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Marabi PM, Musyoki SK, Monari F, Kosiyo PM, Ouma C. Association between coagulation indicators and menorrhagia among women in Kenya. Afr J Lab Med 2024; 13:2438. [PMID: 39364033 PMCID: PMC11447587 DOI: 10.4102/ajlm.v13i1.2438] [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: 02/26/2024] [Accepted: 07/15/2024] [Indexed: 10/05/2024] Open
Abstract
Background Despite the significant burden of menorrhagia (bleeding > 80 mL every menstrual cycle) among women in Western Kenya, it remains unknown whether coagulation disorders are an important underlying cause of this condition in the region. Objective This study assessed differences in coagulation profiles, associations between menorrhagia and coagulation profiles and compared morphological features of platelets among women attending Bungoma County Referral Hospital in Kenya. Methods A comparative cross-sectional study of women with and without menorrhagia, aged 18-45 years, was performed between December 2022 and September 2023. Sociodemographic factors, prothrombin time (PT), activated partial thromboplastin time, thrombin time, fibrinogen, international normalised ratio (INR), and platelet count were compared between groups, and associations with menorrhagia were assessed. Prothrombin time and INR levels above normal references were deemed increased. Results A total of 428 (214 per group) women were included. Family history of bleeding disorders (p < 0.0001) was more frequent in menorrhagic than in non-menorrhagic women. Additionally, menorrhagic women had high PT (p < 0.0001) and high INR (p < 0.0001) levels. Menorrhagia was significantly associated with an increased PT (odds ratio = 2.129, 95% confidence interval = 1.658-2.734; p < 0.0001) and increased INR (odds ratio = 7.479, 95% confidence interval = 3.094-18.080; p < 0.0001). Conclusion In this population in Western Kenya, menorrhagia was associated with a family history of bleeding disorders, increased PT, and increased INR. Routine assessment of the coagulation profile and family history of bleeding disorders is crucial for diagnosing and managing menorrhagia. What this study adds Our findings suggest that menorrhagic and non-menorrhagic women differ in terms of PT and INR, which may be predictive of menorrhagia.
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Affiliation(s)
- Phidelis M Marabi
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Kisii University, Kisii, Kenya
- Department of Biomedical Sciences, Faculty of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Stanslaus K Musyoki
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, South Eastern Kenya University, Kitui, Kenya
| | - Fred Monari
- Department of Mathematics and Actuarial Science, Faculty of Pure Applied Sciences, Kisii University, Kisii, Kenya
| | - Paul M Kosiyo
- Department of Medical Laboratory Sciences, Faculty of Medicine, Maseno University, Maseno, Kenya
| | - Collins Ouma
- Department of Biomedical Sciences, Faculty of Public Health and Community Development, Maseno University, Maseno, Kenya
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Boruah AM, Banerjee D, Bhardwaj F, Mallya S, Singal R, Sharma S, Gautam A. Effect of norethisterone dose and duration in the management of abnormal uterine bleeding: a narrative review and case report. Drugs Context 2024; 13:2024-4-1. [PMID: 38989130 PMCID: PMC11235183 DOI: 10.7573/dic.2024-4-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/15/2024] [Indexed: 07/12/2024] Open
Abstract
Abnormal uterine bleeding (AUB) is an acute/chronic variation in the normal menstrual cycle that affects adolescents, women of reproductive age and perimenopausal women. AUB affects approximately 3-30% of reproductive-aged women worldwide, and reduces their quality of life and productivity whilst increasing the overall healthcare burden. Its management requires thorough medical evaluation and individualized treatment. Depending on the severity and cause of AUB, its treatment ranges from lifestyle modifications and hormonal therapies to more invasive procedures or surgery. Although hormonal therapy is the preferred first-line measure in AUB, the available pharmacological options have various adverse effects. There exists a need for safer and more efficient treatment regimens with high patient compliance to effectively treat AUB. Norethisterone, also known as norethindrone, is a widely used synthetic analogue of progestogen. Controlled release formulations of norethisterone/ norethisterone acetate help maintain constant drug levels in the blood and exert minimal side-effects; therefore, they are promising therapeutic agents for effective AUB management. The present review summarizes the epidemiology and diagnosis of AUB, with a focus on the safety, efficacy and tolerability of norethisterone/ norethisterone acetate in AUB management. We also report a case of AUB in a 40-year-old woman, who was treated with NETA tablets. The treatment resulted in favourable outcomes, and patient satisfaction.
