Kemi Doll
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
| | - Elise Gatsby
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Kristen E Gray
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development (HSR&D), Seattle, Washington; Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Kristine E Lynch
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ernest Moy
- U.S. Department of Veterans Affairs, Office of Health Equity, Washington, District of Columbia
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington
| | - Donna L Washington
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Lisa S Callegari
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development (HSR&D), Seattle, Washington; Department of Health Systems and Population Health, University of Washington, Seattle, Washington; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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Adebamowo CA, Morhason-Bello IO, Adebamowo SN. Validation of self-report of uterine fibroid diagnosis using a transvaginal ultrasound scan. Sci Rep 2023; 13:9091. [PMID: 37277479 DOI: 10.1038/s41598-023-36313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/31/2023] [Indexed: 06/07/2023] Open
Abstract
Self-report of uterine fibroids (UF) has been used for epidemiologic research in different environments. Given the dearth of studies on the epidemiology of UF in Sub-Saharan Africa (SSA), it is valuable to evaluate its performance as a potential tool for much needed research on this common neoplasm in SSA women. We conducted a cross-sectional study of self-report of UF compared with transvaginal ultrasound diagnosis (TVUS) among 486 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria. We used log-binomial regression models to compute the classification, sensitivity, specificity, and predictive values of self-report compared to TVUS, adjusted for significant covariates. The prevalence of UF on TVUS was 45.1% (219/486) compared to 5.4% (26/486) based on self-report of abdominal ultrasound scan and 7.2% (35/486) based on report of healthcare practitioner's diagnosis. Self-report correctly classified 39.5% of the women compared to TVUS in multivariable adjusted models. The multivariable adjusted sensitivity of self-report of healthcare worker diagnosis was 38.8%, specificity was 74.5%, positive predictive value (PPV) was 55.6%, and negative predictive value (NPV) was 59.8%. For self-reported abdominal ultrasound diagnosis, the multivariable adjusted sensitivity was 40.6%, specificity was 75.3%, PPV was 57.4%, and NPV was 60.6%. Self-report significantly underestimates the prevalence of UF and is not accurate enough for epidemiological research on UF. Future studies of UF should use population-based designs and more accurate diagnostic tools such as TVUS.
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Affiliation(s)
- Clement A Adebamowo
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 West Redwood Street, Baltimore, MD, 21201, USA.
- Greenebaum Comprehensive Cancer Center, School of Medicine, University of Maryland, Baltimore, MD, USA.
- Center for Bioethics and Research, Ibadan, Nigeria.
- Institute of Human Virology Nigeria, Abuja, Nigeria.
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, and the Institute of Advanced Medical Research and Training College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 West Redwood Street, Baltimore, MD, 21201, USA
- Greenebaum Comprehensive Cancer Center, School of Medicine, University of Maryland, Baltimore, MD, USA
- Center for Bioethics and Research, Ibadan, Nigeria
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Cappelli A, Mosconi C, Cocozza MA, Brandi N, Bartalena L, Modestino F, Galaverni MC, Vara G, Paccapelo A, Pizzoli G, Villa G, Seracchioli R, Renzulli M. Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience. J Pers Med 2023; 13:906. [PMID: 37373895 PMCID: PMC10302260 DOI: 10.3390/jpm13060906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive.
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Affiliation(s)
- Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Laura Bartalena
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Maria Cristina Galaverni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
| | - Gloria Pizzoli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.P.); (G.V.); (R.S.)
| | - Gioia Villa
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.P.); (G.V.); (R.S.)
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (G.P.); (G.V.); (R.S.)
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (A.C.); (C.M.); (M.A.C.); (L.B.); (F.M.); (M.C.G.); (G.V.); (A.P.); (M.R.)
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Neblett MF, Stewart EA. Oral Gonadotropin-Releasing Hormone Antagonists for the Treatment of Uterine Leiomyomas. Obstet Gynecol 2023; 141:901-910. [PMID: 37103532 DOI: 10.1097/aog.0000000000005145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/27/2022] [Indexed: 04/28/2023]
Abstract
Uterine leiomyomas are common hormone-responsive neoplasms that frequently cause heavy menstrual bleeding, anemia, pelvic pressure, pain, and adverse reproductive outcomes. In this overview, the efficacy and safety of oral gonadotropin-releasing hormone (GnRH) antagonists, co-administered with menopausal replacement-level steroid hormones or used at doses to avoid complete hypothalamic suppression, are reviewed for the management of uterine leiomyomas. Oral GnRH antagonists provide rapid suppression of sex steroids and avoid the initial steroidal flare and resultant temporary worsening of symptoms typically seen with parenteral GnRH agonists. Oral GnRH antagonists are effective in reducing leiomyoma-associated heavy menstrual bleeding, with high rates of amenorrhea and improved anemia and leiomyoma-associated pain, and providing modest reduction in uterine volume when used in combination with menopausal replacement-level steroid hormones. This add-back therapy can reduce hypogonadal side effects, including hot flushes and bone mineral density loss, close to levels seen with placebo therapy. Currently, both elagolix 300 mg twice daily with once-daily estradiol (1 mg) and norethindrone (0.5 mg) and relugolix 40 mg once daily with estradiol (1 mg) and norethindrone (0.5 mg) combination therapy are approved for leiomyoma treatment by the U.S. Food and Drug Administration. Linzagolix is under investigation in the United States but approved at two does with and without steroid hormones in the European Union. The efficacy of these agents appears to be robust over a wide spectrum of clinical presentations, demonstrating that worse disease parameters at baseline do not appear to inhibit efficacy. Across clinical trials, participants largely reflected the population of individuals affected by uterine leiomyomas.
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Affiliation(s)
- Michael F Neblett
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, the Department of Physiology and Biomedical Engineering, the Division of Endocrinology, Department of Medicine, the Department of Surgery, and the Women's Health Research Center, Mayo Clinic, and Mayo Clinic Alix School of Medicine, Rochester, Minnesota
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Sattar S, Naimzadeh D, Behaeddin BC, Fonarov I, Casadesus D. Uterine Artery Embolization in a Patient With Large Uterine Fibroids. Cureus 2023; 15:e39740. [PMID: 37398722 PMCID: PMC10310461 DOI: 10.7759/cureus.39740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
A woman in her 20s with no past medical history presented to the emergency department with a 4-day history of abdominal pain. Imaging revealed several large uterine fibroids that compressed various intra-abdominal structures. Options of observation, medical management, surgical management with abdominal myomectomy, and uterine artery embolization (UAE) were discussed. The patient was counseled about the associated risks of UAE and myomectomy. Since both procedures have a risk of infertility, the patient elected to proceed with uterine artery embolization due to the less invasive nature of the procedure. She was discharged after one day in the hospital following the procedure and readmitted three days later for suspected endometritis. The patient was treated with antibiotics for five days and discharged home. Eleven months post-procedure, the patient became pregnant. The patient had achieved a full-term delivery at 39 weeks and two days via a cesarean section secondary to a breech presentation.
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Affiliation(s)
- Safura Sattar
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - David Naimzadeh
- Internal Medicine, Henry Ford Health System, Clinton Township, USA
| | - Bita C Behaeddin
- Medicine, St. George's University School of Medicine, Great River, USA
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Ilya Fonarov
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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Tal MG, Keidar R, Magnazi G, Henn O, Kim JH, Chudnoff SG, Stepp KJ. Pressure-Induced Fibroid Ischemia: First-In-Human Experience with a Novel Device for Laparoscopic Treatment of Symptomatic Uterine Fibroids. Reprod Sci 2023; 30:1366-1375. [PMID: 35941511 PMCID: PMC9360636 DOI: 10.1007/s43032-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to assess the feasibility of use of a novel uterine fibroid treatment device hypothesized to cause fibroid infarction by increasing intra-tumoral pressure. Between August 2019 and January 2020, 21 uterine fibroids were treated in 16 symptomatic pre-menopausal black women. Pelvic magnetic resonance imaging was performed before the procedure, a day after the procedure and at 1, 3, 6, and 12 months. The subjects were also followed for clinical outcomes and quality of life up to 12 months at a single investigational site. At 3 months, the mean reduction in the fibroid volume was 36.3% (P = .002). Incremental reduction in volume peaked at the end of the follow-up, at the 12-month mark (60.4%; P = .008). There were no procedures in which the users failed to perform laparoscopic pressure suturing of fibroids with the pressure-induced fibroid ischemia device. Improvement in the quality of life was evident in the Health-Related Quality of Life total, Energy/Mood, Control, and Sexual Function domains of the Uterine Fibroid Symptom and Quality of Life questionnaire at 3 months post-procedure. Unanticipated risks were not identified. Serious adverse events were not identified. The initial clinical assessment of the pressure-induced fibroid ischemia device supports feasibility of the approach and does not reveal serious safety concerns. Trial is currently being registered retrospectively (This was a feasibility study and therefore registration was not mandatory).
