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Neumann B, Singh B, Brennan J, Blanck J, Segars JH. The impact of fibroid treatments on quality of life and mental health: a systematic review. Fertil Steril 2024; 121:400-425. [PMID: 38246400 PMCID: PMC11140829 DOI: 10.1016/j.fertnstert.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Fibroids significantly impact the quality of life (QOL) and mental health of affected women. However, there are limited comparative data on QOL measures after medical, surgical, and radiologic interventions in women with fibroids. This study aimed to assess the current literature evaluating the impact of fibroids on QOL measures using several validated questionnaires for radiologic, medical, or surgical interventions or a combination of interventions before and after treatment. PubMed, PsycINFO, ClinicalTrials.gov, Embase, and Cochrane Library were searched from January 1990 to October 2023 to evaluate the available evidence, and the risk of bias was assessed using Cochrane RoB 2.0 or the Newcastle-Ottawa Scale. The review criteria included randomized controlled trials (RCTs) and observational cohort studies that included premenopausal women with symptomatic uterine fibroids, confirmed by imaging, who underwent an intervention to target fibroid disease. Only reports using validated questionnaires with a numerical baseline (pretreatment) and posttreatment scores were included. The exclusion criteria included perimenopausal or postmenopausal patients, conditions in addition to uterine fibroids that share similar symptoms, or studies that did not focus on QOL assessment. Abstracts were screened, and full texts were reviewed to determine whether studies met the inclusion criteria. A total of 67 studies were included after final review: 18 RCTs and 49 observational studies. All interventions were associated with a significant improvement in uterine fibroid-specific QOL measures, mental health metrics, and a reduction in symptom severity scores after treatment. These data reveal a substantial impact of uterine fibroids on the QOL and mental health of women with fibroids and indicate the metrics that can be used to compare the effectiveness of fibroid treatment options.
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Affiliation(s)
- Brooke Neumann
- Department of Obstetrics and Gynecology, Inspira, Vineland, New Jersey
| | - Bhuchitra Singh
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joshua Brennan
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James H Segars
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Qu Y, Chen L, Guo S, Liu Y, Wu H. Genetic liability to multiple factors and uterine leiomyoma risk: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1133260. [PMID: 37576957 PMCID: PMC10415162 DOI: 10.3389/fendo.2023.1133260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Background and objective Uterine leiomyoma is the most common benign tumor in females of reproductive age. However, its causes have never been fully understood. The objective of our study was to analyze the causal association between various factors and uterine leiomyoma using Mendelian randomization (MR). Methods Genetic variables associated with risk factors were obtained from genome-wide association studies. Summary-level statistical data for uterine leiomyoma were obtained from FinnGen and the UK Biobank (UKB) consortium. We used inverse variance weighted, MR-Egger, and weighted median methods in univariate analysis. Multivariable MR analysis was used to identify independent risk factors. A fixed-effect model meta-analysis was used to combine the results of the FinnGen and UKB data. Results In the FinnGen data, higher genetically predicted age at natural menopause, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting insulin were associated with an increased risk of uterine leiomyoma, while higher age at menarche was associated with a reduced risk of uterine leiomyoma. Multivariable MR analysis of SBP and DBP showed that higher DBP might be an independent risk factor of uterine leiomyoma. In the UKB data, the results for age at natural menopause, SBP, DBP, and age at menarche were replicated. The result of the meta-analysis suggested that uterine leiomyoma could also be affected by polycystic ovary syndrome (PCOS), endometriosis, and 2-hour glucose level. Conclusion Our MR study confirmed that earlier menstrual age, hypertension, obesity, and elevated 2-hour glucose post-challenge were risk factors for uterine leiomyoma, and the causal relationship between smoking and uterine leiomyoma was ruled out. In addition, later age of menopause and endometriosis were found to increase the risk of uterine leiomyoma, while PCOS was found to decrease the risk.
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Affiliation(s)
- Yangming Qu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Lanlan Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Shijie Guo
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Liu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Wu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
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Barahmeh S, Shrateh ON, Jobran AWM, Hamarsheh L, Tanib I, Alwahsh MJ. Rare clinical entity of huge leiomyoma uteri in a 17-year-old adolescent managed with a fertility-sparing procedure: Case report and literature review. Int J Surg Case Rep 2023; 107:108367. [PMID: 37271023 DOI: 10.1016/j.ijscr.2023.108367] [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: 05/02/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The most frequent benign uterine tumor is uterine fibroids. Approximately, 20 to 30 % of women between the ages of 30 and 50 have them. Teenagers do, however, rarely experience them; the prevalence is less than 1 % in general population. CASE PRESENTATION We present a 17-year-old nulliparous female who was admitted to the hospital due to gradually increasing abdominopelvic pain. Transabdominal pelvic ultrasound showed massive uterine enlargement, with a heterogenous structure within the fundus measuring 9.8 cm in diameter. Pelvic MRI revealed an enlarged uterus with a heterogeneous complex mass measuring 10.78 cm by 8 cm that seemed to be compressing but was not attached to the endometrium The findings from the radiology review were concerning for leiomyoma. Intraoperative findings showed a 13-cm anterior intramural mass with normally appearing fallopian tubes and ovaries bilaterally. Resection of the mass was done, and the entire specimen was sent to pathology which confirmed the diagnosis of leiomyoma. DISCUSSION Occurrence of uterine fibroids in the young and adolescent age is extremely rare with an estimated prevalence of less than 1 %. Leiomyosarcoma is a less frequent diagnosis to take into account, but it can be identified histologically. Therefore, a myomectomy that preserves fertility enables a diagnostic chance to rule out a probable cancer. CONCLUSION When young women present with steadily worsening abdominopelvic discomfort, it is crucial to include leiomyomas in the differential diagnosis despite the rarity of leiomyomas in adolescents.
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Affiliation(s)
- Samer Barahmeh
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine; Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | | - Lyudmila Hamarsheh
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine.
| | - Iyas Tanib
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
| | - Mohammad J Alwahsh
- Department of Obstetrics and Gynecology, Al-Istishari Arab Hospital, Ramallah, Palestine
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Ahmad A, Kumar M, Bhoi NR, Akhtar J, Khan MI, Ajmal M, Ahmad M. Diagnosis and management of uterine fibroids: current trends and future strategies. J Basic Clin Physiol Pharmacol 2023; 34:291-310. [PMID: 36989026 DOI: 10.1515/jbcpp-2022-0219] [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: 08/18/2022] [Accepted: 02/25/2023] [Indexed: 03/30/2023]
Abstract
Uterine fibroids (UFs), leiomyomas or myomas, are a type of malignancy that affects the smooth muscle of the uterus, and it is most commonly detected in women of reproductive age. Uterine fibroids are benign monoclonal growths that emerge from uterine smooth muscle cells (myometrium) as well as fibroblasts. Uterine fibroid symptoms include abnormal menstrual bleeding leading to anaemia, tiredness, chronic vaginal discharge, and pain during periods. Other symptoms include protrusion of the abdomen, pain during intercourse, dysfunctions of bladder/bowel leading to urinary incontinence/retention, pain, and constipation. It is also associated with reproductive issues like impaired fertility, conceiving complications, and adverse obstetric outcomes. It is the leading cause of gynaecological hospitalisation in the American subcontinent and a common reason for the hysterectomy. Twenty-five percent of the reproductive women experience the symptoms of uterine fibroids, and among them, around 25% require hospitalization due to the severity of the disease. The frequency of the disease remains underestimated as many women stay asymptomatic and symptoms appear gradually; therefore, the condition remains undiagnosed. The exact frequency of uterine fibroids varies depending on the diagnosis, and the population investigated; nonetheless, the incidence of uterine fibroids in reproductive women ranges from 5.4 percent to 77 percent. The uterine fibroid treatment included painkillers, supplementation with iron, vitamin D3, birth control, hormone therapy, gonadotropin-releasing hormone (GnRH) agonists, drugs modulating the estrogen receptors, and surgical removal of the fibroids. However, more research needed at the level of gene to get a keen insight and treat the disease efficiently.
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Affiliation(s)
- Azaz Ahmad
- Department of Pharmacy, Integral University, Lucknow, India
- Department of Reproductive Medicine, Indira IVF Hospital Pvt Ltd, Udaipur, India
| | - Manoj Kumar
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nihar Ranjan Bhoi
- Department of Reproductive Medicine, Indira IVF Hospital Pvt Ltd, Udaipur, India
| | - Juber Akhtar
- Department of Pharmacy, Integral University, Lucknow, India
| | | | - Mohd Ajmal
- Department of Pharmacy, Integral University, Lucknow, India
| | - Mohammad Ahmad
- Department of Pharmacy, Integral University, Lucknow, India
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Kabakci M, Topbas Selcuki NF, Aydin Z, Bagci K, Kaya C, Yalcin Bahat P. Serum sestrin 2 levels in patients with uterine leiomyomas. J OBSTET GYNAECOL 2022; 42:3616-3620. [PMID: 36346966 DOI: 10.1080/01443615.2022.2141613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our aim was to evaluate SESN2 levels in patients with uterine leiomyomas by comparing serum SESN2 levels in myoma patients with the levels in healthy women to deepen our understanding of the pathophysiology of uterine leiomyomas. Patients 18-50 years of age who applied to the University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital between January and March 2021 and who were diagnosed with uterine leiomyoma were defined as the 'myoma group'. The control group included patients without any sign of leiomyomas in routine ultrasonography. The patients' demographic features, gynecological symptoms, myoma volume and classification were recorded. Serum SESN2 concentrations in venous blood samples were measured using a sandwich enzyme-linked immunosorbent assay (ELISA) kit.The study included 31 patients in the myoma group and 30 in the control group. The mean age/gravid/parity or BMI values did not differ significantly between the groups. The only gynecological symptom that showed a significant difference was menorrhagia. Serum SESN2 levels were significantly higher in the myoma group then the control groups (11.7 ± 2.5) (p < 0.001). In conclusion, although uterine leiomyoma is the most common benign tumour in women of reproductive age, there are no known markers for predicting the development of leiomyomas. Based on the results of the current study, SESN2 could be such a marker.IMPACT STATEMENTWhat is already known on this subject? Uterine leiomyoma is the most common type of benign tumour in women of reproductive age as well as the most common indication for a hysterectomy. Symptoms associated with uterine leiomyoma include abnormal bleeding, chronic pelvic pain, menorrhagia, dysmenorrhoea, dyspareunia and anaemia, which adversely affect the patient's quality of life. Sestrins are a family of metabolic regulator proteins that play a potential role in carcinogenesis.What the results of this study add? This is the first study evaluating the role of sestrin in the development of uterine leiomyomas. Significantly higher levels of sestrin 2 (SESN2) were detected in patients with leiomyomas.What are the implications of these findings for clinical practice and/or further research? Although uterine leiomyoma is the most common type of benign tumour in women of reproductive age, there are still many unknowns regarding its pathophysiology. Further, there are still no known markers for predicting the development of leiomyomas. Hence, primary prevention is not possible. Based on the results of the current study SESN2, could be such a marker. Further studies are needed to confirm the results of this study.