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Affiliation(s)
- Arun Madhab Boruah
- Apollo Fertility, Guwahati, India
- Apollo International Hospital, Guwahati, India
| | | | - Farendra Bhardwaj
- Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College (MGU MST), Jaipur, India
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Mahabharathi K, Sharma T, Mukherjee S, Joshi D, Kapoor N. Evaluation of the Vascular Endothelial Growth Factor and Smooth Muscle Actin Expression With Microvessel Density and Morphometric Analysis of Endometrial Vessels in Patients With Abnormal Uterine Bleeding. Cureus 2024; 16:e64125. [PMID: 39119382 PMCID: PMC11306986 DOI: 10.7759/cureus.64125] [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: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) that occurs in a structurally normal uterus with regular menstrual cycles and without other identifiable etiology is often caused by a primary endometrial disorder (AUB-E). Altered vascular morphological changes and expression of markers of angiogenesis have been implicated as an underlying cause in these cases. OBJECTIVES The study was conducted to investigate the expression of vascular endothelial growth factor (VEGF) and smooth muscle actin-alpha (SMA-α), and to perform microvessel density (MVD), and morphometric evaluation of endometrial vessels in patients with AUB-E. MATERIAL AND METHODS Endometrial biopsies and hysterectomy specimens of 40 patients clinically diagnosed with AUB-E were included in the study with 40 age-matched controls. Immunohistochemistry (IHC) with VEGF and SMA-α was performed, and the expression and staining pattern was recorded as the number of positive vessels per 10 high power fields and intensity scores. Morphometric analysis was performed on CD34 stained sections using Leica Application Suite, version 4.4.0 software (Leica Microsystems, Wetzlar, Germany). MVD was calculated by the vascular hotspot method. RESULTS A statistically significant increase in VEGF vessel count (p-value<0.001) and a decline in SMA-α expression (p-value=0.23) was seen in cases as compared to the control group. There was a statistically significant increase in microvessel caliber (p-value=0.01) and MVD (p-value <0.001) in cases as compared to controls. CONCLUSION These findings support aberrant vascular proliferation and impaired vessel maturation, contributing to the pathology of AUB-E. Alterations in angiogenesis in these patients reveal potential therapeutic targets for AUB.
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Affiliation(s)
- Kodavali Mahabharathi
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Tanya Sharma
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Soma Mukherjee
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Deepti Joshi
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Neelkamal Kapoor
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Querevalú-Pancorbo I, Rojas-Cama LF, Soncco-Llulluy F, Li J, Rosales-Rimache J. Abnormal uterine bleeding and associated factors: a cross-sectional study in high-performance Peruvian athletes. BMJ Open Sport Exerc Med 2024; 10:e001820. [PMID: 38818354 PMCID: PMC11138278 DOI: 10.1136/bmjsem-2023-001820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Background Abnormal uterine bleeding (AUB) is a problem that affects women and can cause outcomes such as anaemia, affecting women's quality of life. In high-performance athletes, this problem can be further exacerbated by intense physical activity, strict nutritional regimens and physical stress. Hypothesis There are factors that increase the risk of occurrence of AUB in high-performance Peruvian athletes. Study design Cross-sectional study. Level of evidence Level 4. Methods We applied an online questionnaire with questions to identify AUB according to the International Federation of Gynecology and Obstetrics criteria, demographic characteristics, sport practised and evaluation of the risk of an eating disorder using the Eating Attitudes Test questionnaire. We used a generalised linear model to identify factors associated with AUB. Results We evaluated 101 participants whose mean age was 22.3±4.3 years. The body mass index had a mean of 22.6±2.4 kg/m2. From the total of athletes, 68.3% (95% CI 58.6% to 76.7%) presented AUB. The bivariate analysis showed that the type of sport and the duration of the sporting activity were associated (p<0.05) with AUB, with AUB frequencies of 76.5% observed in athletes who practised anaerobic sports. The multivariate analysis did not report factors significantly associated with AUB. Conclusion We found a high frequency of AUB in high-performance Peruvian athletes, especially in those who practice anaerobic and resistance sports. Clinical relevance High-performance female athletes health must be evaluated periodically, and immediate actions are taken to control and treat AUB.
