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Wright MA, Kinlaw AC, McClurg AB, Carey E, Doll KM, Vines AI, Olshan AF, Robinson WR. Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. J Womens Health (Larchmt) 2024. [PMID: 38864118 DOI: 10.1089/jwh.2024.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, primary indication(s) for hysterectomy, diagnosis codes associated with the hysterectomy, previous treatments, and laboratory results. Subjects: Patients aged 18-44 years. Exposure: Receipt of hysterectomy for benign and nonobstetric conditions from October 2014 to December 2017. Main Outcome Measures: Using these data, we provided a RAND-based (dichotomous: inappropriate/appropriate) and Wright-based (3-level: inappropriate/ambiguous/appropriate) appropriateness rating and characterized missing information patterns associated with inappropriate ratings. Results: We analyzed 1,829 hysterectomies across 30 nonmutually exclusive primary indications for surgery. Nearly a third (32.8%) of surgeries had only one primary indication for surgery. Using the RAND-based classifier, 31.3% of hysterectomies were rated as appropriate and 68.7% as inappropriate. Using the Wright-based algorithm, 58.1% of hysterectomies were rated as appropriate, 15.7% as ambiguous, and 26.2% as inappropriate. Missing information on diagnostic procedures was the most common characteristic related to both RAND-based (46.1%) and Wright-based (51.2%) inappropriate ratings. Conclusions: The 1997 RAND classification lacked guidance for several contemporary indications, including gender-affirming care. RAND also has an outdated requirement for diagnostic surgeries such as laparoscopies, which have decreased in practice as diagnostic imaging has improved. Sensitivity analyses suggest that inappropriate surgeries cannot all be attributed to bias from missing electronic medical record data. Accurately documenting care delivery for benign gynecological conditions is key to ensuring quality and equity in gynecological care.
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Affiliation(s)
- Maya A Wright
- Tanaq Support Services LLC, Atlanta, Georgia, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alan C Kinlaw
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Asha B McClurg
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kemi M Doll
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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2
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Capezzuoli T, Aslan B, Vannuccini S, Orlandi G, La Torre F, Sorbi F, Fambrini M, Petraglia F. Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review. Reprod Sci 2024; 31:1171-1178. [PMID: 38110820 DOI: 10.1007/s43032-023-01418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Batuhan Aslan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Gretha Orlandi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Francesco La Torre
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Flavia Sorbi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Massimiliano Fambrini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy.
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Laily A, Nair I, Shank SE, Wettschurack C, Khamis G, Dykstra C, DeMaria AL, Kasting ML. Enhancing Uterine Fibroid Care: Clinician Perspectives on Diagnosis, Disparities, and Strategies for Improving Health Care. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:293-304. [PMID: 38558944 PMCID: PMC10979696 DOI: 10.1089/whr.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
Objective To explore clinicians' perspectives on diagnosing, treating, and managing uterine fibroids, identifying gaps and challenges in health care delivery, and offering recommendations for improving care. Materials and Methods A qualitative design was used to conduct 14 semistructured interviews with clinicians who treat fibroid patients in central Indiana. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis techniques. Constant comparative analysis was used to identify emergent themes. Results Four themes emerged. (1) Lack of patient fibroid awareness: Patients lacked fibroid awareness, leading to challenges in explaining diagnoses and treatment. Misconceptions and emotional distress highlighted the need for better education. (2) Inequities in care and access: Health care disparities affected Black women and rural patients, with transportation, scheduling delays, and financial constraints hindering access. (3) Continuum of care: Clinicians prioritized patient-centered care and shared decision-making, tailoring treatment based on factors like severity, location, size, cost, fertility goals, and recovery time. (4) Coronavirus disease 2019 (COVID-19) impact: The pandemic posed challenges and opportunities, prompting telehealth adoption and consideration of nonsurgical options. Conclusions Clinician perspectives noted patient challenges with fibroids, prompting calls for enhanced education, interdisciplinary collaboration, and accessible care to address crucial aspects of fibroid management and improve women's well-being. Practice Implications Clinicians identified a lack of patient awareness and unequal access to fibroid care, highlighting the need for improved education and addressing disparities. Findings also emphasized the importance of considering multidimensional aspects of fibroid care and adapting to challenges posed by the COVID-19 pandemic, recommending broader education, affordability, interdisciplinary collaboration, and research for better fibroid health care.
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Affiliation(s)
- Alfu Laily
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Isha Nair
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Sophie E. Shank
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Cameron Wettschurack
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Grace Khamis
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Chandler Dykstra
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Andrea L. DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Monica L. Kasting
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
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4
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Nimma IR, Brahmbhatt P, Nimma S, Stancampiano F. Pantoea agglomerans bacteraemia after uterine artery embolisation: an unusual pathogen. BMJ Case Rep 2024; 17:e258345. [PMID: 38442980 PMCID: PMC10916084 DOI: 10.1136/bcr-2023-258345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
A woman in her 40s presented to the emergency department (ED) with a 3-week history of nausea, vomiting and diarrhoea. Blood cultures were positive for Serratia and Pantoea agglomerans spp. One month before her ED visit, she underwent targeted uterine artery embolisation with particles by an interventional radiologist. Uterine artery embolisation is considered a safe alternative to surgical removal of fibroids or hysterectomy. The patient was initially treated with targeted antibiotics for a large infected uterine fibroid but ultimately required a hysterectomy for source control. To our knowledge, this is the first documented case of P. agglomerans infecting a uterine fibroid.
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Affiliation(s)
- Induja Reddy Nimma
- Internal Medicine, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Pavan Brahmbhatt
- Radiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Sindhuja Nimma
- Anesthesiology, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
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Aggarwal H, Aggarwal H, Wanjari A. Unnecessary Hysterectomies Among Premenopausal Women in Developed and Developing Countries: A Critical Review of Steps Taken to Improve Women's Health. Cureus 2023; 15:e49943. [PMID: 38179386 PMCID: PMC10765271 DOI: 10.7759/cureus.49943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Women with pelvic organ disease often require a hysterectomy for better health. Still, in countries like India, there are many challenges for them as they are subjected many a time to unnecessary hysterectomies. Through this article, we suggest many ways to address this menace, such as proper health education and sensitization of women of premenopausal age group by health workers and mass media. Many preventable hysterectomies can be avoided if we guide women about their pathology before giving consent for surgery. Role enhancement of health agencies and nongovernmental organizations for early identification of such women in the society of all segments, stopping the greed of various health institutions using government-sponsored insurance health schemes for personal gain, and law enforcement by courts and health departments should also be our main focus. This study aims to review nonsurgical procedures adopted to decrease unnecessary hysterectomies and make suitable directions by government and lawful agencies to curb this menace. All states and union territories received the "Guidelines to Prevent Unnecessary Hysterectomies" recommendations from the Ministry of Health and Family Welfare for compliance. The recommendations suggest creating hysterectomy monitoring committees at the district, state, and federal levels. The duration of hospital stays and associated expenditures can decrease by performing minimally invasive treatments as outpatient operations. Minimally invasive options may shape the future of gynecology in developed nations.
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Affiliation(s)
- Hitaishi Aggarwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hardik Aggarwal
- Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chase DM, McCann LD, Treuth A, Cui H, Laniewski P, Jimenez NR, Mahnert ND, Roe DJ, Herbst-Kralovetz MM. Preoperative quality of life at time of gynecologic surgery: considerations for postoperative management. AJOG GLOBAL REPORTS 2023; 3:100275. [PMID: 38077226 PMCID: PMC10701442 DOI: 10.1016/j.xagr.2023.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patients presenting for gynecologic surgery are a heterogeneous group. Preoperative quality of life may be a useful tool to guide postoperative management. OBJECTIVE This study aimed to examine the key drivers of preoperative quality of life to improve counseling and postoperative management. STUDY DESIGN This study analyzed preoperative survey results from 154 participants using the following surveys: National Institutes of Health Toolbox Global Health v1.2, Gastrointestinal: Gas and Bloating v1.1 13a, Gastrointestinal: Diarrhea v1.0 6a, and Sexual Function and Satisfaction Brief Profile (Female) v2.0, Perceived Stress Scale, the Vaginal Assessment Scale, and the Vulvar Assessment Scale. Survey results in the form of T-scores were compared in patients with endometrial cancer and patients with benign gynecologic conditions using the Kruskal-Wallis test. The multivariate analysis was performed using linear regression to adjust the comparisons for age, body mass index, and comorbidity. RESULTS Of the 154 patients, preoperative diagnosis was benign in 66% (n=102) and endometrial cancer in 34% (n=52). Patients with endometrial cancer were more likely to be older, non-White, in lower income brackets, have higher body mass index, and be postmenopausal (P<.05). Although preoperative global health scores were similar between benign and malignant cases (P>.05), when adjusted for age, the differences in global health quality of life between patients with benign gynecologic conditions and those with endometrial cancer became significant, because the endometrial cancer group was older than the benign group (P<.05). However, when adjusting for age, body mass index, and comorbidities (hypertension and diabetes), the differences were no longer significant (P>.05). Sexual interest was decreased in the patients with endometrial cancer both in the unadjusted and adjusted model; and vulvar complaints became significantly different between the groups when controlling for body mass index, age, and comorbidities (P<.05). CONCLUSION Despite substantial differences in preoperative diagnosis, preoperative quality of life is highly influenced by age, body mass index, and comorbidities. Therefore, these factors should be explored in surgical outcomes and postoperative management trials.
