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Sherifi SK, Odahowski CL, López Castillo H. Uterine leiomyomata claim rate estimates and demographic characteristics by county. Florida, 2010-2019. Women Health 2024; 64:75-89. [PMID: 38154484 DOI: 10.1080/03630242.2023.2296524] [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: 08/08/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
To describe the demographic characteristics and estimate the uterine leiomyomata claim rates (ULCRs) by women 18 years and older in Florida, we conducted a cross-sectional analysis of the 2010-2019 administrative claims for uterine leiomyomata and associated study variables (age, race, ethnicity, county of residence, anatomic site, length of stay, and additional diagnoses). ULCR ratios were estimated by race and ethnicity, using ULCR for non-Hispanic White women as the reference group. We identified 232,475 claims, most of which were among non-Hispanic White women in their forties. The overall ULCR estimate [95 percent CI] was 284.8 [284.21, 285.39] per 100,000 women 18 years and older, with a small, nonsignificant trend to increase over time (R2 = .310; p = .094). Black, Hispanic, and other women of color presented with higher ULCR ratios (4.84, 1.87, and 1.58, respectively). Urban counties had significantly higher ULCRs than suburban and rural counties. While non-Hispanic White women had the highest frequency of ULCRs, women of color-especially Black women-presented with significantly higher ULCR ratios. The epidemiologic profile of uterine leiomyomata in terms of age, race, ethnicity, and geographic location points to unmet healthcare needs among specific demographic and geographic groups of women in Florida.
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Affiliation(s)
- Saarah K Sherifi
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
| | - Cassie L Odahowski
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Humberto López Castillo
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, USA
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
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Salcedo AC, Yun J, Carter C, Hart E. Therapeutic Carbohydrate Restriction as a Metabolic Modality for the Prevention and Treatment of Abnormal Uterine Bleeding. Nutrients 2023; 15:3760. [PMID: 37686792 PMCID: PMC10490487 DOI: 10.3390/nu15173760] [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: 06/22/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Therapeutic carbohydrate restriction diets have been becoming increasingly popular over the years, resulting in dramatic weight loss and an improvement in metabolic disorders. Obesity, insulin resistance, and diabetes are the risk factors for many gynecologic morbidities such as uterine leiomyoma, endometrial polyps, and polycystic ovarian syndrome. There is evidence suggesting that the pathogenesis of cardiovascular disease is similar to that seen in many causes of abnormal uterine bleeding. We aim to explain how cardiovascular disease risk factor reduction with the use of therapeutic carbohydrate restriction may prevent and potentially treat these gynecologic disorders.
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Affiliation(s)
- Andrea C. Salcedo
- Department of Gynecology and Obstetrics, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Jane Yun
- Department of Gynecology and Obstetrics, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Cody Carter
- Department of Pathology and Human Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Elaine Hart
- Department of Gynecology and Obstetrics, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
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Afrin S, Kirschen GW, Borahay MA. Obesity Contributes to Transformation of Myometrial Stem-Cell Niche to Leiomyoma via Inducing Oxidative Stress, DNA Damage, Proliferation, and Extracellular Matrix Deposition. Genes (Basel) 2023; 14:1625. [PMID: 37628676 PMCID: PMC10454202 DOI: 10.3390/genes14081625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Leiomyomas (fibroids) are monoclonal tumors in which myometrial stem cells (MSCs) turn tumorigenic after mutation, abnormal methylation, or aberrant signaling. Several factors contribute to metabolic dysfunction in obesity, including abnormal cellular proliferation, oxidative stress, and DNA damage. The present study aims to determine how adipocytes and adipocyte-secreted factors affect changes in MSCs in a manner that promotes the growth of uterine leiomyomas. Myometrial stem cells were isolated from the uteri of patients by fluorescence-activated cell sorting (FACS) using CD44/Stro1 antibodies. Enzyme-linked immunosorbent assay (ELISA), Western blot, and immunocytochemistry assays were performed on human adipocytes (SW872) co-cultured with MSCs and treated with leptin or adiponectin to examine the effects of proliferation, extracellular matrix (ECM) deposition, oxidative damage, and DNA damage. Co-culture with SW872 increased MSC proliferation compared to MSC culture alone, according to 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) results. The expressions of PCNA and COL1A increased significantly with SW872 co-culture. In addition, the expression of these markers was increased after leptin treatment and decreased after adiponectin treatment in MSCs. The Wnt/β-catenin and TGF-β/SMAD signaling pathways promote proliferation and ECM deposition in uterine leiomyomas. The expression of Wnt4, β-catenin, TGFβ3, and pSMAD2/3 of MSCs was increased when co-cultured with adipocytes. We found that the co-culture of MSCs with adipocytes resulted in increased NOX4 expression, reactive oxygen species production, and γ-H2AX expression. Leptin acts by binding to its receptor (LEP-R), leading to signal transduction, resulting in the transcription of genes involved in cellular proliferation, angiogenesis, and glycolysis. In MSCs, co-culture with adipocytes increased the expression of LEP-R, pSTAT3/STAT3, and pERK1/2/ERK/12. Based on the above results, we suggest that obesity may mediate MSC initiation of tumorigenesis, resulting in leiomyomas.
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Affiliation(s)
| | | | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (S.A.); (G.W.K.)
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Qu Y, Chen L, Guo S, Liu Y, Wu H. Genetic liability to multiple factors and uterine leiomyoma risk: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1133260. [PMID: 37576957 PMCID: PMC10415162 DOI: 10.3389/fendo.2023.1133260] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Background and objective Uterine leiomyoma is the most common benign tumor in females of reproductive age. However, its causes have never been fully understood. The objective of our study was to analyze the causal association between various factors and uterine leiomyoma using Mendelian randomization (MR). Methods Genetic variables associated with risk factors were obtained from genome-wide association studies. Summary-level statistical data for uterine leiomyoma were obtained from FinnGen and the UK Biobank (UKB) consortium. We used inverse variance weighted, MR-Egger, and weighted median methods in univariate analysis. Multivariable MR analysis was used to identify independent risk factors. A fixed-effect model meta-analysis was used to combine the results of the FinnGen and UKB data. Results In the FinnGen data, higher genetically predicted age at natural menopause, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting insulin were associated with an increased risk of uterine leiomyoma, while higher age at menarche was associated with a reduced risk of uterine leiomyoma. Multivariable MR analysis of SBP and DBP showed that higher DBP might be an independent risk factor of uterine leiomyoma. In the UKB data, the results for age at natural menopause, SBP, DBP, and age at menarche were replicated. The result of the meta-analysis suggested that uterine leiomyoma could also be affected by polycystic ovary syndrome (PCOS), endometriosis, and 2-hour glucose level. Conclusion Our MR study confirmed that earlier menstrual age, hypertension, obesity, and elevated 2-hour glucose post-challenge were risk factors for uterine leiomyoma, and the causal relationship between smoking and uterine leiomyoma was ruled out. In addition, later age of menopause and endometriosis were found to increase the risk of uterine leiomyoma, while PCOS was found to decrease the risk.