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Affiliation(s)
| | | | | | - Jair Li
- Escuela de Posgrado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jaime Rosales-Rimache
- Facultad de Ciencias de la Salud, Escuela de Tecnología Médica, Universidad Continental, Huancayo, Peru
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Zhong S, Qian L, Tan Y. Xue Ping Tablets treat abnormal uterine bleeding via VEGF-ERK1/2 pathway. Heliyon 2024; 10:e30079. [PMID: 38694046 PMCID: PMC11061727 DOI: 10.1016/j.heliyon.2024.e30079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024] Open
Abstract
Objective To investigate the protective effects against abnormal uterine bleeding (AUB) and possible mechanisms of Xue Ping tablets (XPT) using a rat model. Methods A total of 58 unmated female and 25 male SPF SD rats aged 8-9 weeks were selected. Eight unmated female rats were selected as the blank control group according to the complete random method. The other 50 rats were mated in a female/male ratio of 2:1. In the morning after mating, vaginal smears were collected. Presence of vaginal plug or sperm was regarded as the first day of pregnancy. All pregnant rats were given 8.3 mg/kg of mifepristone by gavage at 8:00 a.m. and 100 μg/kg misoprostol by gavage at 6:00 p.m. on the seventh day of pregnancy to induce incomplete abortion, thereby establishing a rat model of AUB. Forty rats were randomly divided into model, low- (220 mg/kg), medium- (441 mg/kg), high-dose (882 mg/kg) XPT, and positive control groups. The positive group was given 130 mg/kg Gong Xue Ning (GXN). The model group and the blank group were given an equal amount of distilled water. Results Compared with the model group, the volume of bleeding in the positive and middle- and high-dose XPT groups decreased (P < 0.05). Moreover, compared with the model group, the progesterone levels in the positive and XPT groups were significantly increased. Immunohistochemistry showed that XPT significantly decreased the expression levels of VEGF, p-ERK, NF-κB, SAA, MMP-2, MMP-9, TIMP-1, TIMP-2 and TIMP-3. WB results showed that XPT significantly decreased the expression levels of p-ERK, MMP-9, NF-κB, MMP-2 and VEGF. QRT-PCR results showed that XPT significantly decreased the expression levels of VEGF, NF-κB, SAA, MMP-2, TIMP-1, TIMP-2 and TIMP-3 (P < 0.05). Conclusions XPT could reduce AUB by inhibiting the inflammatory factors involved in the VEGF-ERK1/2 pathway.
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Affiliation(s)
- Suqin Zhong
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210029, China
- The Chinese Traditional Medicine Department of Ganzhou Maternity & Child Health Hospital, Ganzhou, Jiangxi, 341000, China
| | - Lichao Qian
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210022, China
| | - Yong Tan
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210029, China
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Ma J, Liu D, Mao X, Huang L, Ren Y, Xu X, Huang X, Deng C, Shi F, Sun P. Enhanced Diagnostic Efficiency of Endometrial Carcinogenesis and Progression in Women with Abnormal Uterine Bleeding through Peripheral Blood Cytokine Testing: A Multicenter Retrospective Cohort Study. Int J Med Sci 2024; 21:601-611. [PMID: 38464838 PMCID: PMC10920852 DOI: 10.7150/ijms.91506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024] Open
Abstract
Objective: This study aimed to evaluate the role of plasma cytokine detection in endometrial cancer screening and tumor progression assessment in patients with abnormal uterine bleeding. Methods: In this multicenter retrospective cohort study of 287 patients with abnormal uterine bleeding, comprehensive clinical information and laboratory assessments, including cytokines, routine blood tests, and tumor markers, were performed. Associations between the clinical indicators and endometrial carcinogenesis/progression were evaluated. The independent risk factors for endometrial cancer and endometrial cancer with deep myometrial invasion were analyzed using multivariate binary logistic regression. Additionally, a diagnostic model was used to evaluate the predictive efficacy of these identified risk factors. Results: In patients with abnormal uterine bleeding, low IL-4 and high IL-8 levels were independent risk factors for endometrial cancer (p < 0.05). Combining IL-4, IL-8, CA125, and menopausal status improved the accuracy of assessing endometrial cancer risk. The area under curve of the model is 0.816. High IL-6 and IL-8 levels were independent risk factors for deep myometrial invasion in patients with endometrial cancer (p < 0.05). Similarly, combining IL-6, IL-8, and Monocyte counts enhanced the accuracy of assessing endometrial cancer risk with deep myometrial invasion. The area under curve of the model is 0.753. Conclusions: Cytokines such as IL-4, IL-8, and IL-6 can serve as markers for monitoring endometrial cancer and its progression in women with abnormal uterine bleeding.