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Affiliation(s)
- Michael G Tal
- Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel.
| | - Ran Keidar
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Ohad Henn
- Empress Medical Ltd., Tel Aviv, Israel
| | - Jin Hee Kim
- Department of Obstetrics & Gynecology, Columbia University, New York, NY, USA
| | - Scott G Chudnoff
- Obstetrics and Gynecology, Maimonides Medical Center, New York, NY, USA
| | - Kevin J Stepp
- Atrium Health Women's Care Urogynecology and Pelvic Surgery, Atrium Health, Charlotte, NC, USA
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Dumitrașcu MC, Nenciu CG, Nenciu AE, Călinoiu A, Neacșu A, Cîrstoiu M, Șandru F. Laparoscopic myomectomy - The importance of surgical techniques. Front Med (Lausanne) 2023; 10:1158264. [PMID: 37020679 PMCID: PMC10067888 DOI: 10.3389/fmed.2023.1158264] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 04/07/2023] Open
Abstract
Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To improve outcomes, research regarding port access, suture type, morcellation, and complication management remains ongoing. Myomectomy is the main surgical option for patients seeking uterus-sparing procedures to maintain future fertility. The laparoscopic technique is the most important in these cases, given that possible complications can impact fertility and pregnancy outcomes. Herein, we reviewed and collated the available data regarding different suture techniques, including advantages, difficulties, and possible long-term impacts.
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Affiliation(s)
- Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Cătălin-George Nenciu
- Department of Obstetrics and Gynecology, “St. John” Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Adina-Elena Nenciu
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Amalia Călinoiu
- Department of Internal Medicine, “Prof. Dr. Agripa Ionescu” Emergency Hospital, Bucharest, Romania
| | - Adrian Neacșu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, “St. John” Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Monica Cîrstoiu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, Elias Emergency University Hospital, Bucharest, Romania
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Palheta MS, Medeiros FDC, Severiano ARG. Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning. Radiol Bras 2023; 56:86-94. [PMID: 37168038 PMCID: PMC10165971 DOI: 10.1590/0100-3984.2022.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/04/2022] [Indexed: 05/13/2023] Open
Abstract
Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.
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McKain L, Edsall K, Dufour R, Lickert C. Treatment Patterns in Patients with Uterine Fibroids With and Without a Diagnosis of Heavy Menstrual Bleeding: Results from a Large U.S. Claims Database. J Womens Health (Larchmt) 2023; 32:332-340. [PMID: 36413048 PMCID: PMC9993160 DOI: 10.1089/jwh.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This retrospective database analysis describes clinical characteristics and treatment patterns of U.S. women with a diagnosis for uterine fibroids (UF), both with and without heavy menstrual bleeding (HMB). Materials and Methods: Two cohorts aged 18-50 years with an incident UF diagnosis, comprising women with and without claims for HMB (UF-HMB and UF-only), were identified from the IQVIA PharMetrics® Plus database (January 1, 2010-December 31, 2019). The index date was the first UF claim following diagnosis; treatment patterns were documented for postindex years 1 and 2 and the full duration of postindex follow-up. Also identified were claims for symptoms or signs potentially associated with UF. Outcomes were the proportion of patients treated with pharmacologic therapies of interest and gynecologic procedures. Logistic regression was used to identify factors associated with postdiagnosis hysterectomy and hormonal therapy. Results: A total of 66,313 (71.8%) women were included in the UF-HMB cohort (mean age [standard deviation]) 42.6 [5.4] years), and 26,068 (28.2%) in the UF-only cohort (41.8 [6.3]). Median follow-up was ∼4 years. Pain was the most common symptom (42.7% in patients with UF-HMB and 36.6% with UF-only); also common were abnormal bleeding (15.6%, 11.5%) and fatigue (22.2%, 15.5%). Within 1 year of UF diagnosis, 28.8% and 49.2% of women with UF-HMB and UF-only, respectively, had no claims for relevant pharmacologic or surgical treatment. In logistic regression, multiple factors were associated with a higher likelihood of receiving hysterectomy or hormonal therapy. Conclusions: Patients with UF-HMB were more likely to receive UF treatment, either surgical or pharmacologic, than women with UF-only. Apart from HMB, pain was the most commonly documented symptom of UF.
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Affiliation(s)
- Laura McKain
- Medical Affairs, Myovant Sciences, Inc., Brisbane, California, USA
| | - Kaitlyn Edsall
- Life Sciences Practice, Charles River Associates, Boston, Massachusetts, USA
| | - Robert Dufour
- Medical Affairs, Myovant Sciences, Inc., Brisbane, California, USA
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Lei Y, Yang L, Yang H, Li M, Ou L, Bai Y, Dong T, Gao F, Wei P. The efficacy and safety of Chinese herbal medicine Guizhi Fuling capsule combined with low dose mifepristone in the treatment of uterine fibroids: a systematic review and meta-analysis of 28 randomized controlled trials. BMC Complement Med Ther 2023; 23:54. [PMID: 36803997 PMCID: PMC9938629 DOI: 10.1186/s12906-023-03842-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/11/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE Guizhi Fuling Capsule (GZFL), a classic traditional Chinese medicine prescription, is often recommended for the treatment of uterine fibroids (UFs). However, the efficacy and safety of GZFL in combination with low-dose mifepristone (MFP) remains controversial. MATERIALS AND METHODS We searched eight literature databases and two clinical trial registries for randomized controlled trials (RCTs) of the efficacy and safety of GZFL combined with low-dose MFP in the treatment of UFs from database inception to April 24, 2022. Data analysis was performed using the Meta package in RStudio and RevMan 5.4. GRADE pro3.6.1 software was used for the assessment of evidence quality. RESULTS Twenty-eight RCTs were included in this study, including a total of 2813 patients. The meta-analysis showed that compared with low-dose MFP alone, GZFL combined with low-dose MFP significantly reduced follicle stimulating hormone (p < 0.001), estradiol (p < 0.001), progesterone (p < 0.001), luteinizing hormone (p < 0.001), uterine fibroids volume (p < 0.001), uterine volume (p < 0.001), menstrual flow (p < 0.001) and increased clinical efficiency rate (p < 0.001). Meanwhile, GZFL combined with low-dose MFP did not significantly increase the incidence of adverse drug reactions compared with low-dose MFP alone (p = 0.16). The quality of the evidence for the outcomes ranged from "very low" to "moderate." CONCLUSION This study suggests that GZFL combined with low-dose MFP is more effective and safe in the treatment of UFs, and it is a potential treatment for UFs. However, due to the poor quality of the included RCTs formulations, we recommend a rigorous, high-quality, large-sample trial to confirm our findings.
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Affiliation(s)
- Yiming Lei
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lili Yang
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Honglian Yang
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Min Li
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Li Ou
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yang Bai
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Taiwei Dong
- Shaanxi University of Chinese Medicine, Xianyang, China
| | - Feng Gao
- Shaanxi University of Chinese Medicine, Xianyang, China.
| | - Peifeng Wei
- The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China.
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Fajardo OM, Chaves KF, Zhao Z, Curlin HL, Harvey LFB, Anderson TL. Preoperative Hematocrit Level and Associated Risk of Transfusion for Myomectomy Based on Myoma Burden and Surgical Route. J Minim Invasive Gynecol 2023; 30:115-121. [PMID: 36332821 DOI: 10.1016/j.jmig.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To determine the association between preoperative hematocrit level and risk of blood transfusion for laparotomic and laparoscopic myomectomy based on myoma burden and surgical route. DESIGN A cohort study of prospectively collected data. SETTING American College of Surgeons National Surgical Quality Improvement Program participating institutions. PATIENTS A total of 26 229 women who underwent a laparotomic or laparoscopic myomectomy from 2010 to 2020. INTERVENTIONS The primary outcome assessed was the risk of transfusion based on preoperative hematocrit level. This was evaluated with respect to myoma burden and surgical route. MEASUREMENTS AND MAIN RESULTS There were 26 229 women who underwent a myomectomy during the study interval, 2345 women (9%) of whom required a blood transfusion. Compared with patients who did not require transfusion, those who did had lower median preoperative hematocrit levels (34.7 vs 38.2). Patients were stratified by surgical approach (laparotomic vs laparoscopic) and myoma burden (1-4 myomas/weight ≤250 g or ≥5 myomas/weight >250 g) using Current Procedural Terminology codes (58140, 58146, 58545, 58546). In all categories, there was an inverse relationship between blood transfusion and preoperative hematocrit level with increasing risk depending on preoperative hematocrit range. The odds ratios comparing hematocrit level of 29% with 39% were 6.16 (95% confidence interval [CI], 5.15-7.36), 4.92 (95% CI, 4.19-5.78), 4.85 (95% CI, 3.72-6.33), and 5.2 (95% CI, 3.63-7.43) for patients with laparotomic (1-4 myomas/≤250 g, ≥5 myomas/>250 g) and laparoscopic myomectomy (1-4 myomas/≤250 g, 5 myomas/>250 g), respectively. CONCLUSION Incremental increases in hematocrit result in a significantly decreased risk of blood transfusion at the time of myomectomy.