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Affiliation(s)
- Dana M. Chase
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA (Dr Chase)
| | - Lelan D. McCann
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, The University of Arizona, Banner University Medical Center Phoenix, Phoenix, AZ (Drs McCann, Mahnert, and Herbst-Kralovetz)
| | - Alice Treuth
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
| | - Haiyan Cui
- University of Arizona Cancer Center, Tucson, AZ (Drs Cui and Roe)
| | - Pawel Laniewski
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
| | - Nicole R. Jimenez
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
| | - Nicole D. Mahnert
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, The University of Arizona, Banner University Medical Center Phoenix, Phoenix, AZ (Drs McCann, Mahnert, and Herbst-Kralovetz)
| | - Denise J. Roe
- University of Arizona Cancer Center, Tucson, AZ (Drs Cui and Roe)
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ (Dr Roe)
| | - Melissa M. Herbst-Kralovetz
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, The University of Arizona, Banner University Medical Center Phoenix, Phoenix, AZ (Drs McCann, Mahnert, and Herbst-Kralovetz)
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
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7
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Tsikouras P, Oikonomou E, Tsatsaris G, Bothou A, Kyriakou D, Nikolettos K, Nalmbanti T, Peitsidis P, Trypsanis G, Iatrakis G, Nikolettos N, Souftas V. Our Experience with Hydrogel-Coated Trisacryl Microspheres in Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids and Adenomyosis: A Follow-Up of 11 Years. J Pers Med 2023; 13:1385. [PMID: 37763151 PMCID: PMC10532514 DOI: 10.3390/jpm13091385] [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: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids and non-controllable adenomyosis symptoms is a relatively new procedure for organ-preserving therapy. These benign conditions can become symptomatic in about 30% of women between the ages of 35 and 50. The purpose of the UAE either for fibroids or adenomyosis is the elimination of blood loss, the reduction in pain, and bulky or rectal pressure symptoms. The purpose of this study is to present our experience in UAE with the use of hydrogel-coated tris acryl microspheres for the treatment of symptomatic uterine fibroids and adenomyosis.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Efthymios Oikonomou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - George Tsatsaris
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Dimitrios Kyriakou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Theopi Nalmbanti
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Grigorios Trypsanis
- Department of Medical Statistics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - George Iatrakis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Vasileios Souftas
- Department of Interventional Radiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Tahapary M, Timmerman S, Ledger A, Dewilde K, Froyman W. Implementation of robot-assisted myomectomy in a large university hospital: a retrospective descriptive study. Facts Views Vis Obgyn 2023; 15:243-250. [PMID: 37742201 PMCID: PMC10643016 DOI: 10.52054/fvvo.15.3.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Background: Myomectomy is often the preferred treatment for symptomatic patients with myomas who wish to preserve their fertility, with a shift from open surgery towards minimally invasive techniques. Objectives Retrospective study assessing patient and surgery characteristics, follow-up, and outcomes of robot-assisted myomectomy (RAM) and abdominal myomectomy (AM) in women treated between January 1, 2018, and February 28, 2022, in a Belgian tertiary care hospital. Materials and Methods A descriptive analysis was conducted on consecutive patients who underwent myomectomies. 2018 was considered the learning curve for RAM. Main outcome measures We assessed rate of open surgery, operation time, postoperative hospital stay, and operative complications. Results In total, 94 RAMs and 15 AMs were performed. The rate of AMs was 56.5% in 2018 versus 2.3% after the learning curve. The median operation time for RAM was 136.5 minutes and 131 minutes for AM. Conversion rate for RAM was 0%. The median postoperative hospital stay after RAM was 1 night and 4 nights for AM. Postoperative complication rate was low, with only 14.9% and 33.3% of patients requiring pharmacological treatment of complications after RAM or AM, respectively. No surgical re-intervention was needed in any group. Conclusions Implementation of RAM at our centre resulted in a significant reduction of open surgery rate. RAM demonstrated shorter hospital stays and a lower incidence of complications compared to AM. What is new? Our study highlights the successful adoption of RAM, showcasing its potential to replace AM even in complex cases. The findings affirm the safety and feasibility of RAM, supporting its use as a valuable technique for minimally invasive myomectomy.
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9
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Frisch EH, Mitchell J, Yao M, Llarena N, Omosigho UR, DeAngelo L, Arakelian M, Bradley L, Falcone T. The Impact of Fertility Goals on Long-term Quality of Life in Reproductive-aged Women Who Underwent Myomectomy versus Hysterectomy for Uterine Fibroids. J Minim Invasive Gynecol 2023; 30:642-651. [PMID: 37044261 DOI: 10.1016/j.jmig.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
STUDY OBJECTIVE The objective of this study is to compare quality of life (QOL) for myomectomy with hysterectomy 1 to 5 years after surgical management for fibroids. This study evaluated the difference in QOL in a population of women of reproductive age, including those who desire fertility. DESIGN A retrospective cohort study. INTERVENTIONS Not applicable. SETTING A large academic hospital. PATIENTS A total of 142 women who underwent hysterectomy or myomectomy in 2015 to 2020. Included patients were women aged 18 years or older who underwent surgical intervention owing to uterine fibroids. MEASUREMENTS AND MAIN RESULTS The 36-Item Short Form Health Survey (SF-36) provides a total score as a single measure of health-related QOL. The Uterine Fibroid Symptom Quality of Life Questionnaire for Hysterectomy and Myomectomy (UFS-QOL) is a patient-reported outcome measure of fibroid symptoms and health-related QOL after hysterectomy and myomectomy. There was no significant difference in SF-36 QOL scores in women after myomectomy who desired fertility compared with those who did not desire fertility, except in the social functioning domain (p = .025). UFS-QOL scores in women after myomectomy who desired fertility were not significantly different compared with women after myomectomy who did not desire fertility (p = .37). There were no significant differences between women who underwent myomectomy and hysterectomy in overall QOL scores on the SF-36 (p = .13) and UFS-QOL scores (p = .16). CONCLUSION Myomectomy is not associated with significant differences in measures of general health and QOL compared with hysterectomy, making it a viable fibroid management option for women who desire fertility. Our study highlights the importance of discussing fertility goals and QOL when counseling patients for surgical fibroid treatment.
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Affiliation(s)
- Emily H Frisch
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena).
| | - Jameson Mitchell
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Meng Yao
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Natalia Llarena
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Ukpebo R Omosigho
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Lydia DeAngelo
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Miranda Arakelian
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Linda Bradley
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Tommaso Falcone
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
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10
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Nawar AT, Binmahfouz A, Abbas E, Almehmadi SF, Turson SA, Kanbayti IH. Increased Risk of Breast Fibroadenomas Among Obese and Postmenopausal Women With Uterine Fibroids. Cureus 2023; 15:e43503. [PMID: 37719568 PMCID: PMC10500960 DOI: 10.7759/cureus.43503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Uterine fibroids and breast fibroadenomas are common female benign neoplasms that are similarly derived from a single clonal origin and are modulated by estradiol concentration in blood. However, the association between these neoplasms has not yet been explored. Hence, this study aims to investigate the relationship between uterine fibroids and breast fibroadenomas. Methods A total of 199 women (cases: 72 women with uterine fibroids, control: 127 women without uterine fibroids) were included in this study. Ultrasound was used to screen for uterine fibroids, and both ultrasound and biopsy were utilized to diagnose breast fibroadenomas. Logistic regression analysis was used to investigate the association between uterine fibroids and breast fibroadenomas and the factors associated with the relationship. Results Women with uterine fibroids have more than two times higher odds of having breast fibroadenomas among older women (p=0.03), more than twofold increased odds of breast fibroadenomas among obese females (p=0.05), and higher odds of having breast fibroadenomas among postmenopausal transition participant groups (OR=9.6; 95% CI 1.98-30.14; p-value=0.005). Conclusion The association between uterine fibroids and breast fibroadenomas is significantly pronounced among older, obese, and postmenopausal women. This relationship might be driven by the indirect stimulation of estrogen hormone receptors via adipose tissue or other lifestyle as well as genetic factors. Therefore, further larger prospective studies considering these factors are needed to replicate the current findings.
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Affiliation(s)
- Angham T Nawar
- Radiological Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University Hospital, Jeddah, SAU
- In Vitro Fertilization Unit, Center for Innovation in Personalized Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Ebrahym Abbas
- Radiology, King Abdulaziz University Hospital, Jeddah, SAU
| | | | | | - Ibrahem H Kanbayti
- Radiological Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University Hospital, Jeddah, SAU
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11
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Lou Z, Huang Y, Li S, Luo Z, Li C, Chu K, Zhang T, Song P, Zhou J. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study. BMC Public Health 2023; 23:916. [PMID: 37208621 DOI: 10.1186/s12889-023-15765-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Uterine fibroids are the most common benign neoplasm of the uterus and a major source of morbidity for women. We report an overview of trends in uterine fibroids of incidence rate, prevalence rate, years lived with disability (YLDs) rate in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort. METHODS The incident case, incidence rate, age-standardized rate (ASR) for incidence, prevalent case, prevalence rate, ASR for prevalence, number of YLDs, YLD rate, and ASR for YLDs were derived from the Global Burden of Disease 2019 (GBD 2019) study. We utilized an age-period-cohort (APC) model to estimate overall annual percentage changes in the rate of incidence, prevalence, and YLDs (net drifts), annual percentage changes from 10 to 14 years to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. RESULTS Globally, the incident cases, prevalent cases, and the number of YLDs of uterine fibroids increased from 1990 to 2019 with the growth of 67.07%, 78.82% and 77.34%, respectively. High Socio-demographic Index (SDI) and high-middle SDI quintiles with decreasing trends (net drift < 0.0%), and increasing trends (net drift > 0.0%) were observed in middle SDI, low-middle SDI, and low SDI quintiles in annual percentage change of incidence rate, prevalence rate and YLDs rate over the past 30 years. There were 186 countries and territories that showed an increasing trend in incidence rate, 183 showed an increasing trend in prevalence rate and 174 showed an increasing trend in YLDs rate. Moreover, the effects of age on uterine fibroids increased with age and peaked at 35-44 years and then declined with advancing age. Both the period and cohort effects on uterine fibroids showed increasing trend in middle SDI, low-middle SDI and low SDI quintiles in recent 15 years and birth cohort later than 1965. CONCLUSIONS The global burden of uterine fibroids is becoming more serious in middle SDI, low-middle SDI and low SDI quintiles. Raising awareness of uterine fibroids, increasing medical investment and improving levels of medical care are necessary to reduce future burden.
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Affiliation(s)
- Zheng Lou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yizhou Huang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuting Li
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou Luo
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunming Li
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ketan Chu
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Zhang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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12
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Begho A, Waterman F. A significant burden: A qualitative exploration of the experience of women living with fibroids in St. Kitts and Nevis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2023. [DOI: 10.1177/22840265231158416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Background: Our study aimed to understand the illness experience of women living in St Kitts and Nevis who have been affected by fibroids by utilising Leventhal’s commonsense model of illness. Methods: Upon receiving ethics approval, females aged between 18 and 55 who were currently a resident in St Kitts and Nevis and who had an experience with fibroids within the last 5 years were recruited to consent and complete 1-hour interviews during which they described the different ways in which fibroids affects them. Results: The interview guide incorporated the common-sense model; all interviews were 1:1 and a thematic analysis was conducted. The final sample consisted of 11 women, 10 from St Kitts and 1 from Nevis. Their ages ranged from 23 to 49, and the average age of participants was 39 years. Participants described their fibroids in generally negative terms and noted several physical, emotional, social and professional consequences as a result of their fibroid symptoms. Conclusions: Our study revealed the need for a clear strategy for managing patients with symptomatic fibroids—a strategy that includes regular monitoring of patients, good communication between doctor and patient and clear guidance on management for patients.