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Affiliation(s)
- Jincheng Ma
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Dabin Liu
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Leyi Huang
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Yuan Ren
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Xiaozhen Xu
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian, China
| | - Xiaoli Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian, China
- Department of Obstetrics and Gynecology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian, China
| | - Caiping Deng
- The Second Hospital of Nanping City, Nanping 354200, Fujian, China
| | - Feifeng Shi
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian, China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
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Lonky NM, Chiu V, Portugal C, Estrada EL, Chang J, Fischer H, Vora JB, Harrison LI, Peng L, Munro MG. Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas. PLoS One 2023; 18:e0294925. [PMID: 38079406 PMCID: PMC10712893 DOI: 10.1371/journal.pone.0294925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches. OBJECTIVE To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis. METHODS The Kaiser Permanente Hysterectomy Database (KPHD) was searched for women aged 18-52 undergoing hysterectomy for leiomyoma-associated chronic AUB (AUB-L) in 2018 and 2019. A target sample of 400 comprised those with at least 3 years in the Health System. Radiologists evaluated preoperative pelvic ultrasound images to determine leiomyoma size and level 2 FIGO type (submucous or other), and the linked electronic medical record abstracted for clinical features, including histopathological evidence of adenomyosis. RESULTS Of the 370 subjects that met the study criteria, adenomyosis was identified via histopathology in 170 (45.9%). There was no difference in the adenomyosis prevalence with (47.1%) and without (43.0%) at least one submucous leiomyoma. Subgroup analysis of ultrasound images by an expert radiologist for the presence of adenomyosis demonstrated a positive predictive value of 54.0% and a negative predictive value of 43.4%. CONCLUSIONS Adenomyosis was present in almost half of this AUB-L cohort undergoing hysterectomy and was equally prevalent in those with and without submucous leiomyomas as determined by sonographic evaluation. The imaging findings are in accord with prior investigators and demonstrate that 2-D ultrasound is insensitive to the presence of adenomyosis when the uterus is affected by leiomyomas. Further research is necessary to determine the impact of various adenomyosis phenotypes on the presence and severity of the symptom of HMB.
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Affiliation(s)
- Neal M. Lonky
- Kaiser Permanente Southern California, Orange County, Department of Obstetrics & Gynecology, Anaheim, California, United States of America
| | - Vicki Chiu
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Cecilia Portugal
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Erika L. Estrada
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - John Chang
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Heidi Fischer
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Jamie B. Vora
- AbbVie Inc, North Chicago, Illinois, United States of America
| | - Lawrence I. Harrison
- Kaiser Permanente Southern California, Orange County, Department of Obstetrics & Gynecology, Anaheim, California, United States of America
| | - Lauren Peng
- Department of Radiology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, United States of America
| | - Malcolm G. Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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Özberk H, Bilgiç D, Badem A. Menstrual cycle abnormalities in women: characteristics, perceptions, and health-seeking behaviours. EUR J CONTRACEP REPR 2023; 28:301-307. [PMID: 37910035 DOI: 10.1080/13625187.2023.2273753] [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: 03/02/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES To evaluate menstruation characteristics, perceptions, and health-seeking behaviours in women. METHODS We conducted this cross-sectional study with 394 women between February 2021 and October 2021. According to the self-perception of women, menstruation characteristics were divided into two groups, including 'normal' and 'abnormal'. The data were collected using the Personal Information Form, Assessment Form of the Menstrual Cycle Characteristics, and Health-Seeking Behaviour Scale. RESULTS Among all women, 49.7% perceived their menstruation characteristics as 'normal', and 50.3% perceived them as 'abnormal'. The menstruation characteristics negatively affected the daily life of 57.6% of women in the normal group and 68.7% of women in the abnormal group. Online health-seeking behaviour was the most common behaviour of seeking remedy; however, professional health-seeking behaviour was inadequate. Among women who perceived their menstruation characteristics as 'normal', excessive menstrual bleeding, extreme pain, and adverse effects on daily life increased health-seeking behaviour. Among women who perceived their menstruation characteristics as 'abnormal', irregular cycles, frequent bleeding, low levels of bleeding, the use of too many pads, extreme pain, and adverse effects on daily life increased health-seeking behaviour. CONCLUSION The participants in this study exhibited insufficient health-seeking behaviour for abnormal menstruation characteristics. Women should be directed by health professionals to reliable online sources to seek help, and they should be encouraged to display professional health-seeking behaviour.