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Affiliation(s)
- Yangming Qu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Lanlan Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Shijie Guo
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Liu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Wu
- Department of Neonatology, the First Hospital of Jilin University, Changchun, Jilin, China
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Acchiardo J, Maita E, Jobanputra K. Ultrasound-Guided Diagnosis of Multiple Uterine Fibroids in a Patient With Polycystic Ovaries and Treatment With Relugolix, Estradiol, and Norethisterone Acetate. Cureus 2023; 15:e39055. [PMID: 37323302 PMCID: PMC10266936 DOI: 10.7759/cureus.39055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Uterine fibroids and ovarian cysts are common gynecological conditions that, while benign, when present simultaneously with bacterial vaginosis, can present a more complicated course of management. Symptoms of uterine fibroids include menorrhagia and dysmenorrhea, while ovarian cysts may present with pelvic pain and an adnexal mass. Each condition is typically managed separately; however, they can coexist in some patients, leading to a more complex presentation. This case report presents a 35-year-old African American female patient with the simultaneous occurrence of uterine fibroids and ovarian cysts, complicated by recurrent vaginitis, along with the treatment approach. The treatment choice, relugolix, estradiol, and norethisterone (norethindrone) acetate, is the first once-daily U.S. Food and Drug Administration (FDA) combination hormonal medication approved for menorrhagia due to fibroids. This case is unique in that although the diagnoses are common, their coexistence makes for a more complex presentation, and the course of management presents a newly approved fixed-dose combination hormonal medication. This report discusses the incidence, pathophysiology, diagnosis, and management of uterine fibroids and ovarian cysts. Factors that may contribute to the concurrence of these conditions, such as genetic, hormonal, and environmental risks, are also explored. Diagnostic modalities and ultrasound techniques are reviewed, and treatment options, such as surgery and medical management, are discussed. The importance of a patient-centered approach in the treatment of multi-symptom gynecological disorders and the need to consider conservative management are emphasized.
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Affiliation(s)
| | - Essence Maita
- Internal Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | - Ketan Jobanputra
- Obstetrics and Gynecology, UChicago Medicine AdventHealth, Bolingbrook, USA
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Alashqar A, El Ouweini H, Gornet M, Yenokyan G, Borahay MA. Cardiometabolic profile of women with uterine leiomyoma: a cross-sectional study. Minerva Obstet Gynecol 2023; 75:27-38. [PMID: 35333033 DOI: 10.23736/s2724-606x.22.04952-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Emerging evidence suggests that cardiometabolic risk factors contribute to uterine leiomyoma development, but cardiometabolic profiles of women with the tumor remain poorly defined. This study aimed to determine the association of cardiometabolic comorbidities and cardiometabolic medication use with a leiomyoma diagnosis. METHODS In this cross-sectional study, aggregate-level data from 2013-2020 were collected using the SlicerDicer feature of Epic (Epic, Verona, WI, USA) electronic medical record system. Women ≥18 years with at least one visit or hospital encounter at the Johns Hopkins Health System (N.=679,981) were assigned as cases or controls according to leiomyoma status. Individual prevalence of each prespecified cardiometabolic comorbidity and relevant prescription medications was obtained. Prevalence Odds Ratios were used to assess the association of cardiometabolic comorbidities and medication use with uterine leiomyoma. RESULTS Women with uterine leiomyoma (N.=27,703) were more likely to be obese (2.56; 95% CI: 2.49-2.63), have metabolic syndrome (1.82; 95% CI: 1.51-2.19), essential hypertension (1.45; 95% CI: 1.42-1.49), diabetes mellitus (1.29; 95% CI: 1.24-1.33) and hyperlipidemia (1.23; 95% CI: 1.19-1.26). These associations were stronger among younger women and persisted after excluding those with a hysterectomy. Notably, statins were the only medications associated with a lower leiomyoma risk (0.81; 95% CI: 0.79-0.84). CONCLUSIONS Uterine leiomyoma is associated with a spectrum of cardiometabolic comorbidities and use of associated medications, constituting an unfavorable cardiometabolic profile in women with the tumor. If definitively correlated, prevention and early management of cardiometabolic risk factors may decrease uterine leiomyoma incidence, and screening women with uterine leiomyoma for cardiometabolic comorbidities may aid in cardiovascular disease prevention.
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Affiliation(s)
- Abdelrahman Alashqar
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.,Department of Obstetrics and Gynecology, Kuwait University, Kuwait City, Kuwait
| | - Hala El Ouweini
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA.,American University of Beirut, Beirut, Lebanon
| | - Megan Gornet
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Biostatistics Center, Baltimore, MD, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA -
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Kim G, Jang G, Song J, Kim D, Lee S, Joo JWJ, Jang W. A transcriptome-wide association study of uterine fibroids to identify potential genetic markers and toxic chemicals. PLoS One 2022; 17:e0274879. [PMID: 36174000 PMCID: PMC9521910 DOI: 10.1371/journal.pone.0274879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Uterine fibroid is one of the most prevalent benign tumors in women, with high socioeconomic costs. Although genome-wide association studies (GWAS) have identified several loci associated with uterine fibroid risks, they could not successfully interpret the biological effects of genomic variants at the gene expression levels. To prioritize uterine fibroid susceptibility genes that are biologically interpretable, we conducted a transcriptome-wide association study (TWAS) by integrating GWAS data of uterine fibroid and expression quantitative loci data. We identified nine significant TWAS genes including two novel genes, RP11-282O18.3 and KBTBD7, which may be causal genes for uterine fibroid. We conducted functional enrichment network analyses using the TWAS results to investigate the biological pathways in which the overall TWAS genes were involved. The results demonstrated the immune system process to be a key pathway in uterine fibroid pathogenesis. Finally, we carried out chemical–gene interaction analyses using the TWAS results and the comparative toxicogenomics database to determine the potential risk chemicals for uterine fibroid. We identified five toxic chemicals that were significantly associated with uterine fibroid TWAS genes, suggesting that they may be implicated in the pathogenesis of uterine fibroid. In this study, we performed an integrative analysis covering the broad application of bioinformatics approaches. Our study may provide a deeper understanding of uterine fibroid etiologies and informative notifications about potential risk chemicals for uterine fibroid.