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Affiliation(s)
- Meric Kabakci
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nura Fitnat Topbas Selcuki
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Zelal Aydin
- Department of Obstetrics and Gynecology, Mus State Hospital, Mus, Turkey
| | - Kubra Bagci
- Department of Obstetrics and Gynecology, Acibadem Bodrum Medical Center, Mugla, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Pinar Yalcin Bahat
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Possible significance of degeneration and decreased expression of progesterone receptor in postmenopausal uterine leiomyoma. BMC Womens Health 2022; 22:346. [PMID: 35974345 PMCID: PMC9382836 DOI: 10.1186/s12905-022-01924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background The growth of uterine leiomyomas is dependent on the levels of sex steroid hormones, and they usually shrink after menopause. However, there are cases in which leiomyomas continue to grow and/or surgery is required after menopause. In addition to estrogen, progesterone has recently been implicated in leiomyoma enlargement, but its relevance to postmenopausal leiomyoma remains unknown. Therefore, we investigated whether hormone receptor expression is associated with postmenopausal leiomyoma enlargement and characterized pathological findings of postmenopausal leiomyoma, which have not been clarified yet. Methods Nine cases that required total hysterectomy for leiomyomas after menopause were examined. Surgeries were conducted because of pelvic pressure, pelvic pain, suspected malignancy, or growing leiomyoma. Six cases of leiomyomas being incidentally found during total hysterectomy for postmenopausal uterine prolapse, and six patients who underwent hysterectomy for leiomyomas before menopause, were examined as controls. We evaluated the expression of estrogen receptor, progesterone receptor B, and progesterone receptor AB by immunohistochemical staining among the cases. We also analyzed the pathological findings of leiomyomas. Results In postmenopausal leiomyomas, the expression of progesterone receptor was higher than that in the adjacent myometrium. Compared with premenopausal leiomyomas, the expression of progesterone receptor decreased. Postmenopausal leiomyomas that required surgery did not show elevated sex steroid hormone receptor expression, compared with the leiomyomas that did not require surgery. The degeneration frequency of leiomyomas was 92% in the group that underwent surgery for postmenopausal leiomyomas, 65% in the group that underwent surgery for reasons other than the presence of leiomyomas after menopause, and 47% in the group operated for leiomyomas before menopause. Conclusions These results suggest that sex steroid hormones are unlikely to be associated with the growth of leiomyomas after menopause. Since leiomyoma degeneration with increased extracellular matrix is likely to occur in postmenopausal women, the degeneration of leiomyomas may be the main mechanism for the growth of postmenopausal leiomyomas.
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Evangelisti G, Barra F, Perrone U, Di Donato N, Bogliolo S, Ceccaroni M, Ferrero S. Comparing the pharmacokinetic and pharmacodynamic qualities of current and future therapies for uterine fibroids. Expert Opin Drug Metab Toxicol 2022; 18:441-457. [DOI: 10.1080/17425255.2022.2113381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Southern Endometriosis Centre, Queen Alexandra Hospital, Portsmouth, UK
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar (Verona), Italy
| | - Umberto Perrone
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nadine Di Donato
- Southern Endometriosis Centre, Queen Alexandra Hospital, Portsmouth, UK
| | - Stefano Bogliolo
- Department of Obstetrics and Gynecology, “P.O del Tigullio” Hospital-ASL4, Metropolitan Area of Genoa, Genoa, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni, 5, 37024, Negrar (Verona), Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Chiuve SE, Huisingh C, Petruski-Ivleva N, Owens C, Kuohung W, Wise LA. Uterine fibroids and incidence of depression, anxiety and self-directed violence: a cohort study. J Epidemiol Community Health 2022; 76:92-99. [PMID: 34301795 PMCID: PMC8666805 DOI: 10.1136/jech-2020-214565] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression and anxiety are prevalent among women with uterine fibroids (UF). The rate of mental health diagnoses in women with UF has not been studied. METHODS Women aged 18-50 years with diagnosed UF were identified in the Optum Clinformatics commercial insurance claims database (OptumInsight, Eden Prairie, Minnesota) from 1 May 2000 to 31 March 2020 (n=313 754) and were matched 1:2 on age and calendar time to women without (n=627 539). Cox proportional hazards models estimated HRs and 95% CIs between UF and diagnosed depression, anxiety and self-directed violence, adjusting for demographics and comorbidities. Among women with diagnosed UF, the association between hysterectomy and mental health outcomes was estimated. RESULTS After adjusting for confounders, women with diagnosed UF had a higher rate of depression (HR: 1.12; 95% CI 1.10 to 1.13), anxiety (HR: 1.12; 95% CI 1.10 to 1.13) and self-directed violence (HR: 1.46; 95% CI 1.29 to 1.64) than women without. Among women with pain symptoms and heavy menstrual bleeding, the HR comparing women with diagnosed UF to women without was 1.21 (95% CI 1.18 to 1.25) for depression, 1.18 (95% CI 1.15 to 1.21) for anxiety and 1.68 (95% CI 1.35 to 2.09) for self-directed violence. Among women with diagnosed UF, the HR comparing women who underwent a hysterectomy to women who did not was 1.22 (95% CI 1.17 to 1.27) for depression, 1.13 (95% CI 1.09 to 1.17) for anxiety and 1.86 (95% CI 1.39 to 2.49) for self-directed violence. CONCLUSIONS Rates of depression, anxiety and self-directed violence were higher among women with diagnosed UF, particularly among those who experienced pain symptoms or who underwent hysterectomy.
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Affiliation(s)
| | | | | | | | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Wang CJ, Lin G, Huang YT, Weng CH, Wu KY, Su YY, Lin YS, Mak KS. Correction to: A feasibility analysis of the ArcBlate MR‑guided high‑intensity focused ultrasound system for the ablation of uterine fibroids. Abdom Radiol (NY) 2022; 47:490-493. [PMID: 34550416 PMCID: PMC9172698 DOI: 10.1007/s00261-021-03275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chin-Jung Wang
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
- Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Gigin Lin
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Ting Huang
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Cindy Hsuan Weng
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Ying Su
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Shan Lin
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kit-Sum Mak
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Apoplectic leiomyomas: does ethnicity make a difference? a clinicopathologic study. Virchows Arch 2021; 480:645-654. [PMID: 34725735 DOI: 10.1007/s00428-021-03225-z] [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: 01/26/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Apoplectic leiomyomas-benign uterine leiomyomas with morphologic changes including hemorrhage, hypercellularity, mitotic activity, nuclear atypia, and even necrosis-can be difficult to distinguish from uterine leiomyosarcomas. Apoplectic leiomyomas have been associated with hormonal therapy; however, the relationship between apoplectic leiomyomas, hormones, and ethnicity has not received much attention in the literature. We evaluated the relationship of hormonal therapy and ethnicity in 869 women with uterine leiomyomas, 136 of which qualified as apoplectic leiomyomas.Apoplectic leiomyomas were observed in 23.3% (49/210) of women exposed to hormonal therapy compared to 13.2% (87/659) of women not exposed to hormonal therapy (p < 0.0001). Women taking ethinyl estradiol/norethindrone (Lo-Estrin), leuprolide, and medroxyprogesterone were significantly more likely to have apoplectic leiomyomas compared to women taking other hormonal therapies. Apoplectic leiomyomas were observed in 28.9% (44/152) of African-American women compared to 12.4% (79/639) of Caucasian women (p < 0.0001), and this difference remained statistically significant regardless of hormone use. Apoplectic leiomyomas were observed in 22.1% (77/349) of women ≤ 45 years of age compared to 11.3% (59/520) of women > 45 years of age (p < 0.0001), and this difference remained statistically significant regardless of hormone use.This is the largest study to date examining apoplectic leiomyomas in women on known hormonal therapy compared to women with uterine leiomyomas, but not on hormonal therapy. Information about hormonal therapy, ethnicity, and age can be helpful in the diagnostic interpretation of apoplectic leiomyoma.
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Wang CJ, Lin G, Huang YT, Weng CH, Wu KY, Su YY, Lin YS, Mak KS. A feasibility analysis of the ArcBlate MR-guided high-intensity focused ultrasound system for the ablation of uterine fibroids. Abdom Radiol (NY) 2021; 46:5307-5315. [PMID: 34241647 PMCID: PMC8502158 DOI: 10.1007/s00261-021-03203-8] [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: 05/18/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
Purpose Uterine fibroids are benign gynecologic tumors and commonly occur in women by the age of 50. Women with symptomatic uterine fibroids generally receive surgical intervention, while they do not favor the invasive therapies. To evaluate the feasibility and safety of a novel magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) modality, ArcBlate, in the treatment of uterine fibroids. Methods Nine patients with uterine fibroids and one patient with adenomyosis were treated with ArcBlate MRgHIFU. Tumor size and quality of life were evaluated postoperatively at 1 and 3 months by magnetic resonance imaging (MRI) and the 36-Item Short Form Survey (SF-36), respectively. Results All patients completed the ArcBlate MRgHIFU procedure and there were no treatment-related adverse effects either during the procedure or during the 3 months of follow-up. Despite limiting the ablation volume to under 50% of the treated fibroid volume as a safety precaution, tumor volumes were markedly reduced in four patients by 15.78–58.87% at 3-month post-treatment. Moreover, SF-36 scale scores had improved at 3 months from baseline by 2–8 points in six patients, indicating relief of symptoms and improved quality of life. Conclusion This study evidence demonstrates the safety and feasibility of ArcBlate MRgHIFU and suggests its potential for treating uterine fibroids.