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Affiliation(s)
- Hülya Özberk
- Department of Gynecologic and Obstetrics Nursing, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Dilek Bilgiç
- Department of Gynecologic and Obstetrics Nursing, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Aysun Badem
- Department of Nursing, Faculty of Health Sciences, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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Kitahara Y, Hiraike O, Ishikawa H, Kugu K, Takai Y, Yoshino O, Ono M, Maekawa R, Ota I, Iwase A. National survey of abnormal uterine bleeding according to the FIGO classification in Japan. J Obstet Gynaecol Res 2023; 49:321-330. [PMID: 36258286 DOI: 10.1111/jog.15464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 01/19/2023]
Abstract
AIM To investigate the status of abnormal uterine bleeding (AUB) in Japan using the International Federation of Gynecology and Obstetrics (FIGO) classification (AUB system 1 and 2; PALM-COEIN) and to clarify the relationship between AUB symptoms and the diseases causing AUB. METHODS In a nationwide study, we enrolled first-time patients who visited target facilities during two consecutive weeks from December 1, 2019 to January 31, 2020. The FIGO classification was used to investigate patients with symptoms and causative diseases of AUB. Based on the proportion of patients in the nationwide study, 373 cases were included in the detailed survey. Survey items included symptoms of AUB according to AUB system 1, examination details, and causative diseases according to the PALM-COEIN classification. RESULTS Within the study period, we encountered 61 740 first-time patients, of which 8081 (13.1%) were diagnosed with AUB. Among them, 39.9% had abnormal menstrual cycles and 56.9% had abnormal menstrual bleeding. In the survey, PALM had the highest percentage of AUB-L and COEIN had the highest percentage of AUB-O. Correspondence analysis showed that COEIN was strongly associated with abnormal menstrual cycles and PALM with abnormal menstrual bleeding. CONCLUSION We conducted the first nationwide survey of AUB in Japan. The FIGO classification was a useful tool for the diagnosis of AUB, with a strong correlation between symptoms of AUB by AUB system 1 and the causative disease of AUB by PALM-COEIN. Conversely, a high percentage of AUB-N and AUB-E suggests that AUB system 1 and PALM-COEIN are ambiguous as diagnostic tools.
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Affiliation(s)
- Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine University Hospital, University of Tokyo, Tokyo, Japan
| | - Hiroshi Ishikawa
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koji Kugu
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi Hospital, Tokyo, Japan
| | - Masanori Ono
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ryo Maekawa
- Department of Obstetrics and Gynecology, Yamaguchi University Hospital, Ube, Japan
| | - Ikuko Ota
- Department of Gynecology, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Akram Z, Mahjabeen I, Irshad F, Ahmed MW, Rehman S, Rizwan M, Shafqat A, Kiran A, Saeed A. Expression deregulation of matrix metalloproteinases and vasoconstriction related genes in Pakistani females with abnormal uterine bleeding. BMC Womens Health 2022; 22:543. [PMID: 36564776 PMCID: PMC9784108 DOI: 10.1186/s12905-022-02132-y] [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: 07/18/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) is irregular menstrual bleeding which has great impact on female health and life style. Various genetic factors are involved in etiology and pathology of AUB. Present study was designed to explore the association of PTGFR, MMP9, MMP2, TGFB3 and VEGFB with AUB. METHODS Blood samples of 212 females with AUB were collected along with age-matched healthy control. Expression variation of targeted genes was evaluated using qPCR. Present study cohort was divided into different groups based on demographic parameters and all targeted genes were correlated with study demographics. RESULTS Expression of targeted genes was significantly (P < 0.001) downregulated in females with AUB compared to control. Reduced (P < 0.01) expression of targeted genes was observed in all age groups (21-30, 31-40, 41-50 year) of AUB patients compared to respective control. Expression of VEGFB increased (P < 0.05) in AUB females with > 9 days bleeding compared to AUB patient had < 9 days bleeding. AUB women with miscarriage history showed upregulation in MMP2, TGFB3 (P < 0.05), and downregulation in MMP9 and VEGFB (P < 0.05) expression compared to AUB group with no miscarriage history. Expression of MMP2 increased (P < 0.05) in AUB females with > 60 kg body weigh compared to AUB patient with < 60 kg weight. CONCLUSION Present study open a new window for diagnosis of AUB at early stages and suggested a possible involvement of PTGFR, MMP9, MMP2, TGFB3 and VEGFB as candidate biomarkers in AUB.