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Affiliation(s)
- Gayeon Kim
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Gyuyeon Jang
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Jaeseung Song
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Daeun Kim
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Sora Lee
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
| | - Jong Wha J. Joo
- Department of Computer Science and Engineering, Dongguk University-Seoul, Seoul, South Korea
| | - Wonhee Jang
- Department of Life Sciences, Dongguk University-Seoul, Seoul, Republic of Korea
- * E-mail:
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Elasam AN, Ahmed MA, Ahmed ABA, Sharif ME, Abusham A, Hassan B, Adam I. The prevalence and phenotypic manifestations of polycystic ovary syndrome (PCOS) among infertile Sudanese women: a cross-sectional study. BMC Womens Health 2022; 22:165. [PMID: 35562723 PMCID: PMC9102290 DOI: 10.1186/s12905-022-01762-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a global health problem associated with significant morbidity during reproductive age. Only a few published studies that address the clinical manifestations and phenotypic presentation of the disease have been conducted in Africa, including Sudan. Thus, this study aimed to evaluate the clinical and biochemical presentation of the different PCOS phenotypes among infertile Sudanese women. METHODS A cross-sectional, descriptive study was conducted from January to December 2019. A total of 368 infertile women with PCOS (based on the Rotterdam criteria) were recruited from a fertility center in Khartoum, Sudan. Clinical, hormonal, and ultrasonographic characteristics were described and compared between the four phenotypes of PCOS. RESULTS Majority (321 [87.2%]) of the women had oligo/anovulation (OA). Polycystic ovary morphology on ultrasound appeared in 236 (64.1%) women, acne in 171 (46.5%) women, acanthosis nigricans in 81 (22.0%) women, and hirsutism in 101 (27.4%) women. Phenotype D was the most prevalent among infertile Sudanese women (51.6%), followed by phenotype B (22.6%), phenotype C (18.2%), and phenotype A (7.6%). No statistical differences in the body mass index and hormonal profile between the four phenotypes were noted. Women with phenotype A were older and had high mean blood pressure, and a higher waist/hip ratio was observed among women with phenotype D. CONCLUSION Unlike the global distribution of PCOS phenotypes, Sudanese women uniquely expressed phenotype D as the most prevalent. More epidemiological studies are needed in the region due to geographical, ethnic, and genetic variations.
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Affiliation(s)
| | | | | | - Manal E. Sharif
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Abdalla Abusham
- College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, 56219 Saudi Arabia
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Wallace K, Stewart EA, Wise LA, Nicholson WK, Parry JP, Zhang S, Laughlin-Tommaso S, Jacoby V, Anchan RM, Diamond MP, Venable S, Shiflett A, Wegienka GR, Maxwell GL, Wojdyla D, Myers ER, Marsh E. Anxiety, Depression, and Quality of Life After Procedural Intervention for Uterine Fibroids. J Womens Health (Larchmt) 2022; 31:415-424. [PMID: 34101502 PMCID: PMC8972021 DOI: 10.1089/jwh.2020.8915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Quality of life (QOL) and psychological health has been reported to be decreased among women with gynecological conditions such as uterine fibroids (UFs). Materials and Methods: Women enrolled in the Comparing Options for Management: PAtient-centered REsults for Uterine Fibroids (COMPARE-UF) registry, receiving procedural therapy for symptomatic UFs, were eligible for this analysis if they completed a series of health-related QOL surveys administered at three time points (baseline, 6-12 weeks postprocedure, and 1 year postprocedure; n = 1486). Ethical approval for this study was obtained at each recruiting site and the coordinating center (NCT02260752, clinicaltrials.gov). Results: More than 26% (n = 393) of women reported moderate anxiety/depression on the baseline anxiety/depression domain of the Euro-QOL 5-dimension instrument. At both the 6-12 weeks and 1-year postprocedural follow-up, there was significant improvement in the UF QOL symptom severity score (p < 0.001, p < 0.001), the total UF symptom QOL score (p < 0.001, p < 0.001), and the Euro-QOL 5-dimension visual analog scale (p < 0.001, p = 0.004) compared with the preprocedural baseline scores. The reporting of anxiety/depression decreased by 66.4% among women who were at baseline, whereas 5.6% of women previously reporting no anxiety/depression reported anxiety/depression at the 1-year follow-up. Conclusion: UF symptoms were more severe among women reporting anxiety/depression at baseline. At the 1-year follow-up, health-related QOL scores improved among all women and the prevalence of anxiety/depression decreased in most, but not all women, whereas severity of anxiety/depression worsened in a small percentage of women (5.6%). Overall, these results suggest that UF treatment improves symptoms of anxiety/depression associated with symptomatic UFs.
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Affiliation(s)
- Kedra Wallace
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Address correspondence to: Kedra Wallace, PhD, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, USA
| | | | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Wanda Kay Nicholson
- Center for Women's Health Research, Department of Obstetrics and Gynecology, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - John Preston Parry
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | | | - Vanessa Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA
| | - Raymond M. Anchan
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia, USA
| | | | - Amber Shiflett
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ganesa R. Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - George Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Evan R. Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erica Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Manuel EC, Plowden TC, Valbuena FM, Bryce RL, Barick AA, Ramakrishnan A, Carnethon MR, Neff LM, Baird DD, Marsh EE. The Environment, Leiomyomas, Latinas, and Adiposity Study: rationale and design. Am J Obstet Gynecol 2022; 226:392.e1-392.e12. [PMID: 33974903 DOI: 10.1016/j.ajog.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Uterine leiomyomas, commonly known as fibroids, are benign tumors in postmenarchal females. By the age of 35 years, approximately 30% of females will have fibroids, and by the age of 50 years, the prevalence approaches 70% with some studies reporting >85% prevalence in African American females. Previous studies evaluating the prevalence of fibroids have largely relied on self-reported fibroid diagnoses, which could have falsely underestimated prevalence because many females with fibroids are asymptomatic. Despite known differences in fibroid prevalence by race, there are very limited data on fibroid prevalence by ethnicity. The Latino population is the largest ethnic minority in the United States, yet there is no large study that utilizes ultrasound to confirm the presence of fibroids in Latina/Latinx females. In addition, fibroids have been associated with obesity and with diabetes mellitus, but the data have been inconsistent and at times conflicting. OBJECTIVE The Environment, Leiomyomas, Latinas, and Adiposity Study was designed to quantify the prevalence of uterine fibroids among Latina/Latinx females and understand the relationships between obesity, glucose dysregulation, and fibroid prevalence and growth. This article presents the study's design and reports early enrollment data. STUDY DESIGN The Environment, Leiomyomas, Latinas, and Adiposity Study is a 5-year longitudinal cohort study based in Southeast Michigan with the goal of recruiting 600 Latina/Latinx females between the ages of 21 and 50 years. Given the recruitment goals, developing a respectful, transparent, and trusting relationship between the study investigators and the community was a major priority. Thus, a community-engaged research approach was utilized in the design of the Environment, Leiomyomas, Latinas, and Adiposity Study. A community advisory board containing community leaders, largely from the Latinx community, provided input and direction during the entirety of the Environment, Leiomyomas, Latinas, and Adiposity Study design and rollout process. A minimum of 3 visits (orientation and consent, baseline, follow-up) will be conducted for each participant, with baseline and follow-up visits approximately 18 to 30 months apart. At each visit, interviewer and self-administered surveys will assess sociodemographic factors, health behaviors, health history, and social determinants of health. In addition, participants undergo a pelvic ultrasound examination and biologic samples are collected. RESULTS Using community-engaged approaches, we have successfully enrolled 633 Latina/Latinx females. The mean participant age is 37.5±7.04 years. The mean body mass index is 30.0±6.54 kg/m2. First study visits have been initiated. CONCLUSION The objective of the Environment, Leiomyomas, Latinas, and Adiposity Study is to address the knowledge gap regarding uterine fibroids in the Latina/Latinx population. The Environment, Leiomyomas, Latinas, and Adiposity Study will generate ultrasound-confirmed evidence of the prevalence and growth patterns of uterine fibroids in this specific population while also examining the associations between obesity and laboratory-confirmed glucose dysregulation with uterine fibroid prevalence and growth patterns.