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Affiliation(s)
- Olga M Fajardo
- Minimally Invasive Gynecologic Surgery Division, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Fajardo, Chaves, Curlin, Harvey and Anderson), Nashville, Tennessee.
| | - Katherine F Chaves
- Minimally Invasive Gynecologic Surgery Division, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Fajardo, Chaves, Curlin, Harvey and Anderson), Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University (Mr. Zhao), Nashville, Tennessee
| | - Howard L Curlin
- Minimally Invasive Gynecologic Surgery Division, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Fajardo, Chaves, Curlin, Harvey and Anderson), Nashville, Tennessee
| | - Lara F B Harvey
- Minimally Invasive Gynecologic Surgery Division, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Fajardo, Chaves, Curlin, Harvey and Anderson), Nashville, Tennessee
| | - Ted L Anderson
- Minimally Invasive Gynecologic Surgery Division, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center (Drs. Fajardo, Chaves, Curlin, Harvey and Anderson), Nashville, Tennessee
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Use of Conservative Therapies Before Hysterectomy for Uterine Leiomyomas. Obstet Gynecol 2023; 141:371-374. [PMID: 36649332 DOI: 10.1097/aog.0000000000005053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/13/2022] [Indexed: 01/18/2023]
Abstract
We used a claims database to identify patients with uterine leiomyomas who underwent hysterectomy between 2011 and 2019. Use of conservative medical and surgical interventions in the 24-month period before hysterectomy was explored. Overall, 59.7% of patients did not receive any conservative intervention before hysterectomy. Individuals who underwent hysterectomy in more recent years and those with endometriosis, abnormal bleeding, greater comorbidity, or prior venous thromboembolism were more likely to receive conservative interventions.
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Li AH, Chen L, Melamed A, Hershman DL, Wright JD. Medical and surgical retreatment for uterine leiomyoma after myomectomy. BJOG 2023; 130:835-837. [PMID: 36705431 DOI: 10.1111/1471-0528.17409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/03/2022] [Accepted: 12/06/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Alicia H Li
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ling Chen
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Alexander Melamed
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA.,Joseph L. Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, New York, New York, USA.,Herbert Irving Comprehensive Cancer Center, New York, New York, USA.,New York Presbyterian Hospital, New York, New York, USA
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Steffen DA, Najafi A, Binkert CA. Postinterventional Patient Comfort After Uterine Artery Embolization and Superior Hypogastric Nerve Block. Cardiovasc Intervent Radiol 2023; 46:152-157. [PMID: 36352125 DOI: 10.1007/s00270-022-03290-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the duration and effect of superior hypogastric nerve block (SHNB) with ropivacaine and clonidine on postinterventional pain levels and opioid requirements in patients undergoing uterine artery embolization. MATERIALS AND METHODS Postinterventional pain levels (numeric rating scale, NRS 0-10) and opioid doses were retrospectively analyzed in 53 patients undergoing transfemoral uterine artery embolization and intraprocedural superior hypogastric nerve block during 24 h. A mixture of 150 mg of ropivacaine and 150 µg of clonidine was used for the block. RESULTS Postinterventional pain averaged between 1.4 and 2.0 during the first 9 h, after which a small but significant increase was observed (NRS 1.7 ± 1.6 vs. NRS 2.6 ± 2.2, p < 0.001). 70% of patients did not exceed a tolerable pain threshold of NRS 4 during the first 9 h after the intervention. Thirty-three patients (62%) did not require any opioid medication. Mean iv morphine dose was 3.1 ± 4.7 mg, whereas 71% of opioid doses were administered after 9 h. CONCLUSION Superior hypogastric nerve block using a mixture of ropivacaine and clonidine provides good pain relief for 9 h after uterine artery embolization requiring only very low amounts of additional opioids.
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Affiliation(s)
- Dominik A Steffen
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Arash Najafi
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Christoph A Binkert
- Department of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
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Harada T, Taniguchi F, Guo S, Choi YM, Biberoglu KO, Tsai SS, Alborzi S, Al‐Jefout M, Chalermchokcharoenkit A, Sison‐Aguilar AG, Fong Y, Senanayake H, Popov A, Hestiantoro A, Kaufman Y. The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis. Reprod Med Biol 2023; 22:e12535. [PMID: 37701076 PMCID: PMC10493363 DOI: 10.1002/rmb2.12535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023] Open
Abstract
This is the first guidelines for adenomyosis from the Asian Society of Endometriosis and Adenomyosis.
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Affiliation(s)
| | | | - Sun‐Wei Guo
- OB/GYN HospitalFudan UniversityShanghaiChina
| | | | | | | | | | - Moamar Al‐Jefout
- United Arab Emirates University, College of Medicine and Health SciencesAbu DhabiUAE
| | | | | | - Yoke‐Fai Fong
- National University of SingaporeSingapore CitySingapore
| | | | - Alexander Popov
- Moscow Regional Scientific Research Institute of Obstetrics and GynecologyMoscowRussia
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An Extremely Rare Case of Disseminated Peritoneal Leiomyomatosis with a Pelvic Leiomyosarcoma and Omental Metastasis after Laparoscopic Morcellation: Systematic Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12123219. [PMID: 36553227 PMCID: PMC9777378 DOI: 10.3390/diagnostics12123219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Minimally invasive treatment of uterine fibroids usually requires a power morcellation, which could be associated with several complications. A rare sequela is disseminated peritoneal leiomyomatosis. Indeed, recurrence or metastasis in these cases could be attributed to iatrogenic or under-evaluation of primary tumors, although a subset of cases is a sporadic sample of biological progression. We present an extremely rare case of a patient who underwent laparoscopic morcellation and after 12 years developed a pelvic leiomyosarcoma with two omental metastases, disseminated peritoneal leiomyomatosis with a parasite leiomyoma with bizarre nuclei and a parasite cellular leiomyoma simultaneously. The diagnosis was predicted preoperatively by an expert sonographer who recognized the ultrasound characteristics of uterine sarcoma and the localization of some of the masses, so the patient was referred to the gynaecological oncologists who could appropriately treat her. We present here a case report and a systematic review that could be a useful tool for further discussion and future clinical practice guidelines.
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Sadick M, Hofmann L, Weiß C, Tuschy B, Schönberg SO, Zöllner FG. Long-term evaluation of uterine fibroid embolisation using MRI perfusion parameters and patient questionnaires: preliminary results. BMC Med Imaging 2022; 22:214. [PMID: 36471287 PMCID: PMC9724260 DOI: 10.1186/s12880-022-00926-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Uterine fibroid embolisation (UFE) is an established treatment method for symptomatic uterine myomas. This study evaluates the efficacy of UFE using objective magnetic resonance imaging (MRI) data for size and perfusion analysis as well as patient questionnaires assessing fibroid-related symptoms. METHOD Patients underwent MR-Angiography before UFE and 4 days, 6 and 12 months after the procedure. The images were evaluated using dedicated software. Patient questionnaires were completed before UFE and at 12 months follow-up, focussing on the embolization procedure and symptoms associated with uterine fibroids. Statistical analysis of the questionnaires was performed using paired sample t-test and Wilcoxon signed rank test, while Kruskal-Wallis test and Friedman test were applied for MRI-analysis. RESULTS Eleven women were included. There was a significant reduction in fibroid-related symptoms. The volume reduction after 12 months was significant in both, uterus and myomas, after an initial increase in uterine volume at the first post-interventional MRI. The perfusion analysis showed that blood flow to the fibroids could be significantly reduced up to 12 months after UFE while uterine tissue was not affected. CONCLUSION This study shows that uterine fibroid embolisation induces a significant long-term decrease in myoma size and perfusion while healthy uterine tissue remains unaffected. Fibroid-related symptoms are reduced for the sake of improved quality of life.