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Wesselink AK, Rosenberg L, Wise LA, Jerrett M, Coogan PF. A prospective cohort study of ambient air pollution exposure and risk of uterine leiomyomata. Hum Reprod 2021; 36:2321-2330. [PMID: 33984861 DOI: 10.1093/humrep/deab095] [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: 12/16/2020] [Revised: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION To what extent are ambient concentrations of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2) and ozone (O3) associated with risk of self-reported physician-diagnosed uterine leiomyomata (UL)? SUMMARY ANSWER In this large prospective cohort study of Black women, ambient concentrations of O3, but not PM2.5 or NO2, were associated with increased risk of UL. WHAT IS KNOWN ALREADY UL are benign tumors of the myometrium that are the leading cause of gynecologic inpatient care among reproductive-aged women. Black women are clinically diagnosed at two to three times the rate of white women and tend to exhibit earlier onset and more severe disease. Two epidemiologic studies have found positive associations between air pollution exposure and UL risk, but neither included large numbers of Black women. STUDY DESIGN, SIZE, DURATION We conducted a prospective cohort study of 21 998 premenopausal Black women residing in 56 US metropolitan areas from 1997 to 2011. PARTICIPANTS/MATERIAL, SETTING, METHODS Women reported incident UL diagnosis and method of confirmation (i.e. ultrasound, surgery) on biennial follow-up questionnaires. We modeled annual residential concentrations of PM2.5, NO2 and O3 throughout the study period. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for a one-interquartile range (IQR) increase in air pollutant concentrations, adjusting for confounders and co-pollutants. MAIN RESULTS AND THE ROLE OF CHANCE During 196 685 person-years of follow-up, 6238 participants (28.4%) reported physician-diagnosed UL confirmed by ultrasound or surgery. Although concentrations of PM2.5 and NO2 were not appreciably associated with UL (HRs for a one-IQR increase: 1.01 (95% CI: 0.93, 1.10) and 1.05 (95% CI: 0.95, 1.16), respectively), O3 concentrations were associated with increased UL risk (HR for a one-IQR increase: 1.19, 95% CI: 1.07, 1.32). The association was stronger among women age <35 years (HR: 1.26, 95% CI: 0.98, 1.62) and parous women (HR: 1.28, 95% CI: 1.11, 1.48). LIMITATIONS, REASONS FOR CAUTION Our measurement of air pollution is subject to misclassification, as monitoring data are not equally spatially distributed and we did not account for time-activity patterns. Our outcome measure was based on self-report of a physician diagnosis, likely resulting in under-ascertainment of UL. Although we controlled for several individual- and neighborhood-level confounding variables, residual confounding remains a possibility. WIDER IMPLICATIONS OF THE FINDINGS Inequitable burden of air pollution exposure has important implications for racial health disparities, and may be related to disparities in UL. Our results emphasize the need for additional research focused on environmental causes of UL. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the National Cancer Institute (U01-CAA164974) and the National Institute of Environmental Health Sciences (R01-ES019573). L.A.W. is a fibroid consultant for AbbVie, Inc. and accepts in-kind donations from Swiss Precision Diagnostics, Sandstone Diagnostics, FertilityFriend.com and Kindara.com for primary data collection in Pregnancy Study Online (PRESTO). M.J. declares consultancy fees from the Health Effects Institute (as a member of the review committee). The remaining authors declare they have no actual or potential competing financial interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael Jerrett
- Department of Environmental Health Sciences, University of California, Los Angeles, CA, USA
| | - Patricia F Coogan
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center, Boston University, Boston, MA, USA
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Wu BJ, Wei W, Hu CY, Zhang XJ, Zhong F. Investigation on factors related to uterine fibroids in rural women of northern Anhui province. J Obstet Gynaecol Res 2021; 47:3279-3287. [PMID: 34212456 DOI: 10.1111/jog.14899] [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: 11/22/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
AIM Given the increasing prevalence of hysteromyoma among the Chinese rural women of childbearing age, it is imperative that more attention should be given to researching risk factors that predispose women to this condition so that early preventive measures may be taken. Our study investigates potential risk factors for uterine fibroids such as participants' demographic characteristics (age, ethnicity, education), physiological characteristics (age at menarche, primiparous age), and the occurrence of several different female reproductive diseases (vaginitis, pelvic inflammatory disease). METHODS 2200 rural women of reproductive age were screened from a cross-sectional study carried out in the northern Anhui province. Data were collected by questionnaire surveys, gynecological and laboratory examinations and were subjected to univariate and multivariate analysis to evaluate the risk factors for uterine fibroids. RESULTS Of the 2200 women, 440 had uterine fibroids. In general, women with endometriosis, ovarian cysts and early menarche were more likely to suffer from hysteromyoma. Factors including higher parity, late age of first childbirth, and a regular menstrual cycle were associated with the reduced risk of uterine fibroids. CONCLUSIONS Our findings indicate that parameters such as earlier age of menarche, early primiparous age, lower parity and a variety of female reproductive diseases were associated with an increased risk of uterine fibroids. These findings may be used to guide the formulation of effective prevention and intervention protocols to improve the reproductive health of rural women.
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Affiliation(s)
- Bing-Jie Wu
- Department of Oncology, Fuyang Hospital of Anhui Medical University, Fuyang, China
| | - Wu Wei
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cheng-Yang Hu
- Department of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical University, Hefei, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Fei Zhong
- Department of Oncology, Fuyang Hospital of Anhui Medical University, Fuyang, China.,Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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14
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Orta OR, Terry KL, Missmer SA, Harris HR. Dairy and related nutrient intake and risk of uterine leiomyoma: a prospective cohort study. Hum Reprod 2021; 35:453-463. [PMID: 32086510 DOI: 10.1093/humrep/dez278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/26/2019] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Is there an association between consumption of dairy foods and related nutrients and risk of uterine leiomyoma? SUMMARY ANSWER While dairy consumption was not consistently associated with uterine leiomyoma risk, intake of yogurt and calcium from foods may reduce risk of uterine leiomyoma. WHAT IS KNOWN ALREADY Two studies have examined the association between dairy intake and uterine leiomyoma risk with inconsistent results. Dairy foods have been inversely associated with inflammation and tumorigenesis, suggesting that vitamins and minerals concentrated in these dietary sources may influence uterine leiomyoma risk. STUDY DESIGN, SIZE, DURATION A prospective cohort study was carried out using data collected from 81 590 premenopausal women from 1991 to 2009 as part of the Nurses' Health Study II cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS Diet was assessed with a validated food frequency questionnaire every 4 years. Cases were restricted to self-reported ultrasound or hysterectomy-confirmation uterine leiomyoma. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE Eight thousand one hundred and forty-two cases of ultrasound or hysterectomy-confirmed uterine leiomyoma were diagnosed over an 18-year period. When compared to participants who consumed two servings a week of total dairy foods, participants who consumed four or more servings had a borderline significant 8% reduced risk of uterine leiomyoma (HR = 0.92, 95% CI = 0.85, 1.00; ptrend = 0.19). When the association between specific dairy foods and uterine leiomyoma was examined, the relation between dairy-food intake and uterine leiomyoma appeared to be driven primarily by yogurt consumption (HR for 2+ servings/day = 0.76; 95% CI = 0.55, 1.04 compared to <=4 servings/week; ptrend = 0.03); however, there was a small number of cases in the 2+ servings/day group (n = 39). Of the nutrients examined, the association was strongest for calcium from foods (HR fifth quintile = 0.92, 95% CI = 0.86, 0.99; ptrend = 0.04). LIMITATIONS, REASONS FOR CAUTION Some cases of uterine leiomyoma were likely misclassified, particularly those that were asymptomatic. It is possible that dairy product constituents reduce uterine leiomyoma symptomology rather than development, giving the appearance of a protective effect on leiomyoma development: no data on uterine leiomyoma symptomology were available. We did not have vitamin and mineral concentrations from actual blood levels. Similarly, there is the potential for misclassification of participants based on predicted 25(OH)D, and changes in vitamin D supplementation over time may have impacted prediction models for 25(OH)D. Further, some error in the self-reporting of dietary intake is expected. Given our prospective design, it is likely that these misclassifications were non-differential with respect to the outcome, likely biasing estimates toward the null. WIDER IMPLICATIONS OF THE FINDINGS While no clear association between overall dairy consumption and uterine leiomyoma risk was observed, our findings suggest that intake of yogurt and calcium from foods may reduce risk of uterine leiomyoma. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by research grant HD081064 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Nurses' Health Study II is supported by the Public Health Service grant UM1 CA176726 from the National Cancer Institute, NIH, U.S. Department of Health and Human Services. H.R.H. is supported by the National Cancer Institute, National Institutes of Health (K22 CA193860). There are no conflicts of interest to declare.
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Affiliation(s)
- O R Orta
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - K L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, 333 Longwood Avenue, Boston, Massachusetts, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, 15 Michigan Street NE, Grand Rapids, Michigan, USA
| | - H R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
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Donnez J. Uterine Fibroids and Progestogen Treatment: Lack of Evidence of Its Efficacy: A Review. J Clin Med 2020; 9:jcm9123948. [PMID: 33291422 PMCID: PMC7762035 DOI: 10.3390/jcm9123948] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The objective of this review is to determine the evidence or, conversely, the absence of evidence regarding the effectiveness of progestogens in treating premenopausal women with uterine fibroids. In particular, the goal is to address recurring questions as to whether they are effective or not for managing symptoms commonly attributed to fibroids. METHODS A review of the most relevant papers (n = 63) on the efficacy of progesterone and progestogens as medical therapy for uterine fibroids. RESULTS Having reviewed the most significant papers on the relationship between uterine fibroids and progesterone/progestogens, it is clear that there is biochemical, histological and clinical evidence that progesterone and progestogens play a critical role in the pathogenesis of myomas. CONCLUSION Since progesterone is already implicated in the pathogenesis of this entity, using progestogens to manage fibroids is like constantly adding fuel to the fire, rendering this treatment ineffective.
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Affiliation(s)
- Jacques Donnez
- Société de Recherche pour l’Infertilité (SRI), 1150 Brussels, Belgium;
- Université Catholique de Louvain, 1200 Brussels, Belgium
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16
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Sangkomkamhang US, Lumbiganon P, Pattanittum P. Progestogens or progestogen-releasing intrauterine systems for uterine fibroids (other than preoperative medical therapy). Cochrane Database Syst Rev 2020; 11:CD008994. [PMID: 33226133 PMCID: PMC8094271 DOI: 10.1002/14651858.cd008994.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Uterine fibroids can cause heavy menstrual bleeding. Medical treatments are considered to preserve fertility. It is unclear whether progestogens or progestogen-releasing intrauterine systems can reduce fibroid-related symptoms. This is the first update of a Cochrane Review published in 2013. OBJECTIVES To determine the effectiveness of progestogens or progestogen-releasing intrauterine systems in treating premenopausal women with uterine fibroids. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, and PsycINFO databases to July 2020. We also searched trials registers for ongoing and registered trials, and checked references of relevant trials. SELECTION CRITERIA All identified published or unpublished randomised controlled trials (RCTs) assessing the effect of progestogens or progestogen-releasing intrauterine systems in treating premenopausal women with uterine fibroids. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk of bias, and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This updated review included four studies with 221 women with uterine fibroids. The evidence was very low quality, downgraded for serious risk of bias, due to poor reporting of study methods, and serious imprecision. Levonorgestrel-releasing intrauterine device (LNG-IUS) versus hysterectomy There was no information on the outcomes of interest, including adverse events. LNG-IUS versus low dose combined oral contraceptive (COC) At 12 months, we are uncertain whether LNG-IUS reduced the percentage of abnormal uterine bleeding, measured with the alkaline hematin test (mean difference (MD) 77.50%, 95% confidence interval (CI) 70.44 to 84.56; 1 RCT, 44 women; very low-quality evidence), or the pictorial blood assessment chart (PBAC; MD 34.50%, 95% CI 11.59 to 57.41; 1 RCT, 44 women; very low-quality evidence); increased haemoglobin levels (MD 1.50 g/dL, 95% CI 0.85 to 2.15; 1 RCT, 44 women; very low-quality evidence), or reduced fibroid size more than COC (MD 1.90%, 95% CI -12.24 to 16.04; 1 RCT, 44 women; very low-quality evidence). The study did not measure adverse events. LNG-IUS versus oral progestogen (norethisterone acetate (NETA)) Compared to NETA, we are uncertain whether LNG-IUS reduced abnormal uterine bleeding more from baseline to six months (visual bleeding score; MD 23.75 points, 95% CI 1.26 to 46.24; 1 RCT, 45 women; very low-quality evidence); increased the percentage of change in haemoglobin from baseline to three months (MD 4.53%, 95% CI 1.46 to 7.60; 1 RCT, 48 women; very low-quality evidence), or from baseline to six months (MD 10.14%, 95% CI 5.57 to 14.71; 1 RCT, 45 women; very low-quality evidence). The study did not measure fibroid size. Spotting (adverse event) was more likely to be reported by women with the LNG-IUS (64.3%) than by those taking NETA (30%; 1 RCT, 45 women; very low-quality evidence). Oral progestogen (dienogest, desogestrel) versus goserelin acetate Compared to goserelin acetate, we are uncertain whether abnormal uterine bleeding was reduced at 12 weeks with dienogest (PBAC; MD 216.00 points, 95% CI 149.35 to 282.65; 1 RCT, 14 women; very low-quality evidence) or desogestrel (PBAC; MD 78.00 points, 95% CI 28.94 to 127.06; 1 RCT, 16 women; very low-quality evidence). Vasomotor symptoms (adverse events, e.g. hot flashes) are only associated with goserelin acetate (55%), not with dienogest (1 RCT, 14 women; very low-quality evidence) or with desogestrel (1 RCT, 16 women; very low-quality evidence). The study did not report fibroid size. AUTHORS' CONCLUSIONS Because of very low-quality evidence, we are uncertain whether the LNG-IUS reduces abnormal uterine bleeding or increases haemoglobin levels in premenopausal women with uterine fibroids, compared to COC or norethisterone acetate. There was insufficient evidence to determine whether the LNG-IUS reduces the size of uterine fibroids compared to COC. We are uncertain whether oral progestogens reduce abnormal uterine bleeding as effectively as goserelin acetate, but women reported fewer adverse events, such as hot flashes.