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Affiliation(s)
- Zertashia Akram
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Ishrat Mahjabeen
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Faiza Irshad
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Malik Waqar Ahmed
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Sadaf Rehman
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Muhammad Rizwan
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Amna Shafqat
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Aniqa Kiran
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Asma Saeed
- grid.418920.60000 0004 0607 0704Cancer Genetics and Epigenetics Lab, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
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11
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Salcedo AC, Shehata H, Berry A, Riba C. Insulin resistance and other risk factors of cardiovascular disease amongst women with abnormal uterine bleeding. JOURNAL OF INSULIN RESISTANCE 2022. [DOI: 10.4102/jir.v5i1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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12
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Diagnostic Value of Vaginal Ultrasound under Improved Clustering Algorithm Combined with Hysteroscopy in Abnormal Uterine Bleeding. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6951692. [PMID: 35669673 PMCID: PMC9167001 DOI: 10.1155/2022/6951692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
In order to explore the diagnostic value of the improved clustering algorithm of vaginal ultrasound combined with hysteroscopy in abnormal uterine bleeding (AUB), 128 patients diagnosed with AUB in the hospital were selected as the research objects. A K-means improved clustering color image segmentation algorithm was designed and applied to AUB vaginal ultrasound image processing. The running time, mean square error (MSE), and peak to signal noise ratio (PSNR) were calculated to evaluate the algorithm, and the sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio were used to evaluate the diagnostic accuracy of the detection method. In addition, combined with hysteroscopy, a comprehensive evaluation of the diagnostic value of abnormal uterine bleeding diseases was implemented. The results showed that compared with the traditional K-means clustering algorithm, the running time of the improved K-means clustering color image segmentation algorithm in the training set was significantly shortened, the MSE was significantly decreased, and the PSNR was significantly increased (
). The sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio (90.5%, 93.2%, 84.3, and 96.3%) of AUB diagnosis were significantly improved in the algorithm of vaginal ultrasound combined with hysteroscopy (
). In summary, the combination of vaginal ultrasound and hysteroscopy based on K-means improved clustering color image segmentation algorithm can significantly improve the clinical diagnostic accuracy of AUB patients.
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13
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Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, Kahramanoglu I, Reyes-Muñoz E, Lin LT, Urman B, Ferrero S, Angioni S. Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality. Diagnostics (Basel) 2022; 12:diagnostics12051176. [PMID: 35626331 PMCID: PMC9140476 DOI: 10.3390/diagnostics12051176] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Abnormal uterine bleeding (AUB) is a frequent symptom in perimenopausal women. It is defined as uterine bleeding in which the duration, frequency, or amount of bleeding is considered excessive and negatively affects the woman’s quality of life (QoL) and psychological well-being. In cases of structural uterine pathology, hysterectomy (usually performed via a minimally invasive approach) offers definitive symptom relief and is associated with long-lasting improvement of QoL and sexuality. However, over the past 30 years, uterus-preserving treatments have been introduced as alternatives to hysterectomy. Hysteroscopic polypectomy, myomectomy, or endometrial resection/endometrial ablation are minimally invasive techniques that can be used as an alternative to hysterectomy to treat AUB due to benign conditions. Although associated with high patient satisfaction and short-term improvement in their QoL, hysteroscopic treatments do not eliminate the risk of AUB recurrence or the need for further intervention. Therefore, considering the impact of different treatment options on QoL and sexuality during preoperative shared decision making could help identify the most appropriate and personalized treatment options for perimenopausal women suffering from AUB.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
- Correspondence: (S.G.V.); (R.W.)
| | - Rafał Watrowski
- Faculty of Medicine (Associate), University of Freiburg, 79106 Freiburg, Germany
- Correspondence: (S.G.V.); (R.W.)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL 33146, USA;
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull HU6 7RX, UK;
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey;
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City 81362, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Pei-Tou, Taipei 11265, Taiwan
- Department of Biological Science, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung City 80424, Taiwan
| | - Bulent Urman
- Centre for Reproductive Endocrinology and Infertility, American Hospital, 34365 Istanbul, Turkey;
- Department of Obstetrics and Gynecology, Reproductive Endocrinology, Infertility Centre Istanbul, Koc University, 34450 Istanbul, Turkey
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
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14
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Jain V, Chodankar RR, Maybin JA, Critchley HOD. Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nat