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Affiliation(s)
- Maliha Sadick
- grid.7700.00000 0001 2190 4373Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Leonie Hofmann
- grid.7700.00000 0001 2190 4373Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christel Weiß
- grid.7700.00000 0001 2190 4373Department for Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Benjamin Tuschy
- grid.7700.00000 0001 2190 4373Department for Gynaecology and Obstetrics, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O. Schönberg
- grid.7700.00000 0001 2190 4373Clinic for Radiology and Nuclear Medicine, University Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Frank G. Zöllner
- grid.7700.00000 0001 2190 4373Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Al-Hendy A, Lukes AS, Poindexter AN, Venturella R, Villarroel C, McKain L, Li Y, Wagman RB, Stewart EA. Long-term Relugolix Combination Therapy for Symptomatic Uterine Leiomyomas. Obstet Gynecol 2022; 140:920-930. [PMID: 36357960 PMCID: PMC9665945 DOI: 10.1097/aog.0000000000004988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In the LIBERTY 1 and LIBERTY 2 placebo-controlled trials, once-daily relugolix combination therapy reduced menstrual blood loss volume and pain in women with heavy menstrual bleeding associated with uterine leiomyomas and was well tolerated, with preservation of bone mineral density (BMD) through 24 weeks. Here we report the long-term efficacy and safety of relugolix combination therapy treatment for up to 52 weeks. METHODS Women with uterine leiomyoma-associated heavy menstrual bleeding who completed any treatment arm in either the LIBERTY 1 or LIBERTY 2 trial were eligible to enroll in a 28-week long-term extension study. All participants received once-daily relugolix combination therapy (40 mg relugolix, estradiol 1 mg, norethindrone acetate 0.5 mg) in the extension study. The primary efficacy endpoint was the proportion of women who achieved or maintained a menstrual blood loss volume of less than 80 mL and a 50% or greater reduction in menstrual blood loss volume from LIBERTY study baseline to the last 35 days of treatment (defined as responders ). Analyses were conducted for all three randomized treatment groups from pivotal studies. RESULTS Overall, 477 women enrolled, 476 were treated, and 363 (76.1%) completed 52 weeks. Among patients treated with relugolix combination therapy through 52 weeks (n=163), sustained improvement in heavy menstrual bleeding was observed in 87.7% (responders). The least squares mean menstrual blood loss volume reduction was 89.9%, with 70.6% of patients achieving amenorrhea. At week 52, 59.0% of patients with anemia at baseline had improvements in hemoglobin concentration of greater than 2 g/dL. Distress due to uterine leiomyoma-associated symptoms measured by the BPD (Bleeding and Pelvic Discomfort) scale score was reduced by 51.3 points. Sustained reductions in uterine and uterine leiomyoma volume were observed. Bone mineral density was preserved through week 52. CONCLUSION Improvements in heavy menstrual bleeding and anemia and reduction of uterine leiomyoma-associated symptom burden were sustained through up to 52 weeks of treatment with relugolix combination therapy in women with uterine leiomyomas. No new safety concerns were identified, and BMD was maintained. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT03049735; NCT03103087; NCT03412890. FUNDING SOURCE Myovant Sciences GmbH.
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Affiliation(s)
- Ayman Al-Hendy
- University of Chicago, Chicago, Illinois; Carolina Woman's Wellness Center, Durham, North Carolina; Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Texas; University Magna Graecia, Catanzaro, Italy; Instituto de Investigaciones Materno Infantil (IDIMI), University of Chile, Santiago, Chile; McKain Consulting, LLC, Las Vegas, Nevada; Myovant Sciences Inc., Brisbane, California; and Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, Minnesota
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Wegienka G, Havstad S, Coleman C, Cooper T, Wesselink A, Upson K, Marsh EE, Vines AI, Harmon Q, Baird D, Wise LA. Ultrasound-Confirmed, Age-Specific Uterine Leiomyoma Incidence in a Cohort of Black Individuals. Obstet Gynecol 2022; 140:1042-1048. [PMID: 36357982 PMCID: PMC9712257 DOI: 10.1097/aog.0000000000004997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the age-specific incidence of uterine leiomyomas identified by transvaginal ultrasonography among participants in SELF (Study of Environment, Lifestyle & Fibroids). METHODS SELF is a longitudinal cohort study of individuals aged 23-35 years who self-identified as Black. Participants were recruited from the Detroit, Michigan, area and underwent up to five transvaginal ultrasonograms over a period of up to 10 years to identify uterine leiomyomas. We randomly imputed incidence dates between the last ultrasonogram date in which no leiomyomas were detected and the date of the ultrasonogram in which leiomyomas were first detected. We used Poisson regression to estimate age-specific incidence rates per 1,000 person-years with 95% CIs. The rates were then compared with those of the BWHS (Black Women's Health Study) and the NHS II (Nurses' Health Study II)-two prospective cohort studies based on self-reported leiomyoma diagnoses. RESULTS In this cohort, 1,693 participants completed a baseline interview and ultrasonogram. We excluded 385 (22.7%) participants with leiomyomas detected during baseline, seven participants whose ultrasonograms were poor quality, and 60 participants with only a baseline ultrasonogram. Among the remaining 1,241 participants, the overall incidence rate was 53.9 cases per 1,000 person-years (95% CI 48.6-59.6). The age-specific incidence rates (cases/1,000 person-years) were: younger than 30 years: 49.7, 95% CI 40.9-59.9; 30-34 years: 55.2, 95% CI 47.0-64.3; and 35-39 years: 58.2, 95% CI 47.3-70.9. Among participants aged younger than 30 years, the incidence rate in SELF was more than double that of the BWHS or the NHS II. CONCLUSION The high age-specific leiomyoma incidence rates in this prospective ultrasound-based study indicate that many young Black individuals with leiomyomas go undiagnosed. These data suggest that individuals could benefit from ultrasound screening when they experience symptoms compatible with leiomyomas (eg, heavy menstrual bleeding, anemia, pelvic pain).
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Affiliation(s)
- Ganesa Wegienka
- Department of Public Health Sciences and the Division of Ultrasound, Department of Diagnostic Radiology, Henry Ford Health, Detroit, the Department of Obstetrics, Gynecology and Reproductive Biology, and the Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, and the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; the Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, the Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, and the Department of Health and Human Services, Durham, North Carolina
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Harmon QE, Patchel SA, Denslow S, LaPorte F, Cooper T, Wise LA, Wegienka G, Baird DD. Vitamin D and uterine fibroid growth, incidence, and loss: a prospective ultrasound study. Fertil Steril 2022; 118:1127-1136. [PMID: 36150919 PMCID: PMC9771933 DOI: 10.1016/j.fertnstert.2022.08.851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Fibroid treatments that have few side-effects and can preserve fertility are a clinical priority. We studied the association between serum vitamin D and uterine fibroid growth, incidence, and loss. DESIGN A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds, measure 25-hydroxyvitamin D (25(OH)D), and update covariates. SETTING Detroit, Michigan area. PATIENTS Self-identified African American or Black women aged 23-35 at enrollment without previous clinical diagnosis of fibroids. INTERVENTION(S) Serum 25(OH)D measured using immunoassay or liquid chromatography-tandem mass spectrometry. MAIN OUTCOME MEASURE(S) The primary outcomes were fibroid growth, as measured by change in log volume per 18 months, and fibroid incidence (first detection of fibroid in previously fibroid-free uterus). Adjusted growth estimates from linear mixed models were converted to estimated difference in volume for high vs. low 25(OH)D. Incidence differences were estimated as hazard ratios from age-specific Cox regression. A secondary outcome fibroid loss (reduction in fibroid number between visits), was modeled using Poisson regression. Covariates (reproductive and hormonal variables, demographics, body mass index, current smoking) and 25(OH)D were modeled as time-varying factors. RESULT(S) At enrollment among 1,610 participants with ≥1 follow-up ultrasound, mean age was 29.2 years, 73% had deficient vitamin D (<20ng/mL), and only 7% had sufficient vitamin D (≥30ng/mL). Serum 25(OH)D ≥20ng/mL compared with <20ng/mL was associated with an estimated 9.7% reduction in fibroid growth (95% confidence interval [CI]: -17.3%, -1.3%), similar to the minimally adjusted estimate -8.4% (95% CI: -16.4, 0.3). Serum 25(OH)D ≥30ng/mL compared with <30ng/mL was associated with an imprecise 22% reduction in incidence (adjusted hazard ratio=0.78; 95% CI: 0.47, 1.30), similar to the unadjusted estimate of 0.84 (95% CI: 0.51, 1.39). The >30ng/mL group also had a 32% increase in fibroid loss (adjusted risk ratio=1.32; 95% CI: 0.95, 1.83). CONCLUSION(S) Our data support the hypothesis that high concentrations of vitamin D decrease fibroid development but are limited by the few participants with serum 25(OH)D ≥30ng/mL. Interventional trials that raise and maintain 25(OH)D concentrations >30ng/mL and then prospectively monitor fibroid development are needed to further assess supplemental vitamin D efficacy and determine optimal treatment protocols.