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Affiliation(s)
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
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Lin Y, Yang C, Tang J, Li C, Zhang ZM, Xia BH, Li YM, He QZ, Lin LM, Liao DF. Characterization and anti-uterine tumor effect of extract from Prunella vulgaris L. BMC Complement Med Ther 2020; 20:189. [PMID: 32552673 PMCID: PMC7301478 DOI: 10.1186/s12906-020-02986-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The flowers and dried fruit spikes of Prunella vulgaris L. (P. vulgaris L.) have been widely used in traditional Chinese medicine and food. P. vulgaris L. is regarded as a good option for treating uterine myoma (UM). However, scientific evidence of anti-UM activity of the extract of P. vulgaris L. (PVE) is lacking. The present study aimed to characterize the chemical composition of PVE and evaluate the pharmacodynamics and mechanism of PVE against UM. METHODS The chemical composition of PVE was analyzed by GC-MS. MTT was used to screen and evaluate cell proliferation and toxicity. Double fluorescence flow cytometry method were used to determine the apoptosis and cell cycle progression of UM cells under PVE treatment. The anti-UM activity of PVE was investigated by using a specific-pathogen-free (SPF) rat model of UM. TUNEL staining was used to detect the apoptosis of UM cells. The concentrations of estrogen and progesterone in the serum of SPF rats were detected by ELISA. The expression levels of PCNA, estrogen receptor alpha, estrogen receptor beta, progesterone receptor, survivin, caspase-3, Bax and Bcl-2 in the uterus of SPF rats was detected by immunohistochemistry (IHC). RESULTS The extraction rate of PVE was 8.1%. The main components were squalene (28.3%), linoleic acid (9.96%), linolenic acid (9.95%), stearic acid (6.26%) and oleic acid (5.51%). In vitro, PVE had significant anti-human UM cell activity, exhibited no drug toxicity, promoted the apoptosis of human UM cells, and inhibited the transition of UM cells from the G0/G1 stage into the G2 stage, in which DNA replication occurs. In vivo, PVE had significant anti-UM activity. PVE decreased the concentrations of estrogen and progesterone and downregulated the expression levels of the estrogen and progesterone receptors through the estrogen signaling pathway. PVE also promoted the apoptosis of UM cells by downregulating the expression levels of the survivin and Bcl-2 proteins and upregulating the expression levels of caspase-3 and Bax through the mitochondria-mediated apoptotic pathway. CONCLUSION PVE has marked anti-UM activity. PVE can be used as an ideal candidate drug to treat UM.
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Affiliation(s)
- Yan Lin
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Chao Yang
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Jie Tang
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Chun Li
- China Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, People's Republic of China
| | - Zhi-Min Zhang
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Bo-Hou Xia
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Ya-Mei Li
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Qing-Zhi He
- Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, School of Pharmacy and Life Science, University of South China, Hengyang, 421001, People's Republic of China
| | - Li-Mei Lin
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China
| | - Duan-Fang Liao
- Key Laboratory for Quality Evaluation of Bulk Herbs of Hunan Province, College of Pharmacy, Hunan University of Chinese Medicine, No.300 Xueshi Road, Changsha, 410208, People's Republic of China.
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18
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Netter A, Pauly V, Siles P, Pivano A, Vidal V, Agostini A. Predictors of uterine fibroid volume reduction under ulipristal acetate: a prospective MRI study. Reprod Biomed Online 2019; 39:795-801. [DOI: 10.1016/j.rbmo.2019.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/31/2019] [Accepted: 07/11/2019] [Indexed: 12/13/2022]
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Huang H, Kuang H, Sun F, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson PR, Christman GM, Hansen KR, Santoro N, Eisenberg E, Zhang H. Lower prevalence of non-cavity-distorting uterine fibroids in patients with polycystic ovary syndrome than in those with unexplained infertility. Fertil Steril 2019; 111:1011-1019.e1. [PMID: 30926125 DOI: 10.1016/j.fertnstert.2019.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To study whether there is a difference in the prevalence of non-cavity-distorting uterine fibroids between infertile patients with polycystic ovary syndrome (PCOS) and those with unexplained infertility (UI). DESIGN A secondary analysis of data from three randomized clinical trials. SETTING Academic health centers. PATIENT(S) A total of 2,249 patients with normal uterine cavities. INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) The presence or absence of non-cavity-distorting fibroids. RESULT(S) Compared with women with UI, those with PCOS were younger, had a higher body mass index, and were more likely to be Hispanic or African American, with a lower percentage of previous conception and live birth, a higher percentage of current smokers, a lower percentage of current alcohol users, and higher total testosterone, fasting insulin, and homeostasis-model-assessment insulin resistance. The prevalence of women with non-cavity-distorting uterine fibroids was lower in women with PCOS than in those with UI (6.7% vs. 12.4%); this result held after patients were divided into Black and non-Black or into three different body mass index groups. After adjustment for all the other variables in the final model, patients with PCOS had a significantly lower prevalence of fibroids than those with UI (odds ratio 0.54). No differences in the prevalence of non-cavity-distorting fibroids with any dimensions ≥4 cm or the volume of the largest fibroid was found between the two groups. CONCLUSION(S) A lower prevalence of non-cavity-distorting uterine fibroids was found in infertile women with PCOS than in those with UI.
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Affiliation(s)
- Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Hongying Kuang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Fangbai Sun
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Peter R Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Karl R Hansen
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
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Ayakannu T, Taylor AH, Marczylo TH, Konje JC. New Insights of Uterine Leiomyoma Pathogenesis: Endocannabinoid System. Med Sci Monit Basic Res 2019; 25:76-87. [PMID: 30842391 PMCID: PMC6421936 DOI: 10.12659/msmbr.914019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to determine if components of the endocannabinoid system are modulated in uterine leiomyomas (fibroids). Components studied included cannabinoid receptors 1 (CB1) and 2 (CB2); the G protein-coupled receptor GPR55; transient potential vanilloid receptor 1 (TRPV1) and the endocannabinoid modulating enzymes N-acylphosphatidylethanolamine-specific phospholipase D (NAPE-PLD) and fatty acid amide hydrolase (FAAH), and their N-acylethanolamine (NAE) ligands: N-arachidonylethanolamine (AEA), N-oleoylethanolamine (OEA), and N-palmityolethanaolamine (PEA). Material/Methods Transcript levels of CB1, CB2, TRPV1, GPR55, NAPE-PLD, and FAAH were measured using RT-PCR and correlated with the tissue levels of the 3 NAEs in myometrial tissues. The tissues studied were: 1) fibroids, 2) myometrium adjacent/juxtaposed to the fibroid lesions, and 3) normal myometrium. Thirty-seven samples were processed for NAE measurements and 28 samples were used for RT-PCR analyses. Results FAAH expression was significantly lower in fibroids, resulting in a NAPE-PLD: FAAH ratio that favors higher AEA levels in pre-menopausal tissues, whilst PEA levels were significantly lower, particularly in post-menopausal women, suggesting PEA protects against fibroid pathogenesis. The CB1: CB2 ratio was lower in fibroids, suggesting that loss of CB1 expression affects the fibroid cell phenotype. Significant correlations between reduced FAAH, CB1, and GPR55 expression and PEA in fibroids indicate that the loss of these endocannabinoid system components are biomarkers of leiomyomata. Conclusions Loss of expression of CB1, FAAH, GPR55, and PEA production are linked to the pathogenesis of uterine fibroids and further understanding of this might eventually lead to better disease indicators or the development of therapeutic potentials that might eventually be used in the management of uterine fibroids.
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Affiliation(s)
- Thangesweran Ayakannu
- Endocannabinoid Research Group, Reproductive Sciences, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.,Department of Obstetrics and Gynaecology, North Cumbria University Hospital NHS Trust, Carlisle, United Kingdom
| | - Anthony H Taylor
- Endocannabinoid Research Group, Reproductive Sciences, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.,Department of Molecular and Cellular Biology, University of Leicester, Leicester, United Kingdom
| | - Timothy H Marczylo
- Endocannabinoid Research Group, Reproductive Sciences, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.,Public Health England, Chilton, Oxford, United Kingdom
| | - Justin C Konje
- Endocannabinoid Research Group, Reproductive Sciences, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.,Department of Obstetrics and Gynaecology, Sidra Medicine, Doha and Wellness Women's Research Centre, Doha, Qatar
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Fertility impairment associated with uterine fibroids - a review of literature. MENOPAUSE REVIEW 2017; 16:137-140. [PMID: 29483857 PMCID: PMC5824684 DOI: 10.5114/pm.2017.72759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/08/2017] [Indexed: 12/24/2022]
Abstract
Uterine fibroids (also known as leiomyomas or myomas) are the most common benign tumors affecting reproductive organs in women. They are monoclonal tumors of the uterine smooth muscle, which spring from myometrium. It is estimated that they occur in 50-60% of the female population and rise to 70% by the age of 50. While mostly asymptomatic, myomas can be connected with several conditions, including abnormal bleeding with subsequent anemia, pelvic masses, pelvic pain, bulk symptoms, unfavorable impact on fertility and obstetric complications. Factors, which predispose the emergence of fibroids are: hormones, Afro-American ethnicity, age, obesity, adverse pregnancy outcome history, early menarche, genetic factors, alcohol, caffeine or eating too much red meat. On the other hand, there are factors, which can decrease this risk: pregnancy, early menopause and tobacco smoking. There are several mechanisms of fertility impairment in females with fibroids: alternations in uterus function (flawed blood supply, increased contractility), changes in the normal uterus anatomy, local hormonal changes induced by fibroids. In this review the connection between fibroids and infertility is analyzed.