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Affiliation(s)
- Abi Begho
- Lake Health and Wellbeing, Saint Kitts and Nevis
| | - Fanta Waterman
- Serrette Brown Research and Consulting, Saint Kitts and Nevis
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13
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Disparities in Benign Gynecologic Surgical Care. Clin Obstet Gynecol 2023; 66:124-131. [PMID: 36657049 DOI: 10.1097/grf.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A person's health is not only affected by their disease states, but also the quality of care and posttreatment sequelae. Research shows that disparities exist in benign gynecologic surgery access to care, techniques, and perioperative outcomes. Surgical education, pathways that emphasize minimally invasive approaches, and patient-centered care that recognizes historical influences on patient perspectives are critical to dampening these disparities.
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14
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McKain L, Edsall K, Dufour R, Lickert C. Treatment Patterns in Patients with Uterine Fibroids With and Without a Diagnosis of Heavy Menstrual Bleeding: Results from a Large U.S. Claims Database. J Womens Health (Larchmt) 2023; 32:332-340. [PMID: 36413048 PMCID: PMC9993160 DOI: 10.1089/jwh.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This retrospective database analysis describes clinical characteristics and treatment patterns of U.S. women with a diagnosis for uterine fibroids (UF), both with and without heavy menstrual bleeding (HMB). Materials and Methods: Two cohorts aged 18-50 years with an incident UF diagnosis, comprising women with and without claims for HMB (UF-HMB and UF-only), were identified from the IQVIA PharMetrics® Plus database (January 1, 2010-December 31, 2019). The index date was the first UF claim following diagnosis; treatment patterns were documented for postindex years 1 and 2 and the full duration of postindex follow-up. Also identified were claims for symptoms or signs potentially associated with UF. Outcomes were the proportion of patients treated with pharmacologic therapies of interest and gynecologic procedures. Logistic regression was used to identify factors associated with postdiagnosis hysterectomy and hormonal therapy. Results: A total of 66,313 (71.8%) women were included in the UF-HMB cohort (mean age [standard deviation]) 42.6 [5.4] years), and 26,068 (28.2%) in the UF-only cohort (41.8 [6.3]). Median follow-up was ∼4 years. Pain was the most common symptom (42.7% in patients with UF-HMB and 36.6% with UF-only); also common were abnormal bleeding (15.6%, 11.5%) and fatigue (22.2%, 15.5%). Within 1 year of UF diagnosis, 28.8% and 49.2% of women with UF-HMB and UF-only, respectively, had no claims for relevant pharmacologic or surgical treatment. In logistic regression, multiple factors were associated with a higher likelihood of receiving hysterectomy or hormonal therapy. Conclusions: Patients with UF-HMB were more likely to receive UF treatment, either surgical or pharmacologic, than women with UF-only. Apart from HMB, pain was the most commonly documented symptom of UF.
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Affiliation(s)
- Laura McKain
- Medical Affairs, Myovant Sciences, Inc., Brisbane, California, USA
| | - Kaitlyn Edsall
- Life Sciences Practice, Charles River Associates, Boston, Massachusetts, USA
| | - Robert Dufour
- Medical Affairs, Myovant Sciences, Inc., Brisbane, California, USA
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15
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Nagai K, Asano R, Sekiguchi F, Asai-Sato M, Miyagi Y, Miyagi E. MED12 mutations in uterine leiomyomas: prediction of volume reduction by gonadotropin-releasing hormone agonists. Am J Obstet Gynecol 2023; 228:207.e1-207.e9. [PMID: 36150519 DOI: 10.1016/j.ajog.2022.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists are used to treat premenopausal uterine leiomyomas; however, leiomyoma volume reduction is not always achieved. The reduction rate after this treatment varies for each leiomyoma, even in the same patient. Therefore, an effective method for predicting uterine leiomyoma volume reduction is required to reduce the adverse hypoestrogenic effects and drug-related economic burden related to gonadotropin-releasing hormone agonists. OBJECTIVE This study aimed to determine the predictive use of MED12 mutations for evaluating the effect of gonadotropin-releasing hormone agonist treatment concerning reducing uterine leiomyoma volume and to predict the MED12 mutation status based on the findings of magnetic resonance imaging performed before treatment. STUDY DESIGN MED12 exon 2 mutation and erythropoietin expression in uterine leiomyomas were evaluated concerning volume reduction, as measured using magnetic resonance imaging. We developed a system for classifying leiomyomas according to T2-weighted magnetic resonance imaging signals to noninvasively predict the presence or absence of MED12 mutations in leiomyomas. Leiomyoma samples (>5 cm) were obtained from 168 patients during surgery (hysterectomy or myomectomy) between 2005 and 2021 at Yokohama City University Hospital. To analyze the rate of leiomyoma volume reduction, 41 patients had been preoperatively administered the gonadotropin-releasing hormone agonist (leuprorelin acetate 3.75 mg, monthly subcutaneous injection) for 3 months; magnetic resonance imaging was performed before and after treatment without contrast material. RESULTS Patients with MED12 exon 2 mutations had smaller volume reduction after treatment with the gonadotropin-releasing hormone agonist (P<.001, Mann-Whitney U test) and displayed lower signal intensity on T2-weighted images than those with leiomyomas expressing wild-type MED12 exon 2. The newly proposed magnetic resonance imaging-based classification system showed that MED12 exon 2 mutations were more frequent in the low-signal group than in the high-signal group, with nearly equal proportions of mutated and wild-type MED12 exon 2 leiomyomas noted in the intermediate group. The low-signal group had significantly lower erythropoietin expression levels than the high-signal group (P<.001, Kruskal-Wallis test with the Dunn posthoc analysis). CONCLUSION MED12 mutation status can be a candidate marker for predicting the effect of gonadotropin-releasing hormone agonists on uterine leiomyoma reduction. Magnetic resonance imaging findings can be used to determine MED12 mutation status as a noninvasive strategy to select patients who will most likely benefit from gonadotropin-releasing hormone agonist treatment.
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Affiliation(s)
- Koichi Nagai
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryoko Asano
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Futoshi Sekiguchi
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Dykstra C, Laily A, Marsh EE, Kasting ML, DeMaria AL. "I think people should be more aware:" Uterine fibroid experiences among women living in Indiana, USA. PATIENT EDUCATION AND COUNSELING 2023; 107:107584. [PMID: 36473404 PMCID: PMC9808590 DOI: 10.1016/j.pec.2022.107584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To understand healthcare experiences among patients with uterine fibroids (fibroids) across the continuum of care, from early symptoms through diagnosis, treatment, and management, while also investigating health disparities. METHODS We conducted 20 semi-structured interviews with patients with fibroids. Interviews were transcribed verbatim and qualitatively analyzed using thematic analysis. Eligible participants were women aged 18 and over, residing within 75 miles of one of the two recruitment locations (Tippecanoe or Marion County) in Indiana, USA. RESULTS Women experienced myriad physical symptoms, which often manifested into psychological and sexual disturbances and infiltrated all aspects of daily life. Internet searches were frequently mentioned as their main information source. Fertility became a prominent factor in deciding treatment options. However, health disparities prevented some from receiving quality fibroids healthcare. Some women reported staying home during COVID-19 pandemic facilitated the management of physical symptoms. Overall, participants advocated for greater fibroids awareness and education. CONCLUSION Results highlight barriers and facilitators to fibroids-related decisions, behaviors, and outcomes. Translation of research to practice was guided by a combined Social-Ecological Model and social determinants of health framework for development of strategic interventions. PRACTICE IMPLICATIONS Interventions should aim to improve fibroids healthcare access, education and awareness, and patient-provider communication for minority, rural, and low socioeconomic status communities disproportionately impacted by fibroids.
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Affiliation(s)
- Chandler Dykstra
- Marian University College of Osteopathic Medicine, Indianapolis, IN, USA.
| | - Alfu Laily
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
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17
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Edzie EKM, Dzefi-Tettey K, Brakohiapa EK, Quarshie F, Ken-Amoah S, Cudjoe O, Boadi E, Kpobi JM, Edzie RA, Kusodzi H, Dziwornu P, Asemah AR. Age of first diagnosis and incidence rate of uterine fibroids in Ghana. A retrospective cohort study. PLoS One 2023; 18:e0283201. [PMID: 36928541 PMCID: PMC10019645 DOI: 10.1371/journal.pone.0283201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Uterine fibroids are benign tumors that grow in or on the uterus of women. Globally, they occur in more than 80% of women of African ancestry and 70% in white women. Uterine fibroid requires much attention because of its high incidence rate among women of all races and ages. This study sought to document the age of first diagnosis and incidence rates of uterine fibroids in our urban setting. METHODS This study reviewed and analyzed the ages and year of diagnosis of all 2,469 patients with the first diagnosis of uterine fibroids from 1st January 2018 to 31st December 2021 in South-Central Ghana. The obtained data were analyzed using GNU PSPP, Python on Jupyter Notebook and Libre Office Calc with statistical significance level set at p≤0.05. RESULTS The overall average age was 36.29±8.08 years, with age range 17-61 years and the age groups with the highest frequencies were 35-39 years (n = 642, 26.00%), 30-34 years (n = 563, 22.80%) and 40-44 years (n = 381, 15.43%). The mean ages of the patients in 2018, 2019, 2020 and 2021 were 36.70±8.00 years (95%CI = 35.97-37.43), 37.07±7.66 years (95%CI = 36.45-37.70), 35.92±7.87 years (95%CI = 35.30-36.53) and 35.78±8.54 years (95%CI = 35.19-36.38) respectively. The incidence rate (per 100,000) of uterine fibroids in 2018, 2019, 2020 and 2021 were 66.77 (95% CI = 60.63-72.90), 81.86 (95%CI = 75.19-88.58), 85.60 (95%CI = 78.85-92.35) and 92.40 (95%CI = 85.88-98.92) respectively, with 35-39 age group recording the highest in all years. CONCLUSION The incidence rate of uterine fibroids increased as the years progressed and it is mostly high in 35-39 years age category, with a decreasing annual mean age trend indicative of early diagnosis.