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Affiliation(s)
- Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina.
| | - Stacy A Patchel
- Public Health and Epidemiology Practice at Westat, Durham, North Carolina
| | - Sheri Denslow
- Social & Scientific Systems, Inc., a DLH Holdings company, Durham, North Carolina
| | - Frankie LaPorte
- Social & Scientific Systems, Inc., a DLH Holdings company, Durham, North Carolina
| | - Tracy Cooper
- Division of Ultrasound, Department of Diagnostic Radiology, Henry Ford Health, Detroit, Michigan
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
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Alomar O, Abu-Zaid A, Jamjoom MZ, Almubarki AAMA, Alsehaimi SO, Alabdrabalamir S, Baradwan S, Abuzaid M, Alshahrani MS, Khadawardi K, Badghish E, Bakhsh H, Baalharith MA, Bukhari IA, Baradwan A, Salem H, Al-Badawi IA. Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: A systematic review and meta-analysis of 11 controlled trials. J Gynecol Obstet Hum Reprod 2022; 51:102485. [DOI: 10.1016/j.jogoh.2022.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
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Characteristics of Submucous Myomas and the Risk of Anemia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111652. [PMID: 36422191 PMCID: PMC9699579 DOI: 10.3390/medicina58111652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas >60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 >10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if > of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.
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Alli A, Thomas AM, Kling JM, Ball RL. Providing Fertility-Sparing Treatment Options for Fibroid Uterus. J Womens Health (Larchmt) 2022; 31:1526-1528. [DOI: 10.1089/jwh.2022.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adebisi Alli
- Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Alyssa M. Thomas
- Department of Emergency Medicine, Houston Methodist Baytown Hospital, Baytown, Texas, USA
| | - Juliana M. Kling
- Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Randall L. Ball
- Department of Gynecology, Phoenix VA Health Care System, Phoenix, Arizona, USA
- Department OB/GYN, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
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Park JW, Choi HY. Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report. World J Clin Cases 2022; 10:11204-11209. [PMID: 36338202 PMCID: PMC9631125 DOI: 10.12998/wjcc.v10.i30.11204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids. Although this procedure is safe and effective, adverse outcomes are becoming a major problem.
CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment. The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids. The ventral hernia, which occurred due to atrophied muscle layers following the procedure, was confirmed by imaging studies and intraoperative findings. She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.
CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates. Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment. Post-procedural long-term follow-up for detecting delayed adverse effects is important.
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Affiliation(s)
- Jung-Woo Park
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan 49201, South Korea
| | - Hwa Yeon Choi
- Department of Obstetrics and Gynecology, Dong-A University College of Medicine, Busan 49201, South Korea
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Kelly B, Buttigieg E. Evaluation and Management of Heavy Vaginal Bleeding (Noncancerous). Obstet Gynecol Clin North Am 2022; 49:591-606. [PMID: 36122987 DOI: 10.1016/j.ogc.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heavy vaginal bleeding is a common, life-altering condition affecting around 30% of women at some point in their reproductive lives. Initial evaluation should focus on hemodynamic stability. A thorough history including the patient's menstrual cycle and personal and family bleeding history should be obtained. Causes are stratified using the structural and nonstructural International Federation of Gynecology and Obstetrics classification system. Further consideration of the patient's age is essential because this can help to narrow the differential diagnosis. Work-up includes laboratory and imaging studies. Treatment approach includes acute stabilization and long-term treatment with medical and surgical modalities.
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Affiliation(s)
- Bridget Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Obstetrics and Gynecology Clinic, 2402 Winnebago Street, Madison, WI 53704, USA
| | - Emily Buttigieg
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Obstetrics and Gynecology Clinic, 20 South Park, Madison, WI 53715, USA.
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General Approaches to Medical Management of Menstrual Suppression: ACOG Clinical Consensus No. 3. Obstet Gynecol 2022; 140:528-541. [PMID: 36356248 DOI: 10.1097/aog.0000000000004899] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
SUMMARY The purpose of this document is to review currently available management options, general principles, and counseling approaches for reproductive-aged patients requesting menstrual suppression. It includes considerations for unique populations, including adolescents, patients with physical or cognitive disabilities or both, and those with limited access to health care. Gynecologists should be familiar with the use of hormonal therapy for menstrual suppression (including combined oral contraceptive pills, combined hormonal patches, vaginal rings, progestin-only pills, depot medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine device, and the etonogestrel implant). Approaches to counseling should be individualized based on patient preferences and goals, average treatment effectiveness, and contraindications or risk factors for adverse events. Counseling regarding the choice of hormonal medication for menstrual suppression should be approached with the utmost respect for patient autonomy and be free of coercion. Complete amenorrhea may be difficult to achieve; thus, obstetrician-gynecologists and other clinicians should counsel patients and caregivers, if applicable, about realistic expectations.
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Liu Y, Liu Y, Lv F, Zhong Y, Xiao Z, Lv F. Factors influencing magnetic resonance imaging finding of endopelvic fascial edema after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids. Int J Hyperthermia 2022; 39:1088-1096. [PMID: 35995432 DOI: 10.1080/02656736.2022.2112306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE Investigate the relationships between endopelvic fascial edema and its influencing factors after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. METHODS This retrospective study included 688 women with uterine fibroids treated by USgHIFU; based on post-treatment MRI, the patients were divided into two groups: endopelvic fascial edema group and nonedema group. The specific location of fascial edema of each patient was also recorded. Fascial edema and fibroid features and treatment parameters were set as the dependent and independent variables, respectively, and the correlations were studied using univariate and multivariate analyses. The relationship between the pain-related adverse events and location of fascial edema was analyzed by χ2 and fisher's exact tests. RESULTS Edema and nonedema groups had 556 and 112 patients, respectively. Among the edema patients, posterior fascial edema incidence was the highest. Multifactorial analysis showed that the energy efficiency factor (EEF), fibroid location, and enhancement type were positively associated with endopelvic fascial edema (p < 0.05), while the distance from dorsal surface of the fibroid to sacrum was negatively correlated (p < 0.001). Patients with anterior, posterior and perirectal, and right lateral fascial edemas were associated with lower abdominal pain, sacrococcygeal pain, and leg numbness/pain, respectively. CONCLUSION Post-USgHIFU ablation, patients were prone to developing endopelvic fascial edema, and some of them experienced pain-related adverse events. The fibroid location, its types of contrast enhancement, the distance from the dorsal surface of the fibroid to the sacrum, and EEF were the influencing factors resulting in the endopelvic fascial edema after USgHIFU ablation.
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Affiliation(s)
- Yuhang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yang Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yuqing Zhong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zhibo Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Shu M, Sosa J, Reyes HD, Eddib A, Eswar A. The role of minimally invasive gynecologic surgeons in the era of subspecialties: when to refer and consult. Curr Opin Obstet Gynecol 2022; 34:190-195. [PMID: 35895960 DOI: 10.1097/gco.0000000000000795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Minimally invasive gynecologic surgery (MIGS) is a subspecialty focus of obstetrics and gynecology with focused expertise on complex benign gynecologic disorders. To date, no formal recommendations have been made in defining a referral system for MIGS. This article reviews the evidence regarding common disorders and procedures and their outcomes, and posits a basis for MIGS referral. RECENT FINDINGS In instances where intraoperative and perioperative features may pose clinical challenges to the surgeon and ultimately the patient, the literature suggests the following scenarios may have adverse outcomes, and therefore, benefit from the skills of MIGS subspecialists: fibroids - at least five myomas, myoma size at least 9 cm, and suspected myoma weight at least 500 g; endometriosis - presence of endometrioma(s), suspected stage III/IV endometriosis, and requirement for advanced adjunct procedures; hysterectomy - uteri at least 250 g or 12 weeks estimated size, at least three prior laparotomies, obesity, and complex surgical history with suspected adhesive disease. SUMMARY A referral system for MIGS subspecialists has proven benefits for both the gynecologic surgical community as well as the patients and their outcomes. This article provides evidence for collaboration with MIGS especially as it relates to leiomyomatous uteri, endometriosis, and complex hysterectomies.