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The Rising Phoenix-Progesterone as the Main Target of the Medical Therapy for Leiomyoma. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4705164. [PMID: 29312996 PMCID: PMC5615958 DOI: 10.1155/2017/4705164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/06/2017] [Indexed: 11/17/2022]
Abstract
Leiomyomas, also known as uterine fibroids, are a common benign tumor in women of reproductive age. These lesions disrupt the function of the uterus causing menorrhagia and pelvic pressure as well as reproductive disorders. These women pose a true challenge for clinicians in the attempt of choosing the suitable treatment for each patient. Patient's age, interest in fertility preservation, and leiomyoma location and size are all factors to be taken into account when deciding upon the preferable therapeutic option. For the past few decades, surgical treatment was the only reliable long-term treatment available. A variety of surgical approaches have been developed over the years but these developments have come at the expense of other treatment options. The classical medical treatment includes gonadotropin-releasing hormone (GnRH) agonists and antagonists. These agents are well known for their limited clinical effect as well as their broad spectrum of side effects, inspiring a need for new pharmacological treatments. In recent years, promising results have been reported with the use of selective progesterone receptor modulators (SPRM). Long-term clinical trials have shown a reduction in bleeding and shrinkage of leiomyoma mass. These results instill hope for women suffering from symptomatic leiomyomas seeking an effective, long-term medical option for their condition.
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Laganà AS, Vergara D, Favilli A, La Rosa VL, Tinelli A, Gerli S, Noventa M, Vitagliano A, Triolo O, Rapisarda AMC, Vitale SG. Epigenetic and genetic landscape of uterine leiomyomas: a current view over a common gynecological disease. Arch Gynecol Obstet 2017; 296:855-867. [DOI: 10.1007/s00404-017-4515-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/31/2017] [Indexed: 01/10/2023]
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Faustino F, Martinho M, Reis J, Águas F. Update on medical treatment of uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2017; 216:61-68. [DOI: 10.1016/j.ejogrb.2017.06.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 06/25/2017] [Accepted: 06/30/2017] [Indexed: 11/25/2022]
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Ernest A, Mwakalebela A, Mpondo BC. Uterine leiomyoma in a 19-year-old girl: Case report and literature review. Malawi Med J 2017; 28:31-3. [PMID: 27217916 DOI: 10.4314/mmj.v28i1.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- A Ernest
- Department of Surgery and Maternal Health, College of Health Sciences, University of Dodoma, Dodoma, Tanzania; Department of Obstetrics and Gynaecology, Iringa Regional Hospital, Iringa, Tanzania
| | - A Mwakalebela
- Department of Obstetrics and Gynaecology, Iringa Regional Hospital, Iringa, Tanzania
| | - B C Mpondo
- Department Internal Medicine, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
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Eroglu S, Haskul İ, Aziz V, Yurtcu E, Karatas F, Neşelioğlu S, Erel O. Dynamic thiol/disulphide homeostasis in patients with Uterine Myoma. Eur J Obstet Gynecol Reprod Biol 2017; 216:24-26. [PMID: 28697394 DOI: 10.1016/j.ejogrb.2017.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/23/2017] [Accepted: 06/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study is to measure and compare the dynamic thiol and disulphide homeostasis between patients with Uterine Myoma (UM) and healthy subjects. MATERIAL AND METHOD A total of 54 patients with UM who were diagnosed by transvaginal ultrasonography and 37 age- and body mass index-matched healthy individuals were included in this study. Thiol/disulphide homeostasis was measured by a novel automatic spectrophotometric method. RESULTS The mean serum native thiol, disulphide, and thiol levels were statistically lower in UM group than those in the control group [(284.66±59.41μmol/L vs. 320.98±56.17μmol/L, P<0.0001), (17.27±5.59μmol/L vs. 22.38±6.93μmol/L, P<0.0001) and (319.21±61.69 vs. 365.76±61.46μmol/L, P<0.0001), respectively]. There were no statistically significant differences in ratios of the disulphide/native thiol, native thiol/total thiol, and disulphide/total thiol among patients with UM versus healthy control group (P=0.096, 0.092, 0.092, respectively). CONCLUSION It was found that the native thiol, total thiol, and disulphide levels in patients with UM decreased while the ratio of native thiol/disulphide remained unchanged.It is necessary to investigate whether these findings have a role in the etiology and clinical course of the UM.
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Affiliation(s)
- Semra Eroglu
- Karabuk University Faculty of Medicine, Department of Gynecology and Obstetrics, Turkey
| | - İsmail Haskul
- Karabuk University Faculty of Medicine, Department of Clinical Biochemistry, Turkey
| | - Vüsale Aziz
- Karabuk University Faculty of Medicine, Department of Gynecology and Obstetrics, Turkey
| | - Engin Yurtcu
- Karabuk University Faculty of Medicine, Department of Gynecology and Obstetrics, Turkey
| | - Fatih Karatas
- Karabuk University Faculty of Medicine, Department of Medical Oncology, Turkey.
| | - Salim Neşelioğlu
- Yıldırım Beyazit University Faculty of Medicine, Department of Clinical Biochemistry, Turkey
| | - Ozcan Erel
- Yıldırım Beyazit University Faculty of Medicine, Department of Clinical Biochemistry, Turkey
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Fuldeore MJ, Soliman AM. Patient-reported prevalence and symptomatic burden of uterine fibroids among women in the United States: findings from a cross-sectional survey analysis. Int J Womens Health 2017; 9:403-411. [PMID: 28652819 PMCID: PMC5476627 DOI: 10.2147/ijwh.s133212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To estimate the prevalence of women diagnosed with uterine fibroids and the associated symptom burden in the US. Patients and methods Responses of women aged 18–54 years, who completed an online survey, were analyzed. Data were weighted based on age, education, race, geographic region, income, and propensity score to derive national estimates of the prevalence of women diagnosed with uterine fibroids and associated symptom burden. Weighted means and percentages were reported. Prevalence across age and ethnic groups was examined. Symptom burden among women with and without uterine fibroids was compared using weighted logistic regressions. Results Of 59,411 respondents who met study inclusion criteria, 7.7% reported receiving a diagnosis of uterine fibroids. Of these, 5,670 women (1,402 in the uterine fibroid group and 4,268 in the control group) were excluded from analysis because they had a hysterectomy. Among the non-hysterectomized study participants, 3,031 self-reported a diagnosis of uterine fibroids (prevalence: 5.8%, 95% confidence interval [CI]: 5.5%–6.1%); prevalence increased as women aged and was greatest in the 50–54 age group (11.4%; 95% CI: 10.4%–12.4%). In addition, prevalence was greater in black vs white women (9.8%; 95% CI: 8.7%–11.0% vs 5.4%; 95% CI: 5.1%–5.7%). A greater percentage of women with uterine fibroids (vs those without) experienced severe heavy menstrual bleeding (16.7% vs 7.7%), severe constipation/bloating/diarrhea (7.7% vs 4.7%), severe passage of clots (6.7% vs 2.4%), severe spotting/bleeding between periods (1.7% vs 1.0%), and severe pelvic pressure (1.6% vs 0.6%). Among uterine fibroid patients with these typical uterine fibroid-related symptoms, 56.4%, 32.3%, 26.4%, 25.8%, and 20.4% reported heavy menstrual bleeding, passage of clots, spotting/bleeding between periods, constipation/bloating/diarrhea, and pelvic pressure, respectively, as extremely bothersome. Conclusion Uterine fibroids impose a heavy burden on women aged 18–54 years in the US.
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Affiliation(s)
- Mahesh J Fuldeore
- Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL, US
| | - Ahmed M Soliman
- Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL, US
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Al-Hendy A, Laknaur A, Diamond MP, Ismail N, Boyer TG, Halder SK. Silencing Med12 Gene Reduces Proliferation of Human Leiomyoma Cells Mediated via Wnt/β-Catenin Signaling Pathway. Endocrinology 2017; 158:592-603. [PMID: 27967206 PMCID: PMC5460776 DOI: 10.1210/en.2016-1097] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 12/08/2016] [Indexed: 12/28/2022]
Abstract
Uterine fibroids, or leiomyoma, are the most common benign tumors in women of reproductive age. In this work, the effect of silencing the mediator complex subunit 12 (Med12) gene in human uterine fibroid cells was evaluated. The role of Med12 in the modulation of Wnt/β-catenin and cell proliferation-associated signaling was evaluated in human uterine fibroid cells. Med12 was silenced in the immortalized human uterine fibroid cell line (HuLM) using a lentivirus-based Med12 gene-specific RNA interference strategy. HuLM cells were infected with lentiviruses carrying Med12-specific short hairpin RNA (shRNA) sequences or a nonfunctional shRNA scrambled control with green fluorescence protein. Stable cells that expressed low levels of Med12 protein were characterized. Wnt/β-catenin signaling, sex steroid receptor signaling, cell cycle-associated, and fibrosis-associated proteins were measured. Med12 knockdown cells showed significantly (P < 0.05) reduced levels of Wnt4 and β-catenin proteins as well as cell proliferation, as compared with scrambled control cells. Med12 knockdown cells also showed reduced levels of cell cycle-associated cyclin D1, Cdk1, and Cdk2 proteins as well as reduced activation of p-extracellular signal-regulated kinase, p-protein kinase B, and transforming growth factor (TGF)-β signaling pathways as compared with scrambled control cells. Moreover, TGF-β-regulated fibrosis-related proteins such as fibronectin, collagen type 1, and plasminogen activator inhibitor-1 were significantly (P < 0.05) reduced in Med12 knockdown cells as compared with scrambled control cells. Together, these results suggest that Med12 plays a key role in the regulation of HuLM cell proliferation through the modulation of Wnt/β-catenin, cell cycle-associated, and fibrosis-associated protein expression.