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11
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Kho PF, Mortlock S, Rogers PAW, Nyholt DR, Montgomery GW, Spurdle AB, Glubb DM, O'Mara TA. Genetic analyses of gynecological disease identify genetic relationships between uterine fibroids and endometrial cancer, and a novel endometrial cancer genetic risk region at the WNT4 1p36.12 locus. Hum Genet 2021; 140:1353-1365. [PMID: 34268601 DOI: 10.1007/s00439-021-02312-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/05/2021] [Indexed: 12/27/2022]
Abstract
Endometriosis, polycystic ovary syndrome (PCOS) and uterine fibroids have been proposed as endometrial cancer risk factors; however, disentangling their relationships with endometrial cancer is complicated due to shared risk factors and comorbidities. Using genome-wide association study (GWAS) data, we explored the relationships between these non-cancerous gynecological diseases and endometrial cancer risk by assessing genetic correlation, causal relationships and shared risk loci. We found significant genetic correlation between endometrial cancer and PCOS, and uterine fibroids. Adjustment for genetically predicted body mass index (a risk factor for PCOS, uterine fibroids and endometrial cancer) substantially attenuated the genetic correlation between endometrial cancer and PCOS but did not affect the correlation with uterine fibroids. Mendelian randomization analyses suggested a causal relationship between only uterine fibroids and endometrial cancer. Gene-based analyses revealed risk regions shared between endometrial cancer and endometriosis, and uterine fibroids. Multi-trait GWAS analysis of endometrial cancer and the genetically correlated gynecological diseases identified a novel genome-wide significant endometrial cancer risk locus at 1p36.12, which replicated in an independent endometrial cancer dataset. Interrogation of functional genomic data at 1p36.12 revealed biologically relevant genes, including WNT4 which is necessary for the development of the female reproductive system. In summary, our study provides genetic evidence for a causal relationship between uterine fibroids and endometrial cancer. It further provides evidence that the comorbidity of endometrial cancer, PCOS and uterine fibroids may partly be due to shared genetic architecture. Notably, this shared architecture has revealed a novel genome-wide risk locus for endometrial cancer.
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Affiliation(s)
- Pik Fang Kho
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sally Mortlock
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Peter A W Rogers
- Department of Obstetrics and Gynaecology, Gynaecology Research Centre, Royal Women's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Dale R Nyholt
- School of Biomedical Science, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Grant W Montgomery
- The Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Amanda B Spurdle
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Dylan M Glubb
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Tracy A O'Mara
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,Molecular Cancer Epidemiology Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.
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12
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Millien C, Manzi A, Katz AM, Gilbert H, Smith Fawzi MC, Farmer PE, Mukherjee J. Assessing burden, risk factors, and perceived impact of uterine fibroids on women's lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study. Int J Equity Health 2021; 20:1. [PMID: 33386078 PMCID: PMC7777531 DOI: 10.1186/s12939-020-01327-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/18/2020] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women's lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women's quality of life. METHODS A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH's (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. RESULTS Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication- 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1-10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6-12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6-13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1-0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1-0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women's lives. The poverty cycle of uterine fibroids emerged. CONCLUSIONS A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.
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Affiliation(s)
- Christophe Millien
- Partners In Health, Boston, MA, USA. .,Zanmi Lasante, Mirebalais University Hospital (MUH), Route Chatulee, Mirebalais, HT5211, Haïti.
| | - Anatole Manzi
- Partners In Health, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Arlene M Katz
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Hannah Gilbert
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Paul E Farmer
- Partners In Health, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Joia Mukherjee
- Partners In Health, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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13
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Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update 2020; 27:584-618. [PMID: 33302299 DOI: 10.1093/humupd/dmaa051] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. An endometrial component has been suggested to contribute to subfertility and poor reproductive outcomes in affected women. OBJECTIVE AND RATIONALE The aim of this review was to determine whether there is sufficient evidence to support that endometrial function is altered in women with PCOS, whether clinical features of PCOS affect the endometrium, and whether there are evidence-based interventions to improve endometrial dysfunction in PCOS women. SEARCH METHODS An extensive literature search was performed from 1970 up to July 2020 using PubMed and Web of Science without language restriction. The search included all titles and abstracts assessing a relationship between PCOS and endometrial function, the role played by clinical and biochemical/hormonal factors related to PCOS and endometrial function, and the potential interventions aimed to improve endometrial function in women with PCOS. All published papers were included if considered relevant. Studies having a specific topic/hypothesis regarding endometrial cancer/hyperplasia in women with PCOS were excluded from the analysis. OUTCOMES Experimental and clinical data suggest that the endometrium differs in women with PCOS when compared to healthy controls. Clinical characteristics related to the syndrome, alone and/or in combination, may contribute to dysregulation of endometrial expression of sex hormone receptors and co-receptors, increase endometrial insulin-resistance with impaired glucose transport and utilization, and result in chronic low-grade inflammation, immune dysfunction, altered uterine vascularity, abnormal endometrial gene expression and cellular abnormalities in women with PCOS. Among several interventions to improve endometrial function in women with PCOS, to date, only lifestyle modification, metformin and bariatric surgery have the highest scientific evidence for clinical benefit. WIDER IMPLICATIONS Endometrial dysfunction and abnormal trophoblast invasion and placentation in PCOS women can predispose to miscarriage and pregnancy complications. Thus, patients and their health care providers should advise about these risks. Although currently no intervention can be universally recommended to reverse endometrial dysfunction in PCOS women, lifestyle modifications and metformin may improve underlying endometrial dysfunction and pregnancy outcomes in obese and/or insulin resistant patients. Bariatric surgery has shown its efficacy in severely obese PCOS patients, but a careful evaluation of the benefit/risk ratio is warranted. Large scale randomized controlled clinical trials should address these possibilities.
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Affiliation(s)
- Stefano Palomba
- Unit of Obstetrics and Gynecology, Grande Ospedale Metropolitano of Reggio Calabria, Reggio Calabria, Italy
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Linda C Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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14
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Huang H, Kuang H, Sun F, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson PR, Christman GM, Hansen KR, Santoro N, Eisenberg E, Zhang H. Lower prevalence of non-cavity-distorting uterine fibroids in patients with polycystic ovary syndrome than in those with unexplained infertility. Fertil Steril 2019; 111:1011-1019.e1. [PMID: 30926125 DOI: 10.1016/j.fertnstert.2019.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To study whether there is a difference in the prevalence of non-cavity-distorting uterine fibroids between infertile patients with polycystic ovary syndrome (PCOS) and those with unexplained infertility (UI). DESIGN A secondary analysis of data from three randomized clinical trials. SETTING Academic health centers. PATIENT(S) A total of 2,249 patients with normal uterine cavities. INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) The presence or absence of non-cavity-distorting fibroids. RESULT(S) Compared with women with UI, those with PCOS were younger, had a higher body mass index, and were more likely to be Hispanic or African American, with a lower percentage of previous conception and live birth, a higher percentage of current smokers, a lower percentage of current alcohol users, and higher total testosterone, fasting insulin, and homeostasis-model-assessment insulin resistance. The prevalence of women with non-cavity-distorting uterine fibroids was lower in women with PCOS than in those with UI (6.7% vs. 12.4%); this result held after patients were divided into Black and non-Black or into three different body mass index groups. After adjustment for all the other variables in the final model, patients with PCOS had a significantly lower prevalence of fibroids than those with UI (odds ratio 0.54). No differences in the prevalence of non-cavity-distorting fibroids with any dimensions ≥4 cm or the volume of the largest fibroid was found between the two groups. CONCLUSION(S) A lower prevalence of non-cavity-distorting uterine fibroids was found in infertile women with PCOS than in those with UI.
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Affiliation(s)
- Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Hongying Kuang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Fangbai Sun
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Peter R Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Karl R Hansen
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut.
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15
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Maya ET, Guure CB, Adanu RM, Sarfo B, Ntumy M, Bonney EY, Lizneva D, Walker W, Azziz R. Why we need epidemiologic studies of polycystic ovary syndrome in Africa. Int J Gynaecol Obstet 2018; 143:251-254. [DOI: 10.1002/ijgo.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Ernest T. Maya
- School of Public Health; University of Ghana; Accra Ghana
- School of Medicine & Dentistry; University of Ghana; Accra Ghana
| | - Chris B. Guure
- School of Public Health; University of Ghana; Accra Ghana
| | | | - Bismark Sarfo
- School of Public Health; University of Ghana; Accra Ghana
| | - Michael Ntumy
- School of Medicine & Dentistry; University of Ghana; Accra Ghana
| | - Evelyn Y. Bonney
- Noguchi Memorial Institute for Medical Research; University of Ghana; Accra Ghana
| | - Daria Lizneva
- Department of Obstetrics & Gynecology; Augusta University; Augusta GA USA
- Division of Endocrinology, Diabetes and Bone Disease; Icahn School of Medicine at Mount Sinai; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Walidah Walker
- Department of Obstetrics & Gynecology; Augusta University; Augusta GA USA
| | - Ricardo Azziz
- Department of Obstetrics & Gynecology; Augusta University; Augusta GA USA
- The State University of New York System Administration; Albany NY USA
- Department of Health Policy; Management & Behavior; School of Public Health; University at Albany; Albany NY USA
- Department of Obstetrics & Gynecology; Albany Medical College; Albany NY USA
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16
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Bray MJ, Torstenson ES, Jones SH, Edwards TL, Velez Edwards DR. Evaluating risk factors for differences in fibroid size and number using a large electronic health record population. Maturitas 2018; 114:9-13. [PMID: 29907250 PMCID: PMC6022822 DOI: 10.1016/j.maturitas.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate individual characteristics of women with fibroids in relation to fibroid size and number. METHODS This cross-sectional study involved 2302 women (black and white, age range 18-87) with image- or surgery-confirmed fibroids from the Synthetic Derivative, a database of de-identified demographic and clinical information from patient electronic health records (EHRs) from the Vanderbilt University Medical Center. We performed multivariate regression analyses on the following outcomes: volume of largest fibroid, largest dimension of all fibroids, and number of fibroids (single vs multiple). Candidate risk factors included age at diagnosis, body mass index (BMI), race, type 2 diabetes status, and number of living children (a proxy for parity). We assessed potential effect measure modification by race and both age and BMI using a likelihood ratio test. RESULTS Black race was strongly associated with having multiple fibroids (adjusted odds ratio [aOR]: 1.83, 95% confidence interval [CI]: 1.49, 2.24) and larger fibroid volume (adjusted beta: 1.77, 95% CI: 1.38, 2.27) and greater largest dimension (adjusted beta: 1.28, 95% CI: 1.18, 1.38). Having multiple fibroids was most strongly associated with ages 43-47 (aOR = 3.37, 95% CI: 2.55, 4.46) compared with the youngest age group (ages 18-36). Having a larger number of living children was associated with having single a fibroid (aOR: 0.88, 95% CI: 0.78, 0.99). CONCLUSIONS Our findings suggest that different underlying etiologies are involved for women developing single versus multiple fibroids and small versus large fibroids. Studies are needed of the mechanisms by which these characteristics influence fibroid formation and growth.
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Affiliation(s)
- Michael J Bray
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Eric S Torstenson
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah H Jones
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Todd L Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States; Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States; Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN, United States.
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17
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Armanini D, Sabbadin C, Donà G, Bordin L, Marin L, Andrisani A, Ambrosini G. Uterine fibroids and risk of hypertension: Implication of inflammation and a possible role of the renin-angiotensin-aldosterone system. J Clin Hypertens (Greenwich) 2018; 20:727-729. [PMID: 29569322 DOI: 10.1111/jch.13262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Decio Armanini
- Department of Medicine - Endocrinology, University of Padova, Padova, Italy
| | - Chiara Sabbadin
- Department of Medicine - Endocrinology, University of Padova, Padova, Italy
| | - Gabriella Donà
- Department of Medicine - Endocrinology, University of Padova, Padova, Italy
| | - Luciana Bordin
- Department of Molecular Medicine - Biological Chemistry, University of Padova, Padova, Italy
| | - Loris Marin
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Alessandra Andrisani
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Guido Ambrosini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
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18
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Epidemiology and Risk Factors of Uterine Fibroids. Best Pract Res Clin Obstet Gynaecol 2018; 46:3-11. [DOI: 10.1016/j.bpobgyn.2017.09.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 09/13/2017] [Indexed: 01/01/2023]
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19
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Uterine Fibroids (Leiomyomata). Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017; 124:1501-1512. [DOI: 10.1111/1471-0528.14640] [Citation(s) in RCA: 466] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
Affiliation(s)
- EA Stewart
- Division of Reproductive Endocrinology and Infertility; Departments of Obstetrics and Gynecology and Surgery; Mayo Clinic; Rochester MN USA
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21
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Velez Edwards DR, Hartmann KE, Wellons M, Shah A, Xu H, Edwards TL. Evaluating the role of race and medication in protection of uterine fibroids by type 2 diabetes exposure. BMC WOMENS HEALTH 2017; 17:28. [PMID: 28399866 PMCID: PMC5387248 DOI: 10.1186/s12905-017-0386-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Uterine fibroids (UF) affect 77% of women by menopause, and account for $9.4 billion in annual healthcare costs. Type-2-diabetes (T2D) has inconsistently associated with protection from UFs in prior studies. To further evaluate the relationship between T2D and UFs we tested for association between T2D and UF risk in a large clinical population as well as the potential differences due to T2D medications and interaction with race. METHODS This nested case-control study is derived from a clinical cohort. Our outcome was UF case-control status and our exposure was T2D. UF outcomes and T2D exposure were classified using validated electronic medical record (EMR) algorithms. Logistic regression, adjusted for covariates, was used to model the association between T2D diagnosis and UF risk. Secondary analyses were performed evaluating the interaction between T2D exposure and race and stratifying T2D exposed subjects by T2D medication being taken. RESULTS We identified 3,789 subjects with UF outcomes (608 UF cases and 3,181 controls), 714 were diabetic and 3,075 were non-diabetic. We observed a nominally significant interaction between T2D exposure and race in adjusted models (interaction p = 0.083). Race stratified analyses demonstrated more protection by T2D exposure on UF risk among European Americans (adjusted odds ratio [aOR] = 0.50, 95% CI 0.35 to 0.72) than African Americans (aOR = 0.76, 95% CI 0.50 to 1.17). We also observed a protective effect by T2D regardless of type of T2D medication being taken, with slightly more protection among subjects on insulin treatments (European Americans aOR = 0.42, 95% CI 0.26 to 0.68; African Americans aOR = 0.60, 95% CI 0.36 to 1.01). CONCLUSIONS These data, conducted in a large population of UF cases and controls, support prior studies that have found a protective association between diabetes presence and UF risk and is further modified by race. Protection from UFs by T2D exposure was observed regardless of medication type with slightly more protection among insulin users. Further mechanistic research in larger cohorts is necessary to reconcile the potential role of T2D in UF risk.