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Affiliation(s)
- Michael Shu
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
| | - J'Leise Sosa
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- GPPC Women's Health, Buffalo
| | - Henry D Reyes
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Great Lakes Cancer Care
| | - Abeer Eddib
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Western New York Urology Associates, Amherst
| | - Alexander Eswar
- Kaleida Health, Minimally Invasive Gynecologic Surgery, Williamsville
- University at Buffalo, The State University of New York (SUNY)
- Invision Health, Williamsville, New York, USA
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Radiofrequency ablation methods for uterine sparing fibroid treatment. Curr Opin Obstet Gynecol 2022; 34:262-269. [PMID: 35895970 DOI: 10.1097/gco.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides a clinical review of radiofrequency ablation (RFA) for the treatment of uterine leiomyomas. RECENT FINDINGS RFA is an effective and durable treatment for fibroids with sustained improvements in fibroid volume, bleeding, and patient reported outcomes with low reintervention rates. Although fertility data is limited, it is overall positive and may represent a uterine conserving and fertility preserving treatment modality. SUMMARY RFA is a safe and effective uterine preserving treatment option for symptomatic leiomyomas.
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80
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Baxter BL, Hur HC, Guido RS. Emerging Treatment Options for Fibroids. Obstet Gynecol Clin North Am 2022; 49:299-314. [DOI: 10.1016/j.ogc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Orlando MS, Luna Russo MA, Richards EG, King CR, Park AJ, Bradley LD, Chapman GC. Racial and ethnic disparities in surgical care for endometriosis across the United States. Am J Obstet Gynecol 2022; 226:824.e1-824.e11. [PMID: 35101410 DOI: 10.1016/j.ajog.2022.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite an estimated 10% prevalence of endometriosis among reproductive-age women, surgical population-based data are limited. OBJECTIVE We sought to investigate racial and ethnic disparities in surgical interventions and complications among patients undergoing endometriosis surgery across the United States. STUDY DESIGN We performed a retrospective cohort study of American College of Surgeons National Surgical Quality Improvement Program data from 2010 to 2018 identifying International Classification of Diseases, Ninth/Tenth Revision codes for endometriosis We compared procedures, surgical routes (laparoscopy vs laparotomy), and 30-day postoperative complications by race and ethnicity. RESULTS We identified 11,936 patients who underwent surgery for endometriosis (65% White, 8.2% Hispanic, 7.3% Black or African American, 6.2% Asian, 1.0% Native Hawaiian or Pacific Islander, 0.6% American Indian or Alaska Native, and 11.5% of unknown race). Perioperative complications occurred in 9.6% of cases. After adjusting for confounders, being Hispanic (adjusted odds ratio, 1.31; 95% confidence interval, 1.06-1.64), Black or African American (adjusted odds ratio, 1.71; confidence interval, 1.39-2.10), Native Hawaiian or Pacific Islander (adjusted odds ratio, 2.08; confidence interval, 1.28-3.37), or American Indian or Alaska Native (adjusted odds ratio, 2.34; confidence interval, 1.32-4.17) was associated with surgical complications. Hysterectomies among Hispanic (adjusted odds ratio, 1.68; confidence interval, 1.38-2.06), Black or African American (adjusted odds ratio, 1.77; confidence interval, 1.43-2.18), Asian (adjusted odds ratio, 1.87; confidence interval, 1.43-2.46), Native Hawaiian or Pacific Islander (adjusted odds ratio, 4.16; confidence interval, 2.14-8.10), and patients of unknown race or ethnicity (adjusted odds ratio, 2.07; confidence interval, 1.75-2.47) were more likely to be open. Being Hispanic (adjusted odds ratio, 1.64; confidence interval, 1.16-2.30) or Black or African American (adjusted odds ratio, 2.64; confidence interval, 1.95-3.58) was also associated with receipt of laparotomy for nonhysterectomy procedures. The likelihood of undergoing oophorectomy was increased for Hispanic and Black women (adjusted odds ratio, 2.57; confidence interval, 1.96-3.37 and adjusted odds ratio, 2.06; confidence interval, 1.51-2.80, respectively), especially at younger ages. CONCLUSION Race and ethnicity were independently associated with surgical care for endometriosis, with elevated complication rates experienced by Hispanic, Black or African American, Native Hawaiian or Pacific Islander, and American Indian or Alaska Native patients.
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82
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Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification. Abdom Radiol (NY) 2022; 47:2468-2485. [PMID: 35554629 DOI: 10.1007/s00261-022-03545-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 12/28/2022]
Abstract
Uterine fibroids are the most common gynecologic neoplasm. Although non-degenerated fibroids are easily identifiable on imaging, degenerated fibroids, fibroid variants, and fibroids with unusual growth patterns can constitute a diagnostic dilemma. Identification of these abnormal morphologic features can alter the diagnosis of presumed uterine fibroids and hence change management plans. This article reviews the typical and atypical radiologic imaging features of uterine fibroids, with an emphasis on the pitfalls, mimics, and radiologically identifiable features that can alter clinical management plans.
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83
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Depot Medroxyprogesterone Acetate Use and the Development and Progression of Uterine Leiomyoma. Obstet Gynecol 2022; 139:797-807. [PMID: 35576339 PMCID: PMC9015023 DOI: 10.1097/aog.0000000000004745] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Investigate the association between use of depot medroxyprogesterone acetate (DMPA) (an injectable progestin-only contraceptive) and leiomyoma development. METHODS We conducted a cohort study in the Detroit, Michigan, area that involved four clinic visits at 20-month intervals over 5 years (2010-2018) and used a standardized ultrasonography protocol to prospectively measure leiomyomas 0.5 cm or more in diameter. Participants were 1,693 self-identified Black women aged 23-35 years with no prior leiomyoma diagnosis and no hysterectomy. For this substudy, years since last use of DMPA was ascertained from questionnaire data at every visit. Leiomyoma incidence was defined as the first visit with an observed leiomyoma among women who were leiomyoma-free at enrollment. Depot medroxyprogesterone acetate associations were examined with Cox models. Leiomyoma growth was calculated as the change in log-volume for leiomyomas matched at successive visits and was modeled using linear mixed models accounting for clustered data. Leiomyoma loss, defined as a reduction in leiomyoma number in successive visits, was modeled using Poisson regression. All models used time-varying exposure and covariates. RESULTS Of participants with at least one follow-up visit (N=1,610), 42.9% had ever used DMPA. Participants exposed to DMPA within the previous 2 years experienced reduced leiomyoma development during the subsequent observation interval compared with never users, including lower leiomyoma incidence (5.2% vs 10.7%), adjusted hazard ratio 0.6 (95% CI 0.4-1.0), 42.0% lower leiomyoma growth (95% CI -51.4 to -30.7) and 60% greater leiomyoma loss (adjusted risk ratio 1.6, 95% CI 1.1-2.2). Excess leiomyoma loss was also seen for those who used DMPA 2-4 years before the visit compared with never users, 2.1-fold increase (95% CI 1.4-3.1). CONCLUSION Recent use of DMPA was associated with reduced leiomyoma development and increased leiomyoma loss. Such changes in early leiomyoma development in young women could delay symptom onset and reduce the need for invasive treatment.
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Telek SB, Gurbuz Z, Kalafat E, Ata B. Oral Gonadotropin-Releasing Hormone Antagonists in the Treatment of Uterine Myomas: A Systematic Review and Network Meta-analysis of Efficacy Parameters and Adverse Effects. J Minim Invasive Gynecol 2022; 29:613-625. [PMID: 34942350 DOI: 10.1016/j.jmig.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this systematic review is to gather and synthesize evidence regarding the use of oral gonadotrophin-releasing hormone (GnRH) antagonist for the treatment of bleeding associated with uterine myomas. DATA SOURCES Web of Science, and MEDLINE databases were searched electronically on March 5, 2021, using combinations of the relevant Medical Subject Headings terms and keywords. The search was restricted to the English language and to human studies. METHODS OF STUDY SELECTION Only randomized controlled trials involving patients with heavy menstrual bleeding associated with uterine myomas treated with different doses of oral nonpeptide GnRH antagonists with or without add-back therapy were included. Studies comparing oral nonpeptide GnRH antagonists with treatments other than placebo were also excluded. TABULATION, INTEGRATION, AND RESULTS A total of 5 randomized trials including 2463 women were included in the analyses. Included studies were found to be at low risk of bias. When treatments were compared against placebo, the top 3 treatments for bleeding suppression were elagolix 600 mg, 400 mg, and 200 mg without add-back. Elagolix 600 mg without add-back therapy had a significantly higher risk of amenorrhea than lower doses of elagolix with and without add-back and relugolix as well. Uterine volume changes were more pronounced in therapies without add-back. All treatments were associated with significantly improved quality of life scores, both for myoma symptom-related and overall health-related scores. With the exception of relugolix with high-dose add-back, all treatments significantly increased low-density lipoprotein (LDL) levels. Again, all treatment modalities except for elagolix 200 mg without add-back significantly increased LDL-to-HDL ratio. The increase was highest for treatment without add-back therapy. CONCLUSION Oral GnRH antagonists seem to be effective for myoma-associated bleeding and for improving quality of life. The safety profile is acceptable for short-term use, but lipid metabolism is affected.