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Affiliation(s)
- Emmanuel Kobina Mesi Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | | | | | - Frank Quarshie
- African Institute for Mathematical Sciences (AIMS), Summerhill Estates, East Legon Hills, Santoe, Accra, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Obed Cudjoe
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Evans Boadi
- Department of Radiology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | | | - Richard Ato Edzie
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Henry Kusodzi
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Prosper Dziwornu
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdul Raman Asemah
- Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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18
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Uterine Fibroids, Perceived Stress, and Menstrual Distress: a Key Role of Heavy Menstrual Bleeding. Reprod Sci 2022; 30:1608-1615. [PMID: 36471219 PMCID: PMC10160184 DOI: 10.1007/s43032-022-01126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age, frequently associated with pain symptoms and heavy menstrual bleeding (HMB), leading to impaired quality of life. Thus, the aim of the study was to evaluate the global perception of stress and the menstrual distress in patients with UFs. A cross-sectional observational study was conducted on a group (n = 69) of fertile age women with UFs compared to age-matched controls, by administering two questionnaires: the perceived stress scale (PSS) and the Menstrual Distress Questionnaire (MEDI-Q). The PSS, MEDI-Q Total Score and 3 subscales—menstrual symptoms (MS), menstrual symptoms distress (MSD), and menstrual specificity index (MESI)—were evaluated. Patients with UFs showed higher PSS than controls (18.5 ± 5.0 vs. 13.8 ± 5.0, p < 0.001) and PSS values were very high in those with HMB, severe dysmenorrhea, and impaired social and working life. Patients with UFs also showed significantly higher score for MEDI-Q Total Score (16.51 ± 12.99 vs. 10.86 ± 12.36) (p < 0.01) as well as for the subscales MSD (2.54 ± 1.07 vs. 1.57 ± 0.98) (p < 0.001) and MESI (0.76 ± 0.30 vs 0.60 ± 0.39) (p < 0.05). The menstrual distress was associated to being uncomfortable about uterine bleeding; in fact, MEDI-Q Total Score was significantly higher in women with HMB compared to those with moderate/normal bleeding. UF characteristics (number, type, and size) did not correlate with perceived stress or menstrual distress. In conclusion, women with UFs have significantly higher levels of perceived stress and menstrual distress than controls and HMB plays a major role in determining such conditions.
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19
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Tsikouras P, Gkaitatzi F, Gerede A, Anthoulaki X, Bothou A, Chalkidou A, Michalopoulos S, Tsirkas I, Gyroglou S, Peitsidis P, Nikolettos K, Alexiou A, Dragoutsos G, Sachnova N, Chloropoulou P, Zervoudis S, Iatrakis G, Rath W, Trypsiannis G, Nikolettos N, Souftas V. Life Quality in Premenopausal Women after Embolization of Uterine Myomas. J Pers Med 2022; 12:jpm12121990. [PMID: 36556210 PMCID: PMC9786225 DOI: 10.3390/jpm12121990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: Fibroids cause significant morbidity and are the most common indication for hysterectomies worldwide, delimiting a major public health problem. Uterine artery embolization (UAE) is an alternative therapy to surgical treatment of symptomatic fibroids; it has satisfactory long-time results and is no longer considered investigational for the treatment of symptomatic fibroids. This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after UAE and to optimize the assessment of safety and outcomes measures for participants who receive UAE to objective compare UAE and surgical alternatives for therapy of symptomatic fibroids. Study design: The analysis was based on questionnaires completed by 270 pre-menopausal females with a mean age of 42 years (range, 38-50 years) who underwent UAE for uterine leiomyomas and/or adenomyosis from November 2013 through December 2019. Only symptomatic women were selected whose symptoms were not improving with medication and who did not wish to have children. The primary outcome measure was a change in fibroid symptoms and HRQOL (health related quality of life) after UAE. Secondary outcomes included the decrease in uterine volume after UAE. Results: Questionnaires were completed by 270 women (100%) at a mean of 12.1 months from UAE. The median follow-up period was two years. Uterine fibroid embolization led to a shrinkage at three months for the 90% of the participants. A reduction of bleeding symptoms, pain and bulk-related symptoms was observed in 89.7%, 88.9%, and 89.5% of the patients, respectively. In the long term, there was no significant difference in parameters assessed compared with the midterm follow-up findings. A total of 6 patients (2.3%) underwent fractional curettage an average of 32.1 months after intervention due to necrotic changes in submucosal fibroids. All participants continued to be satisfied with the intervention, and 240 patients (88.9%) answered that they would recommend uterine fibroid embolization to other patients. Conclusions: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL which is associated with high levels of satisfaction with the procedure (even when subsequent therapies are pursued).
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
- Correspondence:
| | - Foteini Gkaitatzi
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Aggeliki Gerede
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Anna Chalkidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Spyridon Michalopoulos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Ioannis Tsirkas
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Selma Gyroglou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | | | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Alexios Alexiou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - George Dragoutsos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Natalia Sachnova
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Pelagia Chloropoulou
- Department of Anaesthesiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - George Iatrakis
- Rea Maternity Hospital, University of West Attica, 17564 Athens, Greece
| | - Werner Rath
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Grigorios Trypsiannis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Vasileios Souftas
- Department of Interventional Radiology, Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Tan H, Wu J, Zhang R, Zhang C, Li W, Chen Q, Zhang X, Yu H, Shi W. Development, Validation, and Application of a Human Reproductive Toxicity Prediction Model Based on Adverse Outcome Pathway. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:12391-12403. [PMID: 35960020 DOI: 10.1021/acs.est.2c02242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A growing number of environmental contaminants have been proved to have reproductive toxicity to males and females. However, the unclear toxicological mechanism of reproductive toxicants limits the development of virtual screening methods. By consolidating androgen (AR)-/estrogen receptors (ERs)-mediated adverse outcome pathways (AOPs) with more than 8000 chemical substances, we uncovered relationships between chemical features, a series of pathway-related effects, and reproductive apical outcomes─changes in sex organ weights. An AOP-based computational model named RepTox was developed and evaluated to predict and characterize chemicals' reproductive toxicity for males and females. Results showed that RepTox has three outstanding advantages. (I) Compared with the traditional models (37 and 81% accuracy, respectively), AOP significantly improved the predictive robustness of RepTox (96.3% accuracy). (II) Compared with the application domain (AD) of models based on small in vivo datasets, AOP expanded the ADs of RepTox by 1.65-fold for male and 3.77-fold for female, respectively. (III) RepTox implied that hydrophobicity, cyclopentanol substructure, and several topological indices (e.g., hydrogen-bond acceptors) were important, unbiased features associated with reproductive toxicants. Finally, RepTox was applied to the inventory of existing chemical substances of China and identified 2100 and 7281 potential toxicants to the male and female reproductive systems, respectively.
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Affiliation(s)
- Haoyue Tan
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Jinqiu Wu
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Rong Zhang
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Chi Zhang
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Wei Li
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Qinchang Chen
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Xiaowei Zhang
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Hongxia Yu
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
| | - Wei Shi
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing 210023, Jiangsu, China
- Jiangsu Province Ecology and Environment Protection Key Laboratory of Chemical Safety and Health Risk, Nanjing 210023, Jiangsu, China
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21
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Stewart EA, Lukes AS, Venturella R, Arjona Ferreira JC, Li Y, Hunsche E, Wagman RB, Al-Hendy A. Relugolix Combination Therapy for Uterine Leiomyoma-Associated Pain in the LIBERTY Randomized Trials. Obstet Gynecol 2022; 139:1070-1081. [PMID: 35675604 DOI: 10.1097/aog.0000000000004787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effect of once-daily relugolix combination therapy (relugolix-CT: relugolix 40 mg, estradiol 1 mg, and norethindrone acetate 0.5 mg) compared with placebo on moderate-to-severe pain in women with uterine leiomyomas and heavy menstrual bleeding. METHODS Two replicate, multinational, double-blind, 24-week, randomized, phase 3 studies (LIBERTY 1 and 2) were conducted in premenopausal women with uterine leiomyoma-associated heavy menstrual bleeding (80 mL or greater per cycle for two cycles or 160 mL or greater during one cycle). A predefined secondary objective was to determine the effect of relugolix-CT on moderate-to-severe uterine leiomyoma-associated pain in the pain subpopulation (women with maximum pain scores of 4 or higher on the 0-10 numerical rating scale at baseline, with pain score reporting compliance of 80% (ie, 28 days or more over the last 35 days of treatment). This key secondary endpoint was defined as the proportion of women achieving minimal-to-no uterine leiomyoma-associated pain (maximum numerical rating scale score 1 or lower) at week 24; menstrual and nonmenstrual pain were evaluated in prespecified secondary analyses. Treatment comparisons were performed in the pooled LIBERTY 1 and 2 pain subpopulation using the Cochran-Mantel-Haenszel test stratified by baseline menstrual blood loss volume. RESULTS Across both trials, 509 women were randomized to relugolix-CT or placebo (April 2017-December 2018). Of these, 277 (54.4%) met pain subpopulation requirements. With relugolix-CT, 45.2% (95% CI 36.4-54.3) of women achieved minimal-to-no pain compared with 13.9% (95% CI 8.8-20.5) with placebo (nominal P<.001). The proportions of women with minimal-to-no pain during menstrual days and during nonmenstrual days were significantly higher with relugolix-CT (65.0% [95% CI 55.6-73.5] and 44.6% [95% CI 32.3-57.5], respectively) compared with placebo (19.3% [95% CI 13.2-26.7], nominal P<.001, and 21.6% [95% CI 12.9-32.7], nominal P=.004, respectively). CONCLUSION Over 24 weeks, relugolix-CT significantly reduced moderate-to-severe uterine leiomyoma-associated pain with a more pronounced effect on menstrual pain. These data support that relugolix-CT had clinically meaningful effects on women's experience of uterine leiomyoma-associated pain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: LIBERTY 1, NCT03049735; LIBERTY 2, NCT03103087. FUNDING SOURCE Myovant Sciences GmbH.
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Affiliation(s)
- Elizabeth A Stewart
- Mayo Clinic, Rochester, Minnesota; the Carolina Woman's Research and Wellness Center, Durham, North Carolina; the Department of Clinical and Experimental Medicine, Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Catanzaro, Italy; Myovant Sciences, Inc., Brisbane, California; Myovant Sciences GmbH, Basel, Switzerland; and the Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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22
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Hunsche E, Rakov V, Scippa K, Witherspoon B, McKain L. The Burden of Uterine Fibroids from the Perspective of US Women Participating in Open-Ended Interviews. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:286-296. [PMID: 35415708 PMCID: PMC8994433 DOI: 10.1089/whr.2021.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research on women's perspective of uterine fibroids (UF) experiences using their own words is limited. This study aimed to provide new insights on the symptoms experienced and their impacts on daily life. METHODS Interview substudy in 30 US women with heavy menstrual bleeding (HMB) associated with UF who completed one of two phase 3, randomized, double-blind, placebo-controlled trials (LIBERTY 1 and 2; ClinicalTrials.gov identifiers: NCT03049735, NCT03103087). Women who consented to participate in this substudy were interviewed after their last clinical trial study visit. Concepts (i.e., symptoms and impacts) of importance to women were determined via open-ended questions, and the frequency of symptoms and their impacts, including the relationship between pain and menstruation, were assessed. Data were analyzed using established qualitative research methods, including grounded theory and constant comparative methods, and concept saturation was assessed. RESULTS Fifteen unique symptoms of UF emerged: the most commonly reported were HMB (n = 30, 100.0%), pelvic pain (n = 28, 93.3%), and passing of blood clots (n = 24, 80.0%). In total, 25 unique impacts were identified across eight concepts: physical impacts, activities of daily living, sleep, emotional impacts, sex life, social impacts, work and school, and financial impacts. Concept saturation was achieved for both symptoms and impacts. CONCLUSION This study provides data on the symptoms experienced by women with HMB associated with UF, as well as the negative impacts of these symptoms as reported using their own words. The study findings confirm the significant burden associated with symptomatic UF.
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Affiliation(s)
- Elke Hunsche
- Department of Global Market Access & HEOR, Myovant Sciences GmbH, Basel, Switzerland
| | - Viatcheslav Rakov
- Global Market Access and Health Economics/Outcomes Research, Myovant Sciences GmbH, Basel, Switzerland
| | | | | | - Laura McKain
- Myovant Sciences, Inc., Brisbane, California, USA
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23
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Klock J, Radakrishnan A, Runge MA, Aaby D, Milad MP. Body Image and Sexual Function Improve after Both Myomectomy and Hysterectomy for Symptomatic Fibroids. South Med J 2021; 114:733-738. [PMID: 34853847 DOI: 10.14423/smj.0000000000001326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the factors that influence the choice of myomectomy, uterine fibroid embolization (UFE), or hysterectomy in women with symptomatic uterine fibroids and to assess women's perception of body image and sexual functioning before and after treatment. METHODS In this prospective observational cohort pilot study, women scheduled to undergo hysterectomy, myomectomy, or UFE were surveyed before surgery and again at 3 to 6 months after their procedure to assess body image and sexual function using the validated 10-item Body Image Scale and 19-item Female Sexual Function Index. Logistic regression was used to determine predictive factors for surgery choice and paired t tests were used to determine changes in perceived sexual function and body image. RESULTS Of the 71 women surveyed, 69 underwent their scheduled procedure and 68 participants completed the preoperative questionnaire completely (98%). A total of 33 participants completed the postoperative questionnaire (49%). The predictive factor for hysterectomy versus myomectomy/UFE was older age (odds ratio 1.13, P = 0.017, 95% confidence interval [CI] 1.02-1.24). Regardless of surgery type, there were significant improvements in perceived body image and sexual function, including an increase in the overall sexual satisfaction of the participant (mean difference 0.50, P = 0.021, 95% CI 0.92-0.08) and less likely to feel less sexually attractive because of their menstrual bleeding problem (P < 0.0001, 95% CI 0.637-1.675). CONCLUSIONS Women of older age are more likely to choose hysterectomy over myomectomy or UFE for the treatment of symptomatic uterine fibroids. In addition, women who underwent any treatment for fibroids have increases in perception of body image and sexual functioning after their procedure.
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Affiliation(s)
- Julie Klock
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankitha Radakrishnan
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Ada Runge
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David Aaby
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Magdy P Milad
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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24
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Maghraby N, El Noweihi AM, El-Melegy NT, Mostafa NAM, Abbas AM, El-Deek HEM, Radwan E. Increased Expression of Fibroblast Activation Protein is Associated with Autophagy Dysregulation and Oxidative Stress in Obese Women with Uterine Fibroids. Reprod Sci 2021; 29:448-459. [PMID: 34845667 DOI: 10.1007/s43032-021-00810-0] [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: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
Uterine fibroids (UF) represent an immense health burden throughout the world. Obesity is considered one of the risk factors for UF development; however, the underlying mechanisms remain largely unexplored. We investigated the effect of obesity on fibroblast activation and its association with inflammation, autophagy dysfunction, and oxidative stress in UF patients. Thirty-five pre-menopausal UF patients were included in this study and classified into non-obese group (BM1 ≤ 30 kg/m2, n = 15) and obese group (BMI > 30 kg/m2, n = 20). Tissue samples were collected from fibroids and adjacent normal myometrium. Our results showed increased expression of fibroblast activation protein (FAP) together with markers of autophagy, inflammation, and oxidative stress in UF patients, which were all more markedly upregulated in obese compared to non-obese patients. In addition, BMI was significantly positive correlated with FAP and autophagy markers. In conclusion, the results of the present study suggest that obesity-associated autophagy dysregulation together with increased FAP expression may increase the risk of UFs in obese women.
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Affiliation(s)
- Nashwa Maghraby
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Amira M El Noweihi
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Nagla T El-Melegy
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Nashwa A M Mostafa
- Department of Histology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Heba E M El-Deek
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman Radwan
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt. .,Department of Biochemistry, Sphinx University, New Assiut City, Assiut 10, Egypt.
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25
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Anneveldt KJ, Nijholt IM, Schutte JM, Dijkstra JR, Frederix GWJ, Ista E, Verpalen IM, Veersema S, Huirne JAF, Hehenkamp WJK, Boomsma MF. Comparison of (Cost-)Effectiveness of Magnetic Resonance Image-Guided High-Intensity-Focused Ultrasound With Standard (Minimally) Invasive Fibroid Treatments: Protocol for a Multicenter Randomized Controlled Trial (MYCHOICE). JMIR Res Protoc 2021; 10:e29467. [PMID: 34821569 PMCID: PMC8663707 DOI: 10.2196/29467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Magnetic resonance image-guided high-intensity-focused ultrasound (MR-HIFU) is a rather new, noninvasive option for the treatment of uterine fibroids. It is safe, effective, and has a very short recovery time. However, a lack of prospectively collected data on long-term (cost-)effectiveness of the MR-HIFU treatment compared with standard uterine fibroid care prevents the MR-HIFU treatment from being reimbursed for this indication. Therefore, at this point, when conservative treatment for uterine fibroid symptoms has failed or is not accepted by patients, standard care includes the more invasive treatments hysterectomy, myomectomy, and uterine artery embolization (UAE). Primary outcomes of currently available data on MR-HIFU treatment often consist of technical outcomes, instead of patient-centered outcomes such as quality of life (QoL), and do not include the use of the latest equipment or most up-to-date treatment strategies. Moreover, data on cost-effectiveness are rare and seldom include data on a societal level such as productivity loss or use of painkillers. Because of the lack of reimbursement, broad clinical implementation has not taken place, nor is the proper role of MR-HIFU in uterine fibroid care sufficiently clear. OBJECTIVE The objective of our study is to determine the long-term (cost-)effectiveness of MR-HIFU compared with standard (minimally) invasive fibroid treatments. METHODS The MYCHOICE study is a national, multicenter, open randomized controlled trial with randomization in a 2:1 ratio to MR-HIFU or standard care including hysterectomy, myomectomy, and UAE. The sample size is 240 patients in total. Women are included when they are 18 years or older, in premenopausal stage, diagnosed with symptomatic uterine fibroids, conservative treatment has failed or is not accepted, and eligible for MR-HIFU. Primary outcomes of the study are QoL 24 months after treatment and costs of treatment including direct health care costs, loss of productivity, and patient costs. RESULTS Inclusion for the MYCHOICE study started in November 2020 and enrollment will continue until 2024. Data collection is expected to be completed in 2026. CONCLUSIONS By collecting data on the long-term (cost-)effectiveness of the MR-HIFU treatment in comparison to current standard fibroid care, we provide currently unavailable evidence about the proper place of MR-HIFU in the fibroid treatment spectrum. This will also facilitate reimbursement and inclusion of MR-HIFU in (inter)national uterine fibroid care guidelines. TRIAL REGISTRATION Netherlands Trial Register NL8863; https://www.trialregister.nl/trial/8863. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29467.
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Affiliation(s)
- Kimberley J Anneveldt
- Department of Radiology, Isala Hospital, Zwolle, Netherlands.,Department of Gynecology, Isala Hospital, Zwolle, Netherlands
| | | | - Joke M Schutte
- Department of Gynecology, Isala Hospital, Zwolle, Netherlands
| | | | - Geert W J Frederix
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Inez M Verpalen
- Department of Radiology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, Netherlands
| | - Sebastiaan Veersema
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Judith A F Huirne
- Department of Gynecology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, Netherlands.,Department of Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Wouter J K Hehenkamp
- Department of Gynecology, Amsterdam University Medical Center, Academic Medical Center, Amsterdam, Netherlands
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26
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What We Know about the Long-Term Risks of Hysterectomy for Benign Indication-A Systematic Review. J Clin Med 2021; 10:jcm10225335. [PMID: 34830617 PMCID: PMC8622061 DOI: 10.3390/jcm10225335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 12/29/2022] Open
Abstract
Hysterectomy is the most common treatment option in women with uterine fibroids, providing definitive relief from the associated burdensome symptoms. As with all surgical interventions, hysterectomy is associated with risk of complications, short-term morbidities, and mortality, all of which have been described previously. However, information on the potential long-term risks of hysterectomy is only recently becoming available. A systematic literature review was performed to identify studies published between 2005 and December 2020 evaluating the long-term impact of hysterectomy on patient outcomes. A total of 29 relevant studies were identified. A review of the articles showed that hysterectomy may increase the risk of cardiovascular events, certain cancers, the need for further surgery, early ovarian failure and menopause, depression, and other outcomes. It is important to acknowledge that the available studies examine possible associations and hypotheses rather than causality, and there is a need to establish higher quality studies to truly evaluate the long-term consequences of hysterectomy. However, it is of value to consider these findings when discussing the benefits and risks of all treatment options with patients with uterine fibroids to allow for preference-based choices to be made in a shared decision-making process. This is key to ensuring that patients receive the treatment that best meets their individual needs.
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Hur C, Falcone T. Fertility and Pregnancy Outcomes after Robotic-assisted Laparoscopic Myomectomy in a Canadian Cohort. J Minim Invasive Gynecol 2021; 29:1-2. [PMID: 34763065 DOI: 10.1016/j.jmig.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Christine Hur
- Department of Obsteterics and Gynecology, Cleveland Clinic (Dr. Hur), Cleveland, Ohio.
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology, Cleveland Clinic London (Dr. Falcone), London, United Kingdom; Obstetrics, Gynecology and Reproductive Biology, Cleveland Clinic Lerner College of Medicine (Dr. Falcone), Cleveland, Ohio.
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28
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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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29
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Hsieh CH, Lu YY, Liang SY. The health concerns related to hysterectomy among Taiwanese women with uterine fibroids- a mixed-methods study. Women Health 2021; 61:581-590. [PMID: 34187330 DOI: 10.1080/03630242.2021.1938791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to assess health concerns after hysterectomy from different perspectives among Taiwanese women with uterine fibroids. A mixed-methods was used in this study. In a cross-sectional study, 95 patients completed a structured questionnaire (Health Concern Questionnaire-HCQ). Face-to-face interviews with 5 patients were implemented for the qualitative component from OBS-GYN outpatient departments at two hospitals in Northern Taiwan. Participants who met the following criteria, 20 years of age or older, conscious alert without mental disturbances were recruited to this study. Descriptive statistics were calculated for social demographic variables and HCQ. A content analysis was used to analyze the qualitative data. The mean age was 46.28 of 95 patients. Findings of the present study showed that the most health concerns among patients with UFs after hysterectomy are hysterectomy-related complications, follow by impacts on daily life, body image and female identity, and intimacy and sexual relations. The findings of qualitative interviews supported the above findings. In addition, the information needs of post-operative self-care were identify in this qualitative interviews. The results of this research study could help healthcare professionals to address women's health concerns and provide adequate care for Taiwanese women with uterine fibroids after hysterectomy.
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Affiliation(s)
- Chun-Hsin Hsieh
- Nurse Practitioner, MSN, Department of Nursing, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yu-Ying Lu
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Yuan Liang
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Holden LM. Successful uterine-sparing surgical management in a patient with a large multi-fibroid uterus. J Surg Case Rep 2021; 2021:rjab233. [PMID: 34194722 PMCID: PMC8238395 DOI: 10.1093/jscr/rjab233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 12/03/2022] Open
Abstract
Uterine fibroids are a common gynaecological condition. A key factor when deciding on surgical approach for fibroid management is a patient’s age and desire for fertility with uterine-sparing treatment generally recommended in women who are aiming for future pregnancies. This case report discusses a woman who presented with a very large multi-fibroid uterus. In this case, a hysterectomy was recommended due to safety concerns however, this advice was declined as the patient desired uterine preservation. Fertility testing showed that the patient was not peri-menopausal and abdominal myomectomy was safely performed to good effect. This case report outlines the surgical approach undertaken, in addition to considerations for fertility and pregnancy management.
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Affiliation(s)
- Lucy M Holden
- Department of Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, Australia
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El Sabeh M, Saha SK, Afrin S, Islam MS, Borahay MA. Wnt/β-catenin signaling pathway in uterine leiomyoma: role in tumor biology and targeting opportunities. Mol Cell Biochem 2021; 476:3513-3536. [PMID: 33999334 DOI: 10.1007/s11010-021-04174-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
Uterine leiomyoma is the most common tumor of the female reproductive system and originates from a single transformed myometrial smooth muscle cell. Despite the immense medical, psychosocial, and financial impact, the exact underlying mechanisms of leiomyoma pathobiology are poorly understood. Alterations of signaling pathways are thought to be instrumental in leiomyoma biology. Wnt/β-catenin pathway appears to be involved in several aspects of the genesis of leiomyomas. For example, Wnt5b is overexpressed in leiomyoma, and the Wnt/β-catenin pathway appears to mediate the role of MED12 mutations, the most common mutations in leiomyoma, in tumorigenesis. Moreover, Wnt/β-catenin pathway plays a paracrine role where estrogen/progesterone treatment of mature myometrial or leiomyoma cells leads to increased expression of Wnt11 and Wnt16, which induces proliferation of leiomyoma stem cells and tumor growth. Constitutive activation of β-catenin leads to myometrial hyperplasia and leiomyoma-like lesions in animal models. Wnt/β-catenin signaling is also closely involved in mechanotransduction and extracellular matrix regulation and relevant alterations in leiomyoma, and crosstalk is noted between Wnt/β-catenin signaling and other pathways known to regulate leiomyoma development and growth such as estrogen, progesterone, TGFβ, PI3K/Akt/mTOR, Ras/Raf/MEK/ERK, IGF, Hippo, and Notch signaling. Finally, evidence suggests that inhibition of the canonical Wnt pathway using β-catenin inhibitors inhibits leiomyoma cell proliferation. Understanding the molecular mechanisms of leiomyoma development is essential for effective treatment. The specific Wnt/β-catenin pathway molecules discussed in this review constitute compelling candidates for therapeutic targeting.
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Affiliation(s)
- Malak El Sabeh
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA
| | - Subbroto Kumar Saha
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA
| | - Sadia Afrin
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA
| | - Md Soriful Islam
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA
| | - Mostafa A Borahay
- Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA.
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The Risk of Uterine Malignancy in a Population Being Evaluated for Uterine Fibroid Embolization. J Comput Assist Tomogr 2020; 44:893-900. [PMID: 33196598 DOI: 10.1097/rct.0000000000001104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine the frequency of uterine malignancy in patients evaluated for uterine fibroid embolization (UFE) and the role of magnetic resonance imaging in triage. METHODS Records and imaging studies of 864 UFE consult patients were reviewed for MRI findings suggestive of fibroid malignancy. Pathology was obtained for cases with suspicious baseline MRI's, and the most atypical mass was reanalyzed by an experienced radiologist, blinded to the pathological findings. RESULTS Twenty one of 864 patients had baseline MRI findings concerning for malignancy at consultation and 17 had complete records. Re-evaluation suggested that 5 were malignant. Three were confirmed malignant (0.35%). One malignancy among the 843 without suspicious baseline MRI findings was missed at consultation. CONCLUSIONS In our UFE population, uterine malignancy is rare (4/864, 0.46%), and MRI detected the majority, 3 (75%) of 4 before UFE. The observed prevalence of any malignancy was 0.35%, congruent with current Federal Drug Administration estimates.
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Middelkoop MA, Harmsen MJ, Manyonda I, Mara M, Ruuskanen A, Daniels J, Mol BWJ, Moss J, Hehenkamp WJK, Wu O. Uterine artery embolization versus surgical treatment in patients with symptomatic uterine fibroids: Protocol for a systematic review and meta-analysis of individual participant data. Eur J Obstet Gynecol Reprod Biol 2020; 256:179-183. [PMID: 33246202 DOI: 10.1016/j.ejogrb.2020.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Uterine fibroids are the most common benign tumours in women of the reproductive age. Symptoms of heavy menstrual bleeding, abdominal discomfort and infertility may seriously affect a woman's quality of life. Uterine artery embolization is a safe and effective alternative treatment to hysterectomy or myomectomy for symptomatic uterine fibroids. Which treatment provides the highest quality of life, least complications, symptom reduction and least chance intervention, has not been established and might depend on strict patient selection. This study aims to identify which specific subgroups benefit most of each treatment by analyzing individual participant data derived from randomized controlled trials of women undergoing embolization or surgical treatment. This study will primarily assess the effectiveness of both treatment groups by evaluating the effect on quality of life of embolization in comparison to surgery on specific patient and fibroid characteristics and the possible need for re-intervention for fibroid-related symptoms. DATA SOURCES PubMed/MEDLINE, Embase and The Cochrane Library were searched up to August 2020. STUDY ELIGIBILITY CRITERIA We will collect individual participant data from randomized controlled trials that studied clinical and procedural outcomes of premenopausal women with symptomatic uterine fibroids, who were randomized between uterine artery embolization and surgery. STUDY APPRAISAL AND SYNTHESIS METHODS Individual participant data from all eligible trials will be sought and analysed according to intention-to-treat principle. Risk of Bias will be done by using version 2 of the Cochrane tool for Risk of Bias in randomized trials. Subgroup analyses to explore the effect of e.g. age, fibroid characteristics and fibroid complaints will be performed, if data is available. This individual patient data meta-analysis will be analysed according to a one-stage model.
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Affiliation(s)
- Mei-An Middelkoop
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Marissa J Harmsen
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Isaac Manyonda
- Department of Obstetrics and Gynaecology, St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, United Kingdom
| | - Michal Mara
- Department of Obstetrics and Gynaecology, Division of Minimally Invasive Surgery, General Faculty Hospital and 1st Medical Faculty of Charles University, Apolinarska 18, 128 00, Prague 2, Czech Republic
| | - Anu Ruuskanen
- Department of Clinical Radiology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Jonathan Moss
- Department of Interventional Radiology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United Kingdom
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Olivia Wu
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, United Kingdom
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Quantifying the risk of blood transfusion with myomectomy. Fertil Steril 2020; 114:79-80. [PMID: 32532490 DOI: 10.1016/j.fertnstert.2020.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
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Hysterectomy Provides Benefit in Health-Related Quality of Life: A 10-Year Follow-up Study. J Minim Invasive Gynecol 2020; 27:868-874. [DOI: 10.1016/j.jmig.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 11/19/2022]
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Llarena N, Falcone T. Does hysterectomy result in better quality of life than myomectomy? Fertil Steril 2020; 113:549-550. [DOI: 10.1016/j.fertnstert.2019.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
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Small B, Millard CEF, Kisanga EP, Burman A, Anam A, Flannery C, Al-Hendy A, Whirledge S. The Selective Progesterone Receptor Modulator Ulipristal Acetate Inhibits the Activity of the Glucocorticoid Receptor. J Clin Endocrinol Metab 2020; 105:5609012. [PMID: 31665442 PMCID: PMC7112983 DOI: 10.1210/clinem/dgz139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022]
Abstract
CONTEXT The selective progesterone modulator ulipristal acetate (ulipristal) offers a much-needed therapeutic option for the clinical management of uterine fibroids. Although ulipristal initially passed safety evaluations in Europe, postmarketing analysis identified cases of hepatic injury and failure, leading to restrictions on the long-term use of ulipristal. One of the factors potentially contributing to significant side effects with the selective progesterone modulators is cross-reactivity with other steroid receptors. OBJECTIVE To determine whether ulipristal can alter the activity of the endogenous glucocorticoid receptor (GR) in relevant cell types. DESIGN Immortalized human uterine fibroid cells (UtLM) and hepatocytes (HepG2) were treated with the synthetic glucocorticoid dexamethasone and/or ulipristal. Primary uterine fibroid tissue was isolated from patients undergoing elective gynecological surgery and treated ex vivo with dexamethasone and/or ulipristal. In vivo ulipristal exposure was performed in C57Bl/6 mice to measure the effect on basal gene expression in target tissues throughout the body. RESULTS Dexamethasone induced the expression of established glucocorticoid-target genes period 1 (PER1), FK506 binding protein 51 (FKBP5), and glucocorticoid-induced leucine zipper (GILZ) in UtLM and HepG2 cells, whereas cotreatment with ulipristal blocked the transcriptional response to glucocorticoids in a dose-dependent manner. Ulipristal inhibited glucocorticoid-mediated phosphorylation, nuclear translocation, and DNA interactions of GR. Glucocorticoid stimulation of PER1, FKBP5, and GILZ was abolished by cotreatment with ulipristal in primary uterine fibroid tissue. The expression of glucocorticoid-responsive genes was decreased in the lung, liver, and uterus of mice exposed to 2 mg/kg ulipristal. Interestingly, transcript levels of Fkbp5 and Gilz were increased in the hippocampus and pituitary. CONCLUSIONS These studies demonstrate that ulipristal inhibits endogenous glucocorticoid signaling in human fibroid and liver cells, which is an important consideration for its use as a long-term therapeutic agent.
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Affiliation(s)
- Benjamin Small
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Charles E F Millard
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Edwina P Kisanga
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Andreanna Burman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Anika Anam
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Clare Flannery
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
| | - Shannon Whirledge
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Correspondence and Reprint Requests: Shannon Whirledge, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, Office LSOG 204C, New Haven, CT, 06510. E-mail:
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Biscione A, Barra V, Bellone E, Severi FM, Luisi S. Ulipristal acetate on quality of life and sexual function of women with uterine fibromatosis. Gynecol Endocrinol 2020; 36:87-92. [PMID: 31328597 DOI: 10.1080/09513590.2019.1640202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To evaluate quality of life and sexual function of childbearing-age women, affected by uterine fibromatosis undergoing medical treatment with ulipristal acetate. The data obtained by filling the questionnaires European Quality of Life Five-Dimension Scale and modified Female Sexual Function Index, were analyzed to assess UPA usefulness in improving QoL and sexual activity. A total of 139 patients affected by uterine fibromatosis undergoing conservative ulipristal acetate treatment were enrolled in this prospective observational cohort study. Seventy-one women (average age 46.5 years) answered the questionnaires: QoL and sexuality were evaluated before and after ulipristal acetate treatment. 59 patients (83.1%) had an improvement of QoL and general health state, with a reduction of VAS score after ulipristal acetate treatment. EQ-5D-5L showed a statistically significant improvement of usual act impairment, mobility, discomfort, anxiety/depression (p < .0005). There was no difference in personal care management after therapy. Modified FSFI showed a statistically significant improvement (p < .0001) of sexual satisfaction and sexual life. A not statistically significant improvement in dyspareunia was also highlighted. This study provides a clear picture about QoL impact on women and confirms the effectiveness of the ulipristal acetate in improving different aspects of daily and sexual life of patients undergoing medical treatment.
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Affiliation(s)
- Antonella Biscione
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Valeria Barra
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Emma Bellone
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Filiberto Maria Severi
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, Obsterics and Gynecology, University of Siena, Siena, Italy
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Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Med Care 2019; 57:930-936. [PMID: 31730567 DOI: 10.1097/mlr.0000000000001200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Minimally invasive hysterectomy for fibroids decreases recovery time and risk of postoperative complications compared with abdominal hysterectomy. Within Veterans Affair (VA), black women with uterine fibroids are less likely to receive a minimally invasive hysterectomy than white women. OBJECTIVE To quantify the contributions of patient, facility, temporal and geographic factors to VA black-white disparity in minimally invasive hysterectomy. RESEARCH DESIGN A cross-sectional study. SUBJECTS Veterans with fibroids and hysterectomy performed in VA between October 1, 2012 and September 30, 2015. MEASURES Hysterectomy mode was defined using ICD-9 codes as minimally invasive (laparoscopic, vaginal, or robotic-assisted) versus abdominal. The authors estimated a logistic regression model with minimally invasive hysterectomy modeled as a function of 4 sets of factors: sociodemographic characteristics other than race, health risk factors, facility, and temporal and geographic factors. Using decomposition techniques, systematically substituting each white woman's characteristics for each black woman's characteristics, then recalculating the predicted probability of minimally invasive hysterectomy for black women for each possible combination of factors, we quantified the contribution of each set of factors to observed disparities in minimally invasive hysterectomy. RESULTS Among 1255 veterans with fibroids who had a hysterectomy at a VA, 61% of black women and 39% of white women had an abdominal hysterectomy. Our models indicated there were 99 excess abdominal hysterectomies among black women. The majority (n=77) of excess abdominal hysterectomies were unexplained by measured sociodemographic factors beyond race, health risk factors, facility, and temporal or geographic trends. CONCLUSION Closer examination of the equity of VA gynecology care and ways in which the VA can work to ensure equitable care for all women veterans is necessary.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | | | - Kemi M Doll
- Department of Health Services, University of Washington
- Departments of Obstetrics and Gynecology
| | - John Fortney
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA
| | - Kristen E Gray
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Paul Hebert
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
| | - Kristine E Lynch
- Department of Veterans Affairs Salt Lake City Health Care System
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Erica W Ma
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
| | - Donna L Washington
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Laurie Zephyrin
- Women's Health Services, Office of Patient Services, VA Central Office, Washington, DC
- Department of Obstetrics and Gynecology, New York University Langone School of Medicine, New York, NY
| | - Lisa S Callegari
- Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs (VA) Puget Sound Health Care System
- Department of Health Services, University of Washington
- Departments of Obstetrics and Gynecology
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Osuga Y, Enya K, Kudou K, Hoshiai H. Relugolix, a novel oral gonadotropin-releasing hormone antagonist, in the treatment of pain symptoms associated with uterine fibroids: a randomized, placebo-controlled, phase 3 study in Japanese women. Fertil Steril 2019; 112:922-929.e2. [PMID: 31594635 DOI: 10.1016/j.fertnstert.2019.07.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of the oral gonadotropin-releasing hormone receptor antagonist, relugolix, in patients experiencing uterine fibroid-associated pain. DESIGN Phase 3, multicenter, randomized, double-blind, placebo-controlled study. SETTING Medical centers. PATIENT(S) Premenopausal Japanese women (N = 65) experiencing moderate-to-severe uterine fibroid-associated pain with a maximum Numerical Rating Scale (NRS) score of ≥4 were randomized and completed the study. INTERVENTION(S) Once-daily 40 mg relugolix (n = 33) or placebo (n = 32) for 12 weeks. MAIN OUTCOME MEASURE(S) Primary end point: proportion of patients with a maximum NRS score of ≤1 during the 28-day period before the final dose of study drug. Secondary end points: proportion of patients with no pain (NRS = 0) and percentage of days without pain during the 28-day period before the final dose of study drug; adverse events. RESULT(S) More patients receiving relugolix versus placebo achieved a maximum NRS score of ≤1 during the 28-day period before the final dose of study drug (57.6% vs. 3.1%). Similarly, more patients receiving relugolix versus placebo achieved a maximum NRS score of 0 (48.5% vs. 3.1%) and experienced more days without pain (96.4% vs. 71.4%). More patients receiving relugolix versus placebo experienced treatment-emergent adverse events (TEAEs; 87.9% vs. 56.3%); however, the rate of treatment discontinuation was low and not different between groups. Most TEAEs were mild to moderate in intensity. TEAEs (≥10%) included hot flush, metrorrhagia, hyperhidrosis, and menorrhagia, consistent with relugolix's mechanism of action, and viral upper respiratory tract infection. CONCLUSION(S) Relugolix improved uterine fibroid-associated pain and was well tolerated. CLINICAL TRIAL REGISTRATION NUMBERS NCT02655224. JAPIC CLINICAL TRIAL INFORMATION JapicCTI-163127.
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Affiliation(s)
- Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuaki Enya
- Takeda Pharmaceutical Company Limited, Osaka, Japan.
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NAMS 2018 Utian Translational Science Symposium, October 2018, San Diego, California New therapies for leiomyomas: when surgery may not be the best option. Menopause 2019; 26:947-957. [PMID: 31453955 DOI: 10.1097/gme.0000000000001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The North American Menopause Society (NAMS) held the 2018 Utian Translational Science Symposium on October 2, 2018, in San Diego, California, to discuss new therapeutic approaches to uterine leiomyomas when surgery is not the optimal choice.Uterine leiomyomas arise from a single clonal cell and are the most common gynecologic disorder affecting reproductive and perimenopausal women worldwide. The prevalence of this disorder is approximately 40% to 70% in white women and 60% to 80% in black women. Recent research suggests that both estrogen and progesterone modulate the growth of leiomyomas, with progesterone being a major stimulator of leiomyoma growth.Women with symptomatic uterine leiomyomas experience heavy uterine bleeding, bulk symptoms, miscarriages, and pregnancy complications. Surgical therapies such as myomectomy or hysterectomy are highly effective; however, medical therapy with progestin-predominant contraceptives or gonadotropin-releasing hormone (GnRH) agonists are in many ways inadequate to address the unmet need for better, noninvasive, and cost-effective treatments.Recent advances in medical treatment, such as selective progesterone receptor modulators, new oral GnRH analogs, and clinical trials that provide new therapeutic approaches, were presented by speakers at the symposium. Research on why there is a prevalence of leiomyomas in black women, the racial and genetic effects on leiomyoma growth, and potential molecular mechanisms also were discussed.
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Igboeli P, Walker W, McHugh A, Sultan A, Al-Hendy A. Burden of Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention. ACTA ACUST UNITED AC 2019; 2:287-294. [PMID: 32647835 PMCID: PMC7344264 DOI: 10.18314/cogo.v2i1.1701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Black women carry the burden of uterine fibroids, (AKA uterine leiomyomas), at a much higher rate than their racial counterparts. Thus, increasing awareness and discovering a solution to an endemic problem that plagues Sub-Saharan Africa is of critical importance, not only for the region itself, but also for the medical community globally. A collaborative, patient oriented, cost effective, and culturally sensitive approach must be at the forefront of this endeavor. While the exact pathogenesis of uterine fibroid development remains elusive, the racial disparity is well documented. Moreover, in the developed world, women are able to seek treatment through surgical and non-surgical means; however, sub-Saharan regions face their own challenges that, if not addressed, can ultimately extinguish the lives of many suffering women. Unfortunately, the literature is scarce on how to prevent fibroid development, which may be critical for women who do not have access to effective interventions. Recent research from our group and others has shown that vitamin D deficiency plays an important role in fibroid development and may be a preventable risk factor. Daily vitamin D supplementation is a low cost, effective intervention that could be implemented throughout the Sub-Saharan region. Similarly, education and increased awareness as to the nature and symptoms of uterine fibroids could improve the quality of life, remove negative social stigma, and reduce morbidity and mortality rates in women who seek medical care with advanced uterine fibroids.
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Affiliation(s)
- P Igboeli
- University of Nigeria Teaching Hospital, Department of Obstetrics and Gynaecology, Enugu, Nigeria.,Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA.,Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - W Walker
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA
| | - A McHugh
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - A Sultan
- Xavier University School of Medicine, Oranjestad, Aruba
| | - A Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
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Luderer U, Eskenazi B, Hauser R, Korach KS, McHale CM, Moran F, Rieswijk L, Solomon G, Udagawa O, Zhang L, Zlatnik M, Zeise L, Smith MT. Proposed Key Characteristics of Female Reproductive Toxicants as an Approach for Organizing and Evaluating Mechanistic Data in Hazard Assessment. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:75001. [PMID: 31322437 PMCID: PMC6791466 DOI: 10.1289/ehp4971] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND Identification of female reproductive toxicants is currently based largely on integrated epidemiological and in vivo toxicology data and, to a lesser degree, on mechanistic data. A uniform approach to systematically search, organize, integrate, and evaluate mechanistic evidence of female reproductive toxicity from various data types is lacking. OBJECTIVE We sought to apply a key characteristics approach similar to that pioneered for carcinogen hazard identification to female reproductive toxicant hazard identification. METHODS A working group of international experts was convened to discuss mechanisms associated with chemical-induced female reproductive toxicity and identified 10 key characteristics of chemicals that cause female reproductive toxicity: 1) alters hormone receptor signaling; alters reproductive hormone production, secretion, or metabolism; 2) chemical or metabolite is genotoxic; 3) induces epigenetic alterations; 4) causes mitochondrial dysfunction; 5) induces oxidative stress; 6) alters immune function; 7) alters cell signal transduction; 8) alters direct cell–cell interactions; 9) alters survival, proliferation, cell death, or metabolic pathways; and 10) alters microtubules and associated structures. As proof of principle, cyclophosphamide and diethylstilbestrol (DES), for which both human and animal studies have demonstrated female reproductive toxicity, display at least 5 and 3 key characteristics, respectively. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), for which the epidemiological evidence is mixed, exhibits 5 key characteristics. DISCUSSION Future efforts should focus on evaluating the proposed key characteristics against additional known and suspected female reproductive toxicants. Chemicals that exhibit one or more of the key characteristics could be prioritized for additional evaluation and testing. A key characteristics approach has the potential to integrate with pathway-based toxicity testing to improve prediction of female reproductive toxicity in chemicals and potentially prevent some toxicants from entering common use. https://doi.org/10.1289/EHP4971.
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Affiliation(s)
- Ulrike Luderer
- Center for Occupational and Environmental Health, University of California, Irvine, Irvine, California, USA
| | - Brenda Eskenazi
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kenneth S. Korach
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Cliona M. McHale
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Francisco Moran
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, California, USA
| | - Linda Rieswijk
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
- Institute of Data Science, Maastricht University, Maastricht, Netherlands
| | - Gina Solomon
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Osamu Udagawa
- Center for Health and Environmental Risk Research, National Institute of Environmental Studies, Tsukuba-City, Ibaraki, Japan
| | - Luoping Zhang
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Marya Zlatnik
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California, USA
| | - Lauren Zeise
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Sacramento, California, USA
| | - Martyn T. Smith
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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Ghonim M, Magdy R, Sabbour M, Ghonim M, Nabhan A. A systematic review and meta‐analysis of ulipristal acetate for symptomatic uterine fibroids. Int J Gynaecol Obstet 2019; 146:141-148. [DOI: 10.1002/ijgo.12868] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/05/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Mohamed Ghonim
- Extended Modular ProgramFaculty of MedicineAin Shams University Cairo Egypt
- Egyptian Center for Evidence Based Medicine Cairo Egypt
| | - Rana Magdy
- Extended Modular ProgramFaculty of MedicineAin Shams University Cairo Egypt
- Egyptian Center for Evidence Based Medicine Cairo Egypt
| | - Mohamed Sabbour
- Extended Modular ProgramFaculty of MedicineAin Shams University Cairo Egypt
- Egyptian Center for Evidence Based Medicine Cairo Egypt
| | - Mohanad Ghonim
- Extended Modular ProgramFaculty of MedicineAin Shams University Cairo Egypt
- Egyptian Center for Evidence Based Medicine Cairo Egypt
| | - Ashraf Nabhan
- Egyptian Center for Evidence Based Medicine Cairo Egypt
- Department of Obstetrics and GynecologyFaculty of MedicineAin Shams University Cairo Egypt
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Ciebiera M, Męczekalski B, Łukaszuk K, Jakiel G. Potential synergism between ulipristal acetate and vitamin D3 in uterine fibroid pharmacotherapy - 2 case studies. Gynecol Endocrinol 2019; 35:473-477. [PMID: 30632825 DOI: 10.1080/09513590.2018.1550062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This is a preliminary report of the first cases of successful simultaneous use of ulipristal acetate (UPA) and vitamin D3 in uterine fibroid (UF) oral treatment in humans. We present two cases of 37- and 49-year-old females with clinically symptomatic UFs and vitamin D deficiency. Both patients were treated with a standard 3 months of UPA scheme (5 mg daily) with the additional use of vitamin D3 (7000 IU daily orally). In the 37-year-old female all the symptoms (pain, pressure, frequent urination) decreased, total tumor volume after the treatment changed by 47.8%. In the 49-year-old female most symptoms perished, total tumor volume was reduced by 63.3%. UPA and vitamin D share synergistic anti-fibroid properties. Further studies are necessary to show the exact effect of UPA and vitamin D as co-drugs.
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Affiliation(s)
- Michał Ciebiera
- a Second Department of Obstetrics and Gynecology , The Center of Postgraduate Medical Education , Warsaw , Poland
| | - Błażej Męczekalski
- b Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznań , Poland
| | - Krzysztof Łukaszuk
- c Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences , Medical University of Gdańsk , Gdańsk , Poland
- d INVICTA Fertility and Reproductive Center , Gdańsk , Poland
| | - Grzegorz Jakiel
- e First Department of Obstetrics and Gynecology , The Center of Postgraduate Medical Education , Warsaw , Poland
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Oral Gonadotropin-Releasing Hormone Antagonist Relugolix Compared With Leuprorelin Injections for Uterine Leiomyomas. Obstet Gynecol 2019; 133:423-433. [DOI: 10.1097/aog.0000000000003141] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park MJ, Shen H, Kim NH, Gao F, Failor C, Knudtson JF, McLaughlin J, Halder SK, Heikkinen TA, Vahteristo P, Al-Hendy A, Schenken RS, Boyer TG. Mediator Kinase Disruption in MED12-Mutant Uterine Fibroids From Hispanic Women of South Texas. J Clin Endocrinol Metab 2018; 103:4283-4292. [PMID: 30099503 PMCID: PMC6194812 DOI: 10.1210/jc.2018-00863] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/01/2018] [Indexed: 01/09/2023]
Abstract
CONTEXT Mutations in the gene encoding Mediator complex subunit MED12 are dominant drivers of uterine fibroids (UFs) in women of diverse racial and ethnic origins. Previously, we showed that UF-linked mutations in MED12 disrupt its ability to activate cyclin C-CDK8/19 in Mediator. However, validation of Mediator kinase disruption in the clinically relevant setting of MED12-mutant UFs is currently lacking. OBJECTIVE The objective of this study was twofold. First, to extend the ethnic distribution profile of MED12 mutations by establishing their frequency in UFs from Hispanic women of South Texas. Second, to examine the impact of MED12 mutations on Mediator kinase activity in patient-derived UFs. METHODS We screened 219 UFs from 76 women, including 170 tumors from 57 Hispanic patients, for MED12 exon 2 mutations, and further examined CDK8/19 activity in Mediator complexes immunoprecipitated from MED12 mutation-negative and MED12 mutation-positive UFs. RESULTS MED12 exon 2 mutations in UFs from Hispanic women are somatic in nature, predominantly monoallelic, and occur at high frequency (54.1%). We identified a minimal cyclin C-CDK8 activation domain on MED12 spanning amino acids 15 through 80 that includes all recorded UF-linked mutations in MED12, suggesting that disruption of Mediator kinase activity is a principal biochemical defect arising from these pathogenic alterations. Analysis of Mediator complexes recovered from patient UFs confirmed this, revealing that Mediator kinase activity is selectively impaired in MED12-mutant UFs. CONCLUSIONS MED12 mutations are important drivers of UF formation in Hispanic women of South Texas. MED12 mutations disrupt Mediator kinase activity, implicating altered CDK8/19 function in UF pathogenesis.
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Affiliation(s)
- Min Ju Park
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Hailian Shen
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Nam Hee Kim
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Fangjian Gao
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Courtney Failor
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jennifer F Knudtson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jessica McLaughlin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sunil K Halder
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Tuomas A Heikkinen
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Pia Vahteristo
- Research Programs Unit, Genome-Scale Biology Research Program and Medicum, Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Robert S Schenken
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Thomas G Boyer
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Correspondence and Reprint Requests: Thomas G. Boyer, PhD, Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 8257, San Antonio, Texas 78229. E-mail:
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Tuschy B, Gabbert M, Weiss C, Hornemann A, Wuhrer A, Sütterlin M, Berlit S. Changes in sexuality during ulipristal acetate treatment in women with symptomatic uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2018; 228:106-110. [PMID: 29920429 DOI: 10.1016/j.ejogrb.2018.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate changes in sexuality in women treated with Ulipristal acetate (UPA) due to symptomatic uterine fibroids. STUDY DESIGN A total of 102 women with symptomatic uterine fibroids undergoing conservative therapy with UPA were enrolled in this observational study. Sexuality was evaluated before and after a three month UPA treatment using the Female Sexual Functioning Index (FSFI) as well as the Sexual Activity Questionnaire (SAQ). Before treatment was initiated, participants additionally filled in a standardised questionnaire addressing the expected changes in sexuality due to UPA. Demographic parameters, expectations concerning changes in sexuality, and FSFI- and SAQ-scores were analysed. RESULTS The average age of the study collective was 42.3 years. For the majority of the included women (n = 70; 71.4%) sexuality was rated as an important issue and 86 women (87.8%) did not think that UPA would have an impact on the frequency of sexual intercourse, the quality (n = 91; 92.9%) or frequency of orgasms (n = 87; 88.8%) neither sexual receptivity (n = 88; 89.8%). Full data sets were available for 73 patients (71.6%). The FSFI showed significantly higher sub scores regarding desire (3.6 ± 1.2 vs. 3.9 ± 1.2; p = 0.0012) and arousal (4.2 ± 1.7 vs. 4.4 ± 1.9; p = 0.0151) as well as a higher total score (26.6 ± 9.0 vs. 27.4 ± 9.5; p = 0.0008) after UPA treatment. Regarding the SAQ a statistically significant difference regarding the subscore "habit" was found (p < 0.0001) comparing pre with post interventional scores. CONCLUSION Sexuality in general seems to be important for women with symptomatic uterine fibroids. As the treatment with UPA appears to improve sexuality, this circumstance can be mentioned in a pre-therapeutic counselling.
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Affiliation(s)
- Benjamin Tuschy
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany.
| | - Mirja Gabbert
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Ludolf-Krehl-Strasse 13-17 Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Amadeus Hornemann
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Anne Wuhrer
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynaecology, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, University Medical Centre Mannheim, Heidelberg University, Germany
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