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Affiliation(s)
- Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Augusta University, Medical College of Georgia, Augusta, Georgia 30912;
| | - Archana Laknaur
- Department of Obstetrics and Gynecology, Augusta University, Medical College of Georgia, Augusta, Georgia 30912;
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Augusta University, Medical College of Georgia, Augusta, Georgia 30912;
| | - Nahed Ismail
- Clinical Microbiology Division, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; and
| | - Thomas G. Boyer
- Department of Molecular Medicine, Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Sunil K. Halder
- Department of Obstetrics and Gynecology, Augusta University, Medical College of Georgia, Augusta, Georgia 30912;
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Liu C, Lu Q, Qu H, Geng L, Bian M, Huang M, Wang H, Zhang Y, Wen Z, Zheng S, Zhang Z. Different dosages of mifepristone versus enantone to treat uterine fibroids: A multicenter randomized controlled trial. Medicine (Baltimore) 2017; 96:e6124. [PMID: 28207540 PMCID: PMC5319529 DOI: 10.1097/md.0000000000006124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of 10 mg and 25 mg mifepristone per day compared with 3.75 mg enantone in treating uterine fibroids. METHODS This is a Multicenter randomized controlled trial. A total of 501 subjects with symptomatic uterine fibroids were enrolled and randomized into the group of 10mg, 25mg mifepristone and 3.75 enantone (with 307, 102 and 92 subjects respectively), with 458 subjects completed the treatment. Three months of daily therapy with oral mifepristone (at a dose of either 10 mg or 25 mg) or once-monthly subcutaneous injections of enantone (at a dose of 3.75 mg) were used. Change in volume of the largest uterine fibroid was the primary efficacy variable, and secondary efficacy variables included changes in anemia and relevant symptom. Safety evaluation included the analyses of adverse events, laboratory values, and relevant endometrial changes. RESULTS After three months of treatment, the mean volume of the largest leiomyoma was significantly reduced by mifepristone 10 mg or 25 mg or enantone 3.75 mg (40.27%, 42.59% and 44.49% respectively) (P < 0.0001). Percentage change from baseline in largest leiomyoma volume was not statistically significant among the three groups (P = 0.1057). Most of the patients in all groups experienced amenorrhea after the treatment. There were also significant elevations in red blood cell count, hemoglobin and hematocrit (P < 0.0001), and significant reductions in prevalence of dysmenorrhea, pelvic pressure, non-menstrual abdominal pain (P < 0.0001) in each group, while no significant difference among the three groups.All study medications are well-tolerated, and no serious adverse event was reported. Treatment-related adverse event rate was significantly lower in mifepristone 10 mg group, compared to Enantone 3.75 mg group (13.59% vs. 32.58%, P = 0.0002). In both mifepristone groups, estradiol levels were maintained in the premenopausal range, whereas patients in the enantone group had a significant reduction to postmenopausal levels (P < 0.0001). CONCLUSION 10mg is as effective as 25mg mifepristone and 3.75 mg enantone with minimal drug-related side effects, and may provide an alternative for clinical application, especially for patient who are in perimenopause with uterine fibroids.
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Affiliation(s)
- Chongdong Liu
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
| | - Qi Lu
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
| | - Hong Qu
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
| | - Li Geng
- Department of Obstetrics and Gynaecology, Peking University Third Hospital
| | - Meilu Bian
- Department of Obstetrics and Gynaecology, China-Japan Friendship Hospital, Beijing
| | - Minli Huang
- Department of Obstetrics and Gynaecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai
| | - Huilan Wang
- Department of Obstetrics and Gynaecology, The Second Hospital of Hebei Medical University, Hebei
| | - Youzhong Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Shandong
| | - Zeqing Wen
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong, China
| | - Shurong Zheng
- Department of Obstetrics and Gynaecology, Peking University First Hospital
| | - Zhenyu Zhang
- Department of Obstetrics and Gynaecology,Beijing Chaoyang Hospital
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Extreme Anemia (Hemoglobin 1.8 g/dL) Secondary to Abnormal Uterine Bleeding. Case Rep Obstet Gynecol 2017; 2017:5179265. [PMID: 29430312 PMCID: PMC5753002 DOI: 10.1155/2017/5179265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/23/2017] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 39-year-old G5P5 woman who presented to the emergency department with complaints of shortness of breath, lightheadedness, and excessive uterine bleeding for 14 days, with a heart rate of 123 and a blood pressure of 137/65. Menses had been heavy for several months. A hemoglobin of 1.8 g/dL was discovered. An ultrasound revealed an 11.8 cm fibroid uterus, and the patient was transfused with 6 units of blood and placed on oral contraceptive pills.
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Abstract
Leiomyomas are the most common neoplasm found in the uterus and can present with a variety of symptoms or be entirely asymptomatic. Most often, the characteristic imaging appearance of leiomyoma does not pose a diagnostic dilemma. However, leiomyomas can demonstrate atypical imaging features that may be confusing. It is essential for the radiologist to be aware of both the typical and atypical findings to better assist the referring clinician with diagnosis and management decisions. Additionally, as uterine-sparing treatment alternatives with locoregional therapies become more popular, it is important to be aware of pre- and post-procedural imaging questions that may be encountered. Lastly, when atypical features are seen, it is important to understand the characteristics that may suggest a diagnosis of leiomyosarcoma. The goal of this study is to review imaging features of atypical leiomyoma with case-based examples.
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Ohh MH, Kim SJ, Han JK, Pak SC, Chee KM. Effects of herbal medicine on human uterine tumor-bearing nude mice. JOURNAL OF COMPLEMENTARY MEDICINE RESEARCH 2016; 5:422-426. [PMID: 27757274 PMCID: PMC5061487 DOI: 10.5455/jice.20160923100120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/03/2016] [Indexed: 12/01/2022]
Abstract
Aim: Uterine leiomyomas are the most common benign uterine neoplasms associated with significant morbidity. Herbal formulas capable of restoring yin-yang balance by dispersing blood stasis may be useful for managing fibroid symptoms. Materials and Methods: In this study, the antitumor properties of three herbs viz., Trogopterus xanthipes Milen-Edwards, Paeonia lactiflora Pallas, and Ulmus davidiana Planch were evaluated in nude mice injected intravenously with human malignant myomas. Tumor fragments were xenografted subcutaneously through a flank incision in female mice. The mice entered the study for 8 weeks when their tumors reached the threshold volume (260 mm3). The mice were randomly allocated to receive subcutaneous injections of normal saline (Group 1; negative control), P. lactiflora Pallas (Group 2), U. davidiana Planch (Group 3), T. xanthipes Milen-Edwards (Group 4), and intravenous injections of paclitaxel (Group 5; positive control). The weight and tumor volume were measured, followed by histopathology. Results: A few cases of abdominal distention and death were observed in the negative control group. Furthermore, a considerable enlargement of the liver and spleen was observed in the negative control group at autopsy with a gradual increase in body weight during the experiment. The mean tumor volume which increased in negative control mice reduced in mice treated with herbal remedies or paclitaxel from day 14 onwards (P < 0.05). The degree of necrosis and apoptosis induction from herbal treatments was similar to that of paclitaxel. Conclusion: Collectively, three herbs viz., T. xanthipes Milen-Edwards, P. lactiflora Pallas, and U. davidiana Planch were able to induce necrosis and apoptosis of uterine leiomyoma cells, proving antitumor properties against uterine fibroids.
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Affiliation(s)
- Mi Hyang Ohh
- Department of Life and Environmental Science, College of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | - Seong Jin Kim
- Department of Research and Development Center, Milae Resources ML. Co., Ltd., Seoul, Korea
| | - Jong Kwon Han
- Department of Research and Development Center, Milae Resources ML. Co., Ltd., Seoul, Korea
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Kew-Mahn Chee
- Department of Life and Environmental Science, College of Life Sciences and Biotechnology, Korea University, Seoul, Korea
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Walker CL, Burroughs KD, Davis B, Sowell K, Everitt JI, Fuchs-Young R. Preclinical Evidence for Therapeutic Efficacy of Selective Estrogen receptor Modulators for Uterine Leiomyoma. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/107155760000700410] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cheryl Lyn Walker
- University of Texas M. D. Anderson Cancer Center-Science Park, research Division, Smithville, Texas; the national Institute of Environmental Health Sciences, Research Triangle Park, North Carolina; Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina
| | | | | | | | | | - Robin Fuchs-Young
- University of Texas M. D. Anderson Cancer Center-Science Park, research Division, Smithville, Texas; the national Institute of Environmental Health Sciences, Research Triangle Park, North Carolina; Chemical Industry Institute of Toxicology, Research Triangle Park, North Carolina
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Marigliano C, Panzironi G, Molisso L, Pizzuto A, Ciolina F, Napoli A, Ricci P. First experience of real-time elastography with transvaginal approach in assessing response to MRgFUS treatment of uterine fibroids. Radiol Med 2016; 121:926-934. [DOI: 10.1007/s11547-016-0679-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
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35
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Vienonen A, Miettinen S, Bläuer M, Martikainen PM, Tomás E, Heinonen PK, Ylikomi T. Expression of Nuclear Receptors and Cofacotrs in Human Endometrium and Myometrium. ACTA ACUST UNITED AC 2016; 11:104-12. [PMID: 14980312 DOI: 10.1016/j.jsgi.2003.09.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the expression of nuclear receptors and cofactors in human endometrium and myometrium in proliferative and secretory phases of the menstrual cycle. METHODS Multiprobe ribonuclease protection assay and real-time reverse transcriptase polymerase chain reaction were used to quantitate mRNA levels of steroid receptors, vitamin D receptor (VDR), retinoic acid receptors (RAR), and cofactors AIB1 (amplified in breast cancer-1), CBP (cyclic adenosine monophosphate response element binding protein), pCAF (p300/CBP-associated factor), TIF2 (transcription intermediary factor-2), N-CoR (nuclear receptor corepressor), and SMRT (silencing mediator of repressed transcription). Cyclin A expression was analyzed to determine the proliferation status of the tissues. RESULTS The expression of androgen receptor, estrogen receptors alpha and beta, progesterone receptor, and RARalpha followed cyclin A expression. There was more abundant expression in the proliferative phase endometrium than in the secretory phase endometrium. Glucocorticoid receptor, VDR, RARbeta, and RARgamma were stably expressed during the menstrual cycle in both endometrium and myometrium. Cofactors N-CoR, SMRT, pCAF, CBP, TIF2, AIB1, and p300 mRNAs were expressed in all samples in both endometrium and myometrium. N-CoR, pCAF, AIB1, and p300 appeared not to be regulated when comparing proliferative and secretory phases of the cycle. Individual differences were found in the expression levels of both nuclear receptors and cofactors. CONCLUSION The menstrual cycle-dependent regulation of nuclear receptor expression was more apparent in the endometrium than in the myometrium, whereas cofactor expression was not cycle dependent. There were individual differences in the expression levels of different receptors and cofactors. In hormonal therapy these differences might result in different responses, depending on the patient as well as the ligand used.
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Affiliation(s)
- Annika Vienonen
- Department of Cell Biology, Medical School, University of Tampere, Tampere, Finland.