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Affiliation(s)
- Savci Bekir Telek
- Department of Obstetrics and Gynecology, Faculty of Medicine, Istanbul University (Dr. Telek), Istanbul, Turkey
| | - Zeynep Gurbuz
- School of Medicine, Koc University (Ms. Gurbuz), Istanbul, Turkey; Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University (Dr. Kalafat), Ankara, Turkey
| | - Erkan Kalafat
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, Koc University (Drs. Kalafat and Ata), Istanbul, Turkey
| | - Baris Ata
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, Koc University (Drs. Kalafat and Ata), Istanbul, Turkey; ART Fertility Clinics (Dr. Ata), Dubai, UAE.
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Wright D, Kim JW, Lindsay H, Catherino WH. A Review of GnRH Antagonists as Treatment for Abnormal Uterine Bleeding-Leiomyoma (AUB-L) and Their Influence on the Readiness of Service Members. Mil Med 2022; 188:usac078. [PMID: 35348746 DOI: 10.1093/milmed/usac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/17/2022] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Not too long ago, Lupron Depot® (leuprolide acetate), an injectable gonadotropin-releasing hormone (GnRH) agonist, was the only Food and Drug Administration (FDA) approved GnRH analog used to clinically treat abnormal uterine bleeding associated with uterine leiomyoma (AUB-L) when second-line medical management was warranted; however, the FDA has now approved elagolix and relugolix, GnRH antagonists, to be treatment options as well. This is a review of GnRH antagonists for the management of uterine fibroids reviewing their treatment efficacy, side effect profile, and current use in military medicine. METHODS This is a review of studies from multiple electronic databases (Pubmed, ACOG, FDA, U.S. Military Guidelines) published between 1990 and 2021. Keywords used for the search include GnRH antagonist, elagolix, relugolix, uterine leiomyoma, and abnormal uterine bleeding. Our inclusion criteria for articles reviewed were: systematic reviews with the listed keywords, multicenter randomized trials, and meta-analyses. The DODI on Medical Standards for Medical Service, Air Force Aerospace Medicine Waiver Guide, Navy Guidance Aeromedical Reference and Waiver Guide, and the Army Regulation 40-501 Standards of Medical Fitness were used to review the military standards and current restrictions placed on service members. RESULTS Thirty-three articles were reviewed and summarized. CONCLUSION Uterine leiomyoma can impact service members' eligibility and fitness for duty. The oral administration of elagolix and relugolix adds convenience to this drug class through its oral administration while lengthening the duration of treatment up to 24 months. All military medical facilities should advocate for the well-being of their service members by stocking all options available. Health care providers should collaborate with patients in making the best therapy choice that is suited for their lifestyle and military occupation.
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Affiliation(s)
- Danielle Wright
- Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Ji Won Kim
- Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Halle Lindsay
- Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - William H Catherino
- Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
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Current Trends in the Evaluation and Management of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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87
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Uimari O, Subramaniam KS, Vollenhoven B, Tapmeier TT. Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:818243. [PMID: 36303616 PMCID: PMC9580818 DOI: 10.3389/frph.2022.818243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Uterine Fibroids, or leiomyomata, affect millions of women world-wide, with a high incidence of 75% within women of reproductive age. In ~30% of patients, uterine fibroids cause menorrhagia, or heavy menstrual bleeding, and more than half of the patients experience symptoms such as heavy menstrual bleeding, pelvic pain, or infertility. Treatment is symptomatic with limited options including hysterectomy as the most radical solution. The genetic foundations of uterine fibroid growth have been traced to somatic driver mutations (MED12, HMGA2, FH -/-, and COL4A5-A6). These also lead to downstream expression of angiogenic factors including IGF-1 and IGF-2, as opposed to the VEGF-driven mechanism found in the angiogenesis of hypoxic tumors. The resulting vasculature supplying the fibroid with nutrients and oxygen is highly irregular. Of particular interest is the formation of a pseudocapsule around intramural fibroids, a unique structure within tumor angiogenesis. These aberrations in vascular architecture and network could explain the heavy menstrual bleeding observed. However, other theories have been proposed such as venous trunks, or venous lakes caused by the blocking of normal blood flow by uterine fibroids, or the increased local action of vasoactive growth factors. Here, we review and discuss the evidence for the various hypotheses proposed.
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Affiliation(s)
- Outi Uimari
- Department of Obstetrics and Gynecology, Oulu University, Oulu, Finland
- Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO) Research Unit and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Kavita S. Subramaniam
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Beverley Vollenhoven
- Women's and Newborn Program, Monash Health, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Thomas T. Tapmeier
- Endometriosis CaRe Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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88
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Armano G, Barbuto S, Wagner S, Carugno J, Bifulco G, Di Spiezio Sardo A. Incorporating 3D reconstruction in preoperative surgical planning of Multiple Myomectomy. Facts Views Vis Obgyn 2022; 14:87-89. [PMID: 35373553 PMCID: PMC9612863 DOI: 10.52054/fvvo.14.1.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Medical 3D imaging is a promising emerging technology that allows recreating the details of human anatomy. The use of this innovative technology has resulted in improved surgical efficiency and better clinical outcomes. However, its incorporation in gynaecologic surgery has not been widely adopted. Objectives To demonstrate the use of Hyper Accuracy 3D reconstruction in a patient with infertility who underwent multiple myomectomy. Materials and Methods A stepwise approach describing the incorporation of Hyper Accuracy 3D imaging technology into the preoperative surgical planning and intraoperative guidance of a patient with multiple myomas undergoing multiple myomectomy. Main Outcome Measures Preoperative evaluation of a patient with multiple myoma and infertility who presented to our department seeking surgical management. Hyper Accuracy 3D image was obtained, and a 3D digital image reconstruction of the uterus delineating the exact number, volume, and location of the fibroids was created. The 3D digital image was available during the surgical procedure which helped to plan the surgical steps allowing a systematic surgical approach resulting in an effective surgery with minimal blood loss. Results The benefits of intraoperative guidance using Hyper Accuracy 3D in a patient with multiple myomas and infertility are demonstrated. Conclusions The adoption of this promising imaging technology into gynaecologic surgery is feasible and should be further investigated. Additional studies evaluating the clinical impact of using Hyper Accuracy 3D imaging in the preoperative planning of patients with gynaecologic surgical pathology are needed.
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Wise LA, Thomas L, Anderson S, Baird DD, Anchan RM, Terry KL, Marsh EE, Wegienka G, Nicholson WK, Wallace K, Bigelow R, Spies J, Maxwell GL, Jacoby V, Myers ER, Stewart EA. Route of myomectomy and fertility: a prospective cohort study. Fertil Steril 2022; 117:1083-1093. [PMID: 35216832 PMCID: PMC9081130 DOI: 10.1016/j.fertnstert.2022.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess prospectively the association between the myomectomy route and fertility. DESIGN Prospective cohort study. SETTING The Comparing Treatments Options for Uterine Fibroids (COMPARE-UF) Study is a multisite national registry of eight clinic centers across the United States. PATIENT(S) Reproductive-aged women undergoing surgery for symptomatic uterine fibroids. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) We used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by the myomectomy route during 12, 24, and 36 months of follow-up (2015-2019). We also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios and 95% CIs for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes. RESULT(S) Among 1,095 women who underwent myomectomy (abdominal = 388, hysteroscopic = 273, and laparoscopic = 434), 202 reported pregnancy and 91 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.28 (95% CI, 0.76-2.14) for hysteroscopic myomectomy and 1.19 (95% CI, 0.76-1.85) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.27 (95% CI, 0.72-2.23) for hysteroscopic myomectomy and 1.26 (95% CI, 0.77-2.04) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth. CONCLUSION(S) The probability of conception or live birth did not differ appreciably by the myomectomy route among women observed for 36 months postoperatively. CLINICAL TRIALS REGISTRATION NUMBER: (NCT02260752, clinicaltrials.gov).