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Affiliation(s)
- Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA. .,Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Genetics Institute, Vanderbilt University Medical Center , Nashville, TN, USA. .,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA.,Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa Wellons
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anushi Shah
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hua Xu
- The University of Texas School Health Science Center, School of Biomedical Informatics, Houston, TX, USA
| | - Todd L Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA.,Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center , Nashville, TN, USA.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
Uterine leiomyomata (UL) have a substantial impact on women's health, but relatively few studies have identified opportunities for primary prevention of these neoplasms. Most established risk factors are not modifiable, including premenopausal age, African ancestry, age at menarche, and childbearing history. The main challenge in studying UL is that a large proportion of tumors are asymptomatic. Herein, we review the epidemiology of UL from published studies to date. We highlight the advantages of ultrasound screening studies and the ways in which their innovative methods have helped clarify the etiology of disease. We conclude with a discussion of promising new hypotheses.
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Abstract
PURPOSE OF REVIEW This article reviews fibroids management in the perimenopausal period, and addresses future directions in care. RECENT FINDINGS Aromatase inhibitors, selective estrogen receptor modulators and antiprogestogens for medical management and minimally surgical techniques are promising treatments. SUMMARY The disease and the symptoms may persist in the peri and postmenopausal periods. The assumption that they will resolve with the onset of the menopause is too simplistic and not always valid. The number of perimenopausal women who wish to retain their uterus for reasons other than childbearing is increasing. The accurate diagnosis of these conditions may result in minor surgical or medical treatments being directed at the specific pathology and may avoid the need for major surgery.
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Reis FM, Bloise E, Ortiga-Carvalho TM. Hormones and pathogenesis of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2016; 34:13-24. [DOI: 10.1016/j.bpobgyn.2015.11.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/18/2015] [Indexed: 12/30/2022]
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25
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Abstract
Uterine fibroids are the most common type of benign gynecologic mass, and are present in up to 80 percent of women. Research exploring risk factors for fibroids presents conflicting or inconclusive findings. Symptoms for up to 50 percent of women experiencing fibroids include heavy menstrual bleeding, pelvic pressure or pain and gastrointestinal and genitourinary changes. Diagnosis is made by history and symptoms, physical examination and imaging. Several treatment options are available, and are based on symptoms, preferences and reproductive plans. Given the high prevalence of fibroids and the potential for women's health implications, it is essential that clinicians are aware of the latest evidence regarding fibroids to provide the highest quality of care for women whose health is affected by this condition.
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Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of Uterine Myomas: A Review. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:424-35. [PMID: 26985330 PMCID: PMC4793163 DOI: 10.22074/ijfs.2015.4599] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/16/2014] [Indexed: 11/09/2022]
Abstract
Myomas are the most common benign tumors of the genital organs in women of
childbearing age, causing significant morbidity and impairing their quality of life.
In our investigation, we have reviewed the epidemiological data related to the development of myomas in order to homogenize the current data. Therefore, a MEDLINE
and PubMed search, for the years 1990-2013, was conducted using a combination
of keywords, such as "myoma," "leiomyoma," "fibroids," "myomectomy," "lifestyle," "cigarette," "alcohol," "vitamins," "diet," and "hysterectomy". Randomized
controlled studies were selected based upon the authors’ estimation. Peer-reviewed
articles examining myomas were sorted by their relevance and included in this research. Additional articles were also identified from the references of the retrieved
papers and included according to authors’ estimation. Many epidemiologic factors are linked to the development of myomas; however,
many are not yet fully understood. These factors include age, race, heritage, reproductive factors, sex hormones, obesity, lifestyle (diet, caffeine and alcohol consumption, smoking, physical activity and stress), environmental and other influences,
such as hypertension and infection. Some of the epidemiological data is conflicting.
Thus, more research is needed to understand all the risk factors that contribute to
myoma formation and how they exactly influence their onset and growth.
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Affiliation(s)
- Radmila Sparic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | - Ljiljana Mirkovic
- Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy; International Translational Medicine and Biomodelling Research Group Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia
| | - Andrea Tinelli
- International Translational Medicine and Biomodelling Research Group Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia; Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology Vito Fazzi Hospital, Lecce, Italy
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Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy. Obstet Gynecol Int 2015; 2015:967568. [PMID: 25969688 PMCID: PMC4417601 DOI: 10.1155/2015/967568] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/25/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. To examine success of robot-assisted laparoscopic myomectomy (RALM) measured by sustained symptom relief and fertility. Methods. This is a retrospective survey of 426 women who underwent RALM for fibroids, symptom relief, or infertility at three practice sites across the US. We examined rates of symptom recurrence and pregnancy and factors associated with these outcomes. Results. Overall, 70% of women reported being symptom-free, with 62.9% free of symptoms after three years. At >3 years, 66.7% of women who underwent surgery to treat infertility and 80% who were also symptom-free reported achieving pregnancy. Factors independently associated with symptom recurrence included greater time after surgery, preoperative dyspareunia, multiple fibroid surgeries, smoking after surgery, and preexisting diabetes. Factors positively correlated with achieving pregnancy included desiring pregnancy, prior pregnancy, greater time since surgery, and Caucasian race. Factors negatively correlated with pregnancy were advanced age and symptom recurrence. Conclusions. This paper, the first to examine symptom recurrence after RALM, demonstrates both short- and long-term effectiveness in providing symptom relief. Furthermore, RALM may have the potential to improve the chance of conception, even in a population at high risk of subfertility, with greater benefits among those who remain symptom-free. These findings require prospective validation.
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Fibroid growth and medical options for treatment. Fertil Steril 2014; 102:630-9. [DOI: 10.1016/j.fertnstert.2014.07.1238] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022]
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Makker A, Goel MM, Das V, Agarwal A. PI3K-Akt-mTOR and MAPK signaling pathways in polycystic ovarian syndrome, uterine leiomyomas and endometriosis: an update. Gynecol Endocrinol 2012; 28:175-81. [PMID: 21916800 DOI: 10.3109/09513590.2011.583955] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PI3K-Akt-mTOR and MAP kinase are two important cell signaling pathways that are activated by steroid hormones and growth factors leading to cellular events including gene expression, cell proliferation and survival. These pathways are considered as an attractive target for the development of novel anticancer molecules, and selective inhibitors specifically targeting different components of these cascades have been developed. This review summarizes the current available knowledge on the PI3K-Akt-mTOR and MAPK pathways and their targeting in estrogen-dependent benign gynecological disorders viz. polycystic ovarian syndrome, uterine leiomyomas and endometriosis, which are a significant cause of high morbidity in women of reproductive age group. Increasing knowledge about the role of the two growth regulatory pathways in the pathogenesis of these disorders may give the opportunity to use specific signal transduction inhibitors for management of these patients in future.
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Affiliation(s)
- Annu Makker
- Post-Graduate Department of Pathology, CSM Medical University, Lucknow, India.
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30
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Warshowsky A. Uterine Fibroids (Leiomyomata). Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tehrani FR, Rashidi H, Azizi F. The prevalence of idiopathic hirsutism and polycystic ovary syndrome in the Tehran Lipid and Glucose Study. Reprod Biol Endocrinol 2011; 9:144. [PMID: 22044512 PMCID: PMC3214199 DOI: 10.1186/1477-7827-9-144] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no clear and contemporaneous method for screening of idiopathic hirsutism (IH) and polycystic ovary syndrome (PCOS) at the community level and current estimates regarding their prevalence are limited. We aimed to ascertain the prevalence of IH and PCOS in a randomly selected sample of reproductive aged female participants of the Tehran Lipid and Glucose Study (TLGS). METHODS One thousand and two women, aged 18-45 years, were randomly selected from among reproductive aged women who participated in the TLGS. Those women with either hirsutism or menstrual dysfunction were assessed for biochemical hyperandrogenemia; whereas those participants with hirsutism per se were further assessed for subclinical menstrual dysfunction. PCOS were diagnosed using the National Institute of Health (NIH) criteria. IH was defined as hirsutism without clinical or sub clinical menstrual dysfunction or biochemical hyperandrogenemia (BH). RESULTS The mean±SD of age of study population was 29.2±8.7 years. Estimated prevalences of idiopathic hirsutism and pure menstrual dysfunction were 13.0% (95% CI: 10.9%-15.1%) and 1.5%(95% CI: 1.1%-1.9%), respectively. The prevalence of PCOS was 8.5% (95% CI: 6.8%-10.2%); more than one third of these cases would possibly have remained undiagnosed or misdiagnosed, had we not assessed them for subclinical menstrual dysfunction or biochemical hyperandrogenemia. CONCLUSIONS These data from a large representative and non selected population of women confirm the concept that IH and PCOS are the two most common gynecological endocrinopathies among reproductive aged women. The estimated prevalence of these conditions is highly influenced by their screening methods at the community level.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homeira Rashidi
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lambertino A, Turyk M, Anderson H, Freels S, Persky V. Uterine leiomyomata in a cohort of Great Lakes sport fish consumers. ENVIRONMENTAL RESEARCH 2011; 111:565-72. [PMID: 21310402 PMCID: PMC3111144 DOI: 10.1016/j.envres.2011.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/21/2010] [Accepted: 01/06/2011] [Indexed: 05/22/2023]
Abstract
Diet and endocrine disrupting persistent organic pollutants (POPs) have been associated with gynecologic conditions including uterine leiomyomata (UL), endometriosis, and ovarian cysts. Great Lakes sport fish consumption is a source of exposure to POPs such as p,p'-diphenyldichloroethene (DDE) and polychlorinated biphenyls (PCBs). This study was designed to examine retrospectively the effects Great Lakes sport fish consumption on the incidence of UL and to examine the effects of DDE and PCB serum levels on prevalent UL in women participating in the Great Lakes Fish Consumption Study. We hypothesized that associations of exposures with UL would be modified by breastfeeding status. Years of sport fish consumption, demographic, health, and reproductive data were assessed by survey. In a subgroup, serum was collected and tested for DDE and PCB levels. Effects of years of Great Lakes sport fish and sport fish consumption were modeled using time-dependent Cox proportional hazards regression and effects of POP exposures on UL were modeled using multiple logistic regression. Years of sport fish consumption were associated with UL, with an incidence rate ratio of 1.2 (95% CI 1.0-1.3) for each 10-year increment of fish consumption. Summary measures of POP exposures in the overall group were not associated with UL. In the subgroup of women who never breastfed and in whom PCB measurements were available, however, UL was significantly associated with PCBs and groupings of estrogenic, antiestrogenic, and dioxin-like PCBs. These findings support the possibility that PCB exposures from fish consumption may increase the risk of UL and highlight the importance of additional studies exploring biologic pathways by which they could be acting.
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Affiliation(s)
- Anissa Lambertino
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street, Room 879, (M/C 923), Chicago, IL 60612, USA.
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Testosterone dependent androgen receptor stabilization and activation of cell proliferation in primary human myometrial microvascular endothelial cells. Fertil Steril 2011; 95:1247-55.e1-2. [DOI: 10.1016/j.fertnstert.2010.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/15/2010] [Accepted: 11/08/2010] [Indexed: 01/09/2023]
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35
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Cozier YC, Berman JS, Palmer JR, Boggs DA, Serlin DM, Rosenberg L. Sarcoidosis in black women in the United States: data from the Black Women's Health Study. Chest 2010; 139:144-50. [PMID: 20595459 DOI: 10.1378/chest.10-0413] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There have been few epidemiologic studies of sarcoidosis focusing on black women. METHODS In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Women's Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles. RESULTS There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids. CONCLUSIONS This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.
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Affiliation(s)
- Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA 02215, USA.
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Radin RG, Palmer JR, Rosenberg L, Kumanyika SK, Wise LA. Dietary glycemic index and load in relation to risk of uterine leiomyomata in the Black Women's Health Study. Am J Clin Nutr 2010; 91:1281-8. [PMID: 20200259 PMCID: PMC2854903 DOI: 10.3945/ajcn.2009.28698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND High dietary glycemic index (GI) and glycemic load (GL) may promote tumorigenesis by increasing endogenous concentrations of insulin-like growth factor I (IGF-I) or the bioavailability of estradiol. In vitro studies have shown that uterine leiomyoma (UL) cells proliferate in response to IGF-I and display increased IGF-I gene expression and protein synthesis. Previous epidemiologic studies suggest that a high GL is a risk factor for endometrial and ovarian cancers, which, like UL, are hormone-responsive tumors. OBJECTIVE We investigated the relation of dietary GI and GL with UL risk in the Black Women's Health Study. DESIGN In this prospective cohort study, we followed 21,861 premenopausal women for incident UL from 1997 to 2007. Diet was assessed in 1995 and 2001 with food-frequency questionnaires. We used Cox regression to estimate incidence rate ratios (IRRs) and 95% CIs, controlled for potential confounders. RESULTS During 162,604 person-years of follow-up, there were 5800 cases of UL diagnosed by ultrasound or surgery. Dietary GI was weakly associated with UL risk overall (IRR for highest compared with lowest quintile: 1.09; 95% CI: 0.99, 1.19; P for trend = 0.04). Positive associations were observed between GL and UL in women aged <35 y (IRR for highest compared with lowest quintile: 1.18; 95% CI: 1.02, 1.37; P for trend = 0.15) and between GI and UL in college-educated women (IRR for highest compared with lowest quintile: 1.17; 95% CI: 1.03, 1.34; P for trend = 0.004). CONCLUSIONS Our results suggest that high dietary GI and GL may be associated with an increased UL risk in some women. The observed associations warrant investigation in future studies.
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Affiliation(s)
- Rose G Radin
- Slone Epidemiology Center, Boston University, Boston, MA 02215, USA.
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Abstract
Although uterine leiomyomata (fibroids) have been the leading indication for hysterectomy in the United States for decades, the epidemiological data on fibroid prevalence and risk factors are limited. Given the hormonal dependence of fibroids, most earlier studies focused on reproductive or hormonal factors. Recent analyses have extended that focus to other areas. We present previously unpublished data on the association between reproductive tract infections and fibroids that highlight the need for more detailed studies. Our review suggests that metabolic, dietary, stress, and environmental factors may also play a role in fibroid development.
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Affiliation(s)
- Shannon K Laughlin
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
BACKGROUND Insulin-like growth factor-I (IGF-I) and insulin stimulate cell proliferation in uterine leiomyoma (fibroid) tissue. We hypothesized that circulating levels of these proteins would be associated with increased prevalence and size of uterine fibroids. METHODS Participants were 35-49-year-old, randomly selected members of an urban health plan who were enrolled in the study in 1996-1999. Premenopausal participants were screened for fibroids with ultrasound. Fasting blood samples were collected. Associations between fibroids and diabetes, plasma IGF-I, IGF binding protein 3 (BP3), and insulin were evaluated for blacks (n = 585) and whites (n = 403) by using multiple logistic regression. RESULTS IGF-I showed no association with fibroids in blacks, but in whites the adjusted odds ratios (aORs) for both mid and upper tertiles compared with the lowest tertile were 0.6 (95% confidence intervals [CI] = 0.3-1.0 and 0.4-1.1, respectively). Insulin and diabetes both tended to be inversely associated with fibroids in blacks. The insulin association was with large fibroids; aOR for the upper insulin tertile relative to the lowest was 0.4 (0.2-0.9). The aOR for diabetes was 0.5 (0.2-1.0). Associations of insulin and diabetes with fibroids were weak for whites. Binding protein 3 showed no association with fibroids. CONCLUSIONS Contrary to our hypothesis, high circulating IGF-I and insulin were not related to increased fibroid prevalence. Instead, there was suggestion of the opposite. The inverse association with diabetes, although based on small numbers, is consistent with previously reported findings. Future studies might investigate vascular dysfunction as a mediator between hyperinsulinemia or diabetes and possible reduced risk of fibroids.
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Weiss G, Noorhasan D, Schott LL, Powell L, Randolph JF, Johnston JM. Racial differences in women who have a hysterectomy for benign conditions. Womens Health Issues 2009; 19:202-10. [PMID: 19447324 PMCID: PMC3786579 DOI: 10.1016/j.whi.2009.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate if there are racial differences between African-American and Caucasian women who have hysterectomy for benign conditions in terms of (1) presenting symptoms (prolapse, vaginal bleeding, pain, and known history of leiomyomas), (2) serum estradiol and testosterone levels at the visit before hysterectomy, and (3) uterine weight. METHODS A multi-ethnic, multisite, community-based longitudinal cohort study of 3,302 women ages 42-52 at enrollment was conducted. During 9 years of follow-up, 203 African-American and Caucasian women reported a hysterectomy, 90 with evidence of uterine leiomyomas. Women were surveyed regarding their overall perceived health before and after hysterectomy, presenting symptoms, and their motivations for surgery. Serum estradiol and testosterone levels were measured. Uterine weight at time of hysterectomy and clinical pathology were determined via medical record abstraction. RESULTS Previously diagnosed leiomyomas were presenting symptoms more frequently in African-American women than Caucasian women (85% vs. 63%; p = .02). African-American women had less prolapse than Caucasian women (0% vs. 10%; p = 0.04). Chronic pain was a more frequent reason for hysterectomy in African-American women than in Caucasian women (49% vs. 29%; p = .05). There were no differences between the groups in levels of estradiol or testosterone. African-American women had almost twice the uterine weight as that of Caucasian women (448 vs. 240 g; p = .0005). CONCLUSION Racial differences in frequency of hysterectomy for benign conditions are consistent with differences in presenting symptoms, where African-American women seemingly have larger, more symptomatic fibroids.
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Affiliation(s)
- Gerson Weiss
- New Jersey Medical School, UMDNJ, Newark, New Jersey
| | | | | | - Lynda Powell
- Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois
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Abstract
Uterine fibroids are the most common benign tumour of the female genital tract. However, their true prevalence is probably under-estimated, as the incidence at histology is more than double the clinical incidence. Recent longitudinal studies have estimated that the lifetime risk of fibroids in a woman over the age of 45 years is more than 60%, with incidence higher in blacks than in whites. The cause of fibroids remains unclear and their biology poorly understood. No single candidate gene has been detected for commonly occurring uterine fibroids. However, the occurrence of rare uterine fibroid syndromes, such as multiple cutaneous and uterine leiomyomatosis, has been traced to the gene that codes for the mitochondrial enzyme, fumarate hydratase. Cytogenetic abnormalities, particularly deletions of chromosome 7, which are found in up to 50% of fibroid specimens, seem to be secondary rather than primary events, and investigations into the role of tumour suppressor genes have yielded conflicting results. The key regulators of fibroid growth are ovarian steroids, both oestrogen and progestogen, growth factors and angiogenesis, and the process of apoptosis. Black race, heredity, nulliparity, obesity, polycystic ovary syndrome, diabetes and hypertension are associated with increased risk of fibroids, and there is emerging evidence that familial predisposition to fibroids is associated with a distinct pattern of clinical and molecular features compared with fibroids in families without this prevalence.
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Affiliation(s)
- Stanley Okolo
- North Middlesex University Hospital, Sterling Way, London, UK.
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