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Kashani BN, Centini G, Morelli SS, Weiss G, Petraglia F. Role of Medical Management for Uterine Leiomyomas. Best Pract Res Clin Obstet Gynaecol 2016; 34:85-103. [DOI: 10.1016/j.bpobgyn.2015.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 12/15/2022]
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Miller MA, Ramos-Vara JA, Dickerson MF, Johnson GC, Pace LW, Kreeger JM, Turnquist SE, Turk JR. Uterine Neoplasia in 13 Cats. J Vet Diagn Invest 2016; 15:515-22. [PMID: 14667013 DOI: 10.1177/104063870301500602] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thirteen uterine tumors were diagnosed in 13 cats and accounted for 0.29% of all feline neoplasms received during a 9.6-year period. Age at diagnosis ranged from 3 to 16 years; median 9 years. Six were Domestic Shorthair cats, and 7 were purebred cats of 5 different breeds. Eight adenocarcinomas and 1 mixed Müllerian tumor (adenosarcoma) comprised the endometrial tumors. Myometrial tumors included 3 leiomyomas and 1 leiomyosarcoma. One of the adenocarcinomas developed in the uterine stump of an ovario-hysterectomized cat; the other cats were sexually intact. Concurrent mammary adenocarcinoma was diagnosed in 1 cat with uterine adenocarcinoma and in another with uterine leiomyoma. Tumors were discovered during elective ovariohysterectomy in 2 cats, but at least 3 others had experienced reproductive problems (infertility or pyometra). Five cats presented for abdominal or pelvic masses. Endometrial adenocarcinomas were positive immunohistochemically for cytokeratins and negative for smooth muscle actin (SMA); 1 of 6 cats was positive for vimentin and 4 of 8 were positive for estrogen receptor—α (ERα). Adenosarcoma stromal cells were positive for vimentin and ERα but negative for cytokeratins and SMA. Smooth muscle tumors were positive for vimentin and SMA and negative for cytokeratins. Leiomyomas, but not the leiomyosarcomas, were positive for ERα. Adenocarcinomas in 4 cats had metastasized by the time of ovariohysterectomy. Two other cats were euthanized 5 months after ovariohysterectomy; at least one of these cats had developed an abdominal mass that was not examined histologically. Only 2 cats with endometrial adenocarcinoma had disease-free intervals longer than 5 months after surgery. Metastasis was not detected in any mesenchymal tumor; however, these cats were either euthanized on discovery of the tumor or the tumor was first detected at necropsy.
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Affiliation(s)
- Margaret A Miller
- Veterinary Medical Diagnostic Laboratory and Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, PO Box 6023, Columbia, MO 65205, USA
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Abstract
Introduction: Leiomyomas are benign tumors composed of smooth muscle cells and varying amounts of fibrous connective tissue commonly encountered in women of reproductive age group. Leiomyomas need hormonal milieu for their growth and maintenance. Unopposed estrogenic stimulation manifests as leiomyomas undergoing secondary changes, endometrial proliferation or hyperplasia, and other associated pathological findings. Objective: To study and analyze various histopathological changes within uterine leiomyomas in hysterectomy specimens. And also, to analyze the associated endometrial and adnexal structures pathology. Materials and Methods: A 4 years retrospective study from June 2010 to June 2014 conducted in the Department of Pathology and Obstetrics and Gynecology, ESIC Medical College and PGIMSR, wherein 820 hysterectomy specimens clinically diagnosed as uterine leiomyomas were subjected to histopathological examination and relevant clinical data were analyzed. Results: Leiomyomas occurred mostly in women aged 31-50 years (90.23%). Menorrhagia (49.36%) and pain abdomen (30.6%) were the chief clinical manifestations. Endometrial patterns commonly seen were proliferative and hyperplastic endometrium together accounting for 73.4% and dual pathology with adenomyosis was 29.1%. Four cases of tubercular etiology and a single case of granulosa cell tumor of ovary was noted. Conclusion: Though hysterectomy is a routine procedure in the management of uterine leiomyomas, occasional cases of tumor or infective pathology may be missed. Therefore, histopathology is mandatory and conscientious quest must be done for confirmed diagnosis and ensuring optimal management.
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Affiliation(s)
- Kempula Geethamala
- Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana, India
| | | | | | - Sudha Rao
- Department of Pathology, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India
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Wise LA, Sponholtz TR, Rosenberg L, Adams-Campbell LL, Kuohung W, LaValley MP, Palmer JR. History of uterine leiomyoma and risk of endometrial cancer in black women. Cancer Causes Control 2016; 27:545-52. [PMID: 26923705 PMCID: PMC4798859 DOI: 10.1007/s10552-016-0728-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have found an association between uterine leiomyomata (UL) and uterine malignancies. This relation has not been studied in black women, who are disproportionately affected by UL. METHODS We investigated prospectively the association between self-reported physician-diagnosed UL and endometrial cancer in the Black Women's Health Study. During 1995-2013, 47,267 participants with intact uteri completed biennial health questionnaires. Reports of endometrial cancer were confirmed by pathology data from medical records and cancer registries. Cox regression was used to derive incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS There were 300 incident endometrial cancer cases during 689,546 person-years of follow-up. In multivariable models, UL history was associated with a 42% greater incidence of endometrial cancer compared with no such history (95% CI 1.12-1.80). IRRs for cancer diagnosed 0-2, 3-9, and ≥10 years after UL diagnosis were 3.20 (95% CI 2.06-4.98), 0.95 (95% CI 0.60-1.52), and 1.35 (95% CI 1.03-1.77), respectively. Stronger overall associations between UL history and endometrial cancer were observed for later stages at cancer diagnosis (IRR = 2.25, 95% CI 1.09-4.63) and type II/III cancers (IRR = 3.13, 95% CI 1.64-5.99). CONCLUSIONS In this large cohort of black women, a history of UL was positively associated with endometrial cancer, particularly type II/III tumors. The strongest association was observed for cancer diagnosed within 2 years of UL diagnosis, a finding that might be explained by greater surveillance of women with UL or misdiagnosis of cancer as UL. However, an association was also observed for cancer reported ≥10 years after UL diagnosis.
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Affiliation(s)
- Lauren A Wise
- Slone Epidemiology Center at Boston University, Boston, MA, USA.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Todd R Sponholtz
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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Khunnarong J, Tangjitgamol S, Srijaipracharoen S. Other Gynecologic Pathology in Endometrial Cancer Patients. Asian Pac J Cancer Prev 2016; 17:713-7. [PMID: 26925668 DOI: 10.7314/apjcp.2016.17.2.713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the prevalence and features of other gynecologic or surgical lesions in endometrial cancer (EMC) patients. MATERIALS AND METHODS Clinico-pathological data of EMC patients who were treated in the institution from 1995 to 2012 were collected. Data collected were age, stage of disease according to the FIGO 2009 criteria (FIGO), histopathology, tumor grade, adjuvant therapy, other gynecologic or surgical lesions, follow-up period, and living status. RESULTS The mean age of 396 patients was 56.7 ± 10.64 years. Abnormal uterine bleeding was the most common presenting symptom (90.1%). Bleeding was accompanied with pelvic mass in 7.7% and 5.4% had only a pelvic mass. Abnormal cervical cytology was found in 3.8%. Approximately 75% had early stage diseases and 86% had endometrioid histology. We found 55.8% of EMC patients had other gynecologic lesions: 89.6% benign and 9.5% malignant. Some 4.5% had pre-invasive cervical/vulva/vagina lesions. The two most common gynecologic lesions were myoma uteri and ovarian tumors. Focusing on the latter, approximately 14% were benign while 8% were malignant. Among 364 patients with available data, surgical lesions were found in 11.8%, 5.7% benign and 9.2% malignant. The most common benign surgical condition was chronic appendicitis while breast and colon cancers were the two most common malignant lesions found. CONCLUSIONS More than half of EMC patients had other gynecologic lesions including benign and malignant tumors. Surgical lesions were also found in more than one-tenth of patients. Careful pre-operative evaluation and intra-operative inspection are advised for proper management and better prognosis.
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Affiliation(s)
- Jakkapan Khunnarong
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand E-mail :
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Spontaneous Expulsion of Intramural Fibroid Six Weeks after Emergency Caesarean Section. Case Rep Obstet Gynecol 2015; 2015:640570. [PMID: 26380133 PMCID: PMC4563065 DOI: 10.1155/2015/640570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/18/2022] Open
Abstract
We present a thirty-six-year-old woman with a high risk pregnancy, complicated by multiple congenital anomalies, severe hyperemesis, a pulmonary embolus, and a large intramural fibroid. This fibroid grew in size during the pregnancy. At 34 + 5 weeks, there were reduced fetal movements and a pathological CTG. A live infant was delivered by an emergency cesarean section. Five weeks postpartum, she presented with abdominal pain, offensive vaginal discharge, and fevers. She was given antibiotics and ferrous sulphate. An abdominal ultrasound showed an 11 × 12 × 9 cm fibroid with a coarse degenerative appearance. Clinically, she showed signs of sepsis; a CT scan and laparotomy performed under general anesthetic did not find any collections as a source of sepsis. When stable, she was discharged. She re-presented two days later with a large mass (necrotic fibroid) in her vagina. This is the first case of spontaneous expulsion of fibroid six weeks after caesarean section. Presentation of pain and fever after the delivery may be due to red degeneration of the fibroid, caused by diminished blood supply, ischaemia, and necrosis. This case highlights the importance of considering fibroids as a cause for abdominal pain during and after pregnancy, even up to 6 weeks after delivery.
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Courtoy GE, Donnez J, Marbaix E, Dolmans MM. In vivo mechanisms of uterine myoma volume reduction with ulipristal acetate treatment. Fertil Steril 2015; 104:426-34.e1. [DOI: 10.1016/j.fertnstert.2015.04.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 04/20/2015] [Indexed: 01/22/2023]
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Depressive symptoms and risk of uterine leiomyomata. Am J Obstet Gynecol 2015; 212:617.e1-10. [PMID: 25514762 DOI: 10.1016/j.ajog.2014.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/12/2014] [Accepted: 12/10/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Uterine leiomyomata (UL) are a major source of gynecologic morbidity and the primary indication for hysterectomy. Depression can cause dysregulation of the hypothalamic-pituitary-adrenal axis, which may affect the synthesis of reproductive hormones involved in UL pathogenesis. We assessed the association between depressive symptoms and UL among 15,963 premenopausal women. STUDY DESIGN Data were derived from the Black Women's Health Study, a prospective cohort study. In 1999 and 2005, the Center for Epidemiologic Studies Depression Scale (CES-D) was used to ascertain depressive symptoms. On biennial follow-up questionnaires from 1999 through 2011, women reported physician-diagnosed depression, antidepressant use, and UL diagnoses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression. RESULTS There were 4722 incident UL cases diagnosed by ultrasound (n=3793) or surgery (n=929) during 131,262 person-years of follow-up. Relative to baseline CES-D scores<16, IRRs were 1.05 (95% CI, 0.98-1.13) for CES-D scores 16-24 and 1.16 (95% CI, 1.06-1.27) for CES-D scores≥25 (P-trend=.001). IRRs for current and past physician-diagnosed depression relative to no depression were 1.15 (95% CI, 0.98-1.34) and 1.25 (95% CI, 1.13-1.39), respectively. Results persisted after further control for antidepressant use. IRRs for current and past use of antidepressants (any indication) relative to never use were 1.11 (95% CI, 0.97-1.28) and 1.32 (95% CI, 1.14-1.52), respectively. CONCLUSION In this cohort of black women, greater depressive symptoms were associated with UL, independent of antidepressant use, supporting the hypothesis that dysregulation of the hypothalamic-pituitary-adrenal axis increases UL risk.
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Al-Hendy A, Diamond MP, El-Sohemy A, Halder SK. 1,25-dihydroxyvitamin D3 regulates expression of sex steroid receptors in human uterine fibroid cells. J Clin Endocrinol Metab 2015; 100:E572-82. [PMID: 25625804 PMCID: PMC4399292 DOI: 10.1210/jc.2014-4011] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Uterine fibroids (UFs) are the most common benign tumors in premenopausal women. In this study, we evaluated the effects of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] for the treatment of UFs. OBJECTIVE To determine the role of 1,25(OH)2D3 on the expression of sex steroid receptors in human UF cells. DESIGN Human UFs and their adjacent myometrium were analyzed for expression of estrogen receptor (ER)-α, progesterone receptor (PR)-A, and PR-B, as well as members of the steroid receptor coactivator (SRC) family. Immortalized human uterine fibroid (human uterine leiomyoma [HuLM]) cells were treated with 1,25(OH)2D3 and assayed for the expression and localization of the aforementioned receptors and SRCs using Western blot, immunohistochemistry, immunofluorescence, and immunoprecipitation assays. MAIN OUTCOME MEASURES We discovered a correlation between reduced levels of vitamin D receptor (VDR) and increased levels of ER-α, PR-A, and PR-B in these tissues. We evaluated the effects of 1,25(OH)2D3 on the regulation of the aforementioned sex steroid receptors. RESULTS We observed an inverse correlation between the up-regulated ER-α, PR-A, and PR-B and expression of VDR in UFs. Treatment with 1,25(OH)2D3 significantly decreased levels of ER-α, PR-A, and PR-B, as well as SRCs in HuLM cells (P < .05). In contrast, 1,25(OH)2D3 self-induced its own VDR, which resulted in an induction of VDR-retinoid X receptor-α complex in HuLM cells. Together, these results suggest that 1,25(OH)2D3 functions as an antagonist of sex steroid hormone receptors in HuLM cells. CONCLUSIONS 1,25(OH)2D3 functions as a potent antiestrogenic/antiprogesteronic agent that may have utility as a novel therapeutic option for UF.
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Affiliation(s)
- Ayman Al-Hendy
- Department of Obstetrics and Gynecology (A.A.-H., M.P.D., S.K.H.), Georgia Regents University, Medical College of Georgia, Augusta, Georgia 30912; and Department of Nutritional Sciences (A.E.-S.), University of Toronto, Toronto, Canada M5S 3E2
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Wu X, Ling J, Fu Z, Ji C, Wu J, Xu Q. Effects of miRNA-197 overexpression on proliferation, apoptosis and migration in levonorgestrel treated uterine leiomyoma cells. Biomed Pharmacother 2015; 71:1-6. [PMID: 25960207 DOI: 10.1016/j.biopha.2015.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/AIMS Uterine leiomyoma is the ahead benign tumor of the female genital tract, which resulted in menstrual abnormalities, recurrent pregnancy loss, and other serious gynecological disorders in women. Recently, as the process of exploring the brief molecular mechanisms of tumorgenesis, microRNAs (miRNAs) have attracted much more attention. METHODS In this study, we first confirmed that microRNA-197 (miR-197) was down-regulated significantly in human uterus leiomyoma by quantity real-time polymerase chain reaction, compared to normal uterus myometrium. Then we observed the potential effects of miR-197 overexpression on human uterus leiomyoma cells by cell counting kit 8, wound healing assay, and flow cytometric assessment separately. RESULTS The data showed that miR-197 could inhibit cell proliferation, induce cell apoptosis, and block cell migration in vitro. Coincidently, levonorgestrel (LNG), a well-known uterus leiomyoma therapy, could induce miR-197 expression in human uterus leiomyoma cells, and over-expression of miR-197 showed a synergy effect on human uterus leiomyoma cell proliferation and apoptosis with LNG. CONCLUSION In this study, the data showed that miR-197 could play an anti-oncogenic role in human uterus leiomyoma cells, and cooperate with LNG on the cell proliferation and apoptosis, which suggested that miR-197 might be a potential target and provided database for clinical treatment.
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Affiliation(s)
- Xiaoli Wu
- Department of Women Health Care, Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, China
| | - Jing Ling
- Department of Obstetrics and Gynecology, Affiliated Jiangyin Hospital of South-East University, Jiangyin 214400, China
| | - Ziyi Fu
- Nanjing Maternal and Child Health Medical Institute, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, China
| | - Chenbo Ji
- Nanjing Maternal and Child Health Medical Institute, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, China
| | - Jiangping Wu
- Department of Women Health Care, Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, China
| | - Qing Xu
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, China.
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Seet MJ, Chonkar S, Mathur M. An unusual presentation of a ruptured degenerative fibroid in a perimenopausal woman. BMJ Case Rep 2014; 2014:bcr-2014-207473. [PMID: 25498115 DOI: 10.1136/bcr-2014-207473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 55-year-old woman in a perimenopausal state presented with severe suprapubic pain and fever. Physical examination revealed a tender pelvic mass measuring 24 weeks in size. Ultrasound of the pelvis and CT scan of the abdomen and pelvis showed a 12 cm mass arising from the posterior wall of the uterus with irregular margin inferiorly, raising suspicion of a ruptured mass. The patient was treated conservatively and discharged from the hospital with regular simple analgaesia. She had an elective total hysterectomy bilateral salpingo-oophrectomy and frozen section the following week and histology revealed a benign leiomyoma with extensive necrosis. Moreover, intraoperatively, the fibroid was found to have ruptured its capsule. This case illustrates that a ruptured degeneration of uterine leiomyoma should be considered as one of the differential diagnoses for all women presenting with abdominal pain and a large fibroid mass regardless of their hormonal status or age.
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Affiliation(s)
- Meei Jiun Seet
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sonali Chonkar
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Manisha Mathur
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
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Lam SJ, Best S, Kumar S. The impact of fibroid characteristics on pregnancy outcome. Am J Obstet Gynecol 2014; 211:395.e1-5. [PMID: 24705132 DOI: 10.1016/j.ajog.2014.03.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/28/2014] [Accepted: 03/31/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study was to assess the influence of different characteristics of fibroids on pregnancy outcome. STUDY DESIGN We identified women with fibroids 4 cm or greater in size on ultrasonography at the dating scan between January 2002 and December 2012. The size (4-7 cm, 7-10 cm, >10 cm), number (multiple/single), location (lower uterus/body of uterus), and type (intramural, combination of intramural/subserosal, subserosal) were ascertained. Medical records were reviewed to obtain pregnancy outcomes (preterm delivery, birthweight, mode of delivery, estimated blood loss, postpartum hemorrhage, and admission for fibroid-related pain). RESULTS A total of 121 patients with 179 pregnancies were identified. Preterm delivery was more likely in those with multiple fibroids compared with single fibroids (18% vs 6%; P = .05). The location of the fibroid had an important effect on the mode of delivery with a higher cesarean section rate for fibroids in the lower part of uterus than in the body of the uterus (86% vs 40%; P = .01), a higher rate of postpartum hemorrhage (22% vs 11%; P = .03), and greater estimated blood loss (830 mL [SD, 551] vs 573 mL [SD, 383]; P = .03). Increasing size of fibroid was associated with greater rates of hemorrhage (11% vs 13% vs 36%; P = .04), increased estimated blood loss (567 mL [SD, 365] vs 643 mL [SD, 365] vs 961 mL [SD, 764]; P = .01), and higher rates of admissions for fibroid-related pain (5% vs 23% vs 21%; P = .01). CONCLUSION Different fibroid characteristics affect pregnancy outcome in varying ways. This information can be used to aid counseling women antenatally and in risk-stratifying patients.
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Affiliation(s)
- Sarah-Jane Lam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, England, UK
| | - Sunayna Best
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, England, UK
| | - Sailesh Kumar
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, England, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London, England, UK; Mater Research Institute/University of Queensland, South Brisbane, QLD, Australia.
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Etiology, Pathogenesis, and Malignant Potential of Uterine Leiomyoma – A Review. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0091-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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MicroRNA and gynecological reproductive diseases. Fertil Steril 2014; 101:1545-51. [PMID: 24882618 DOI: 10.1016/j.fertnstert.2014.04.044] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/22/2022]
Abstract
MicroRNAs (miRNAs) are a class of small non-coding RNAs estimated to regulate the translation of mRNAs in 30% of all genes in animals by inhibiting translation. Aberrant miRNA expression is associated with many human diseases, including gynecological diseases, cancer, inflammatory diseases, and cardiovascular disorders. Abnormal expression of miRNAs has been observed in multiple human reproductive tract diseases including preeclampsia, endometrioid endometrial adenocarcinoma, uterine leiomyomata, ovarian carcinoma, endometriosis, and recurrent pregnancy loss. In the following review, an update of the role of microRNA and gynecological diseases is performed covering, not only impact of microRNA dysregulation in the origin of each disease, but also showing the potential useful diagnostic and therapeutic tool that miRNA may play in these gynecological pathologies.
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Islam MS, Akhtar MM, Ciavattini A, Giannubilo SR, Protic O, Janjusevic M, Procopio AD, Segars JH, Castellucci M, Ciarmela P. Use of dietary phytochemicals to target inflammation, fibrosis, proliferation, and angiogenesis in uterine tissues: promising options for prevention and treatment of uterine fibroids? Mol Nutr Food Res 2014; 58:1667-84. [PMID: 24976593 DOI: 10.1002/mnfr.201400134] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 12/31/2022]
Abstract
Uterine leiomyomas (fibroids, myomas) are the most common benign tumors of female reproductive tract. They are highly prevalent, with 70-80% of women burdened by the end of their reproductive years. Fibroids are a leading cause of pelvic pain, abnormal vaginal bleeding, pressure on the bladder, miscarriage, and infertility. They are the leading indication for hysterectomy, and costs exceed 6 billion dollars annually in the United States. Unfortunately, no long-term medical treatments are available. Dysregulation of inflammatory processes are thought to be involved in the initiation of leiomyoma and extracellular matrix deposition, cell proliferation, and angiogenesis are the key cellular events implicated in leiomyoma growth. In modern pharmaceutical industries, dietary phytochemicals are used as source of new potential drugs for many kinds of tumors. Dietary phytochemicals may exert therapeutic effects by interfering with key cellular events of the tumorigenesis process. At present, a negligible number of phytochemicals have been tested as therapeutic agents against fibroids. In this context, our aim was to introduce some of the potential dietary phytochemicals that have shown anti-inflammatory, antiproliferative, antifibrotic, and antiangiogenic activities in different biological systems. This review could be useful to stimulate the evaluation of these phytochemicals as possible therapies for uterine fibroids.
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Affiliation(s)
- Md Soriful Islam
- Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, Ancona, Italy; Biotechnology and Microbiology Laboratory, Department of Botany, University of Rajshahi, Rajshahi, Bangladesh
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