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Affiliation(s)
- Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Laine Thomas
- Department of Biostatistics, Duke University, Durham, North Carolina
| | - Sophia Anderson
- Department of Biostatistics, Duke University, Durham, North Carolina
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Raymond M Anchan
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erica E Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Wanda Kay Nicholson
- Center for Women's Health Research, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Kedra Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Robert Bigelow
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, D.C
| | - George L Maxwell
- Department of Obstetrics and Gynecology and the Women's Health Integrated Research Center, Inova Fairfax Hospital, Falls Church, Virginia
| | - Vanessa Jacoby
- School of Medicine, University of California San Francisco, San Francisco California
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
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90
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A Call-to-Action for Clinicians to Implement Evidence-Based Best Practices When Caring for Women with Uterine Fibroids. Reprod Sci 2022; 29:1188-1196. [PMID: 35178678 PMCID: PMC8853611 DOI: 10.1007/s43032-022-00877-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/06/2022] [Indexed: 11/12/2022]
Abstract
Uterine fibroids are common benign tumors that occur in up to 80% of women. Approximately half of the women affected experience considerable physical, psychological, and economic burdens and impact on quality of life due to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Several medical and surgical options are available to treat uterine fibroids; however, healthcare providers may benefit from practical guidance in the development of individualized treatment plans based on a personalized approach. Medical treatments and minimally invasive procedures are generally preferred by most patients before considering more invasive, higher risk surgical interventions. In general, patient-centered, uterine-preserving procedures may be prioritized based on the patient’s goals and the clinical scenario. Occasionally, hysterectomy may be the preferred treatment option for some patients who require definitive treatment. This call-to-action highlights recent challenges to patient care, including radical shifts in physician–patient interactions due to the COVID-19 pandemic and recent changes to evidence-based, clinically approved therapies. This report also reviews contemporary recommendations for women’s health providers in the diagnosis and medical and surgical management of uterine fibroids. This call-to-action aims to empower healthcare providers to optimize the quality of care for women with uterine fibroids utilizing the best available evidence and best practices.
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91
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Polin M, Hur HC. Radiofrequency Ablation of Uterine Fibroids and Pregnancy Outcomes: An Updated Review of the Literature. J Minim Invasive Gynecol 2022; 29:709-715. [PMID: 35123041 DOI: 10.1016/j.jmig.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide a systematic review of pregnancy outcomes after radiofrequency ablation of uterine fibroids. DATA SOURCES A literature search was conducted using PubMed, Cochrane Library, Scopus, Web of Science, and EMBASE, from database inception until October 2021. METHODS OF STUDY SELECTION Two reviewers conducted independent literature searches. Studies that met criteria based on title and abstract underwent full text review. Publications were included if they reported pregnancies and obstetric outcomes after laparoscopic or transcervical radiofrequency ablation (RFA) of fibroids. TABULATION, INTEGRATION, AND RESULTS 405 publications were initially identified and screened, 39 underwent full text review, and 10 publications were ultimately included. There were 50 pregnancies reported among 923 RFA patients: 40 pregnancies after 559 laparoscopic RFAs and 10 pregnancies after 364 transcervical RFAs. The number of patients from these studies actively trying to conceive after RFA is unknown. Among the RFA patients who conceived, the average age at ablation was 37 years old (range 27 to 46 years). The majority of patients had between 1 and 3 fibroids ablated, and fibroid size ranged from less than 2 centimeters to 12.5 centimeters. There were 6 spontaneous abortions (12%) and 44 full-term pregnancies (88%), of which 24 were vaginal deliveries and 20 were cesarean deliveries. There were only 2 complications among 44 deliveries: 1 placenta previa that underwent an uncomplicated cesarean delivery and 1 delayed postpartum hemorrhage with expulsion of a degenerated myoma, with no long-term sequelae. There were no cases of uterine rupture, uterine window, or invasive placentation, and no fetal complications. The spontaneous abortion rate was comparable to the general obstetric population. CONCLUSION Almost all pregnancies after radiofrequency ablation of fibroids were full-term deliveries with no maternal or neonatal complications. These findings add to the literature that radiofrequency fibroid ablation may offer a safe and effective alternative to existing treatments for women who desire future fertility.
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Affiliation(s)
- Melanie Polin
- Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Irving Medical Center, New York, New York.
| | - Hye-Chun Hur
- Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, Columbia University Irving Medical Center, New York, New York
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Systematic review of oral pharmacotherapeutic options for the management of uterine fibroids. J Am Pharm Assoc (2003) 2022; 62:674-682.e5. [DOI: 10.1016/j.japh.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
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Abstract
Uterine fibroids (leiomyomas) are present in >75% of women and can cause serious morbidity. They are by far the leading cause of hysterectomy. Fibroids are a complex mixture of cells that include fibroblasts and smooth muscle cells. Rich in extracellular matrix, they typically arise through somatic mutations, most commonly MED12. Their lack of growth inhibition and their ability to have facets of malignancy yet be histologically and biologically benign provide opportunities to explore basic processes. To date, the mechanisms responsible for growth and development of leiomyomas are an enigma. This review provides an overview of current understanding and future directions for clinical and basic research of fibroids.
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Affiliation(s)
- Elizabeth A. Stewart
- 1Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota,2Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota,3Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota,4Department of Surgery, Mayo Clinic, Rochester, Minnesota,5Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
| | - Romana A. Nowak
- 6Department of Animal Sciences, University of Illinois, Urbana, Illinois,7Institute for Genomic Biology, University of Illinois, Urbana, Illinois
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Christoffel L, Bends R, Toub D, Schiermeier S, Pschadka G, Engelhardt M, Quinn S, Hartmann M, Habiba M, Felberbaum R, Brössner A, Schippert C, Römer T. Pregnancy Outcomes After Transcervical Radiofrequency Ablation of Uterine Fibroids with the Sonata System. J Gynecol Surg 2021; 38:207-213. [PMID: 35785107 PMCID: PMC9245720 DOI: 10.1089/gyn.2021.0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: To describe pregnancy outcomes in women who conceived after undergoing transcervical fibroid ablation (TFA) as treatment for symptomatic uterine fibroids. Materials and Methods: TFA was used to treat symptomatic uterine fibroids with radiofrequency energy, both under clinical trial protocol and commercial usage in hospitals in Europe, the United Kingdom, Mexico, and the United States. All women who reported pregnancies to their physicians after undergoing TFA with the Sonata® System and provided consent for use of their data were included. Results: There have been 36 pregnancies representing 20 deliveries among 28 women who were treated with TFA. Five women conceived more than once postablation, and four conceived as a result of assisted reproductive technology (ART). Outcomes include 8 vaginal deliveries, 12 Cesarean sections, 3 therapeutic abortions, and 8 first trimester spontaneous abortions (four occurring in a patient with a history of recurrent pregnancy loss and an immunologic disorder). Five women are currently pregnant, two of whom previously delivered after TFA. There were no 5-minute Apgar scores <7, and all neonates weighed >2500 g. All deliveries occurred at ≥37 weeks except for one delivery at 35 6/7 weeks. There were no uterine ruptures or abnormal placentation and no reports of postpartum hemorrhage or stillbirths. Ablated fibroids included transmural, submucous, and intramural myomata up to 7 cm in diameter. Conclusions: Normal pregnancy outcomes at term have occurred after TFA with the Sonata System, including in women with recurrent abortion and in those undergoing ART. There were no instances of low Apgar scores, low birthweight, stillbirth, postpartum hemorrhage, or uterine rupture (FAST-EU, NCT01226290; SONATA, NCT02228174; SAGE, NCT03 118037). (J GYNECOL SURG 38:207)
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Affiliation(s)
- Ladina Christoffel
- Chefärztin Gynäkologie/Geburtshilfe, Spital Oberengadin, Samedan, Switzerland
| | - Ralf Bends
- Evangelisches Klinikum Köln-Weyertal, Köln, Germany
| | - David Toub
- Gynesonics, Redwood City, California, USA
| | - Sven Schiermeier
- Zentrum für Frauenheilkunde und Geburtshilfe, Marien Hospital, Witten, Germany
| | | | | | - Stephen Quinn
- Department of Gynaecology, St Mary's Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | | | - Marwan Habiba
- Obstetrics and Gynaecology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | | | | | - Thomas Römer
- Evangelisches Klinikum Köln-Weyertal, Köln, Germany
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ACOG Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas: Correction. Obstet Gynecol 2021; 138:683. [PMID: 34623086 DOI: 10.1097/aog.0000000000004557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Intramural myomas more than 3-4 centimeters should be surgically removed before in vitro fertilization. Fertil Steril 2021; 116:945-958. [PMID: 34579828 DOI: 10.1016/j.fertnstert.2021.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/29/2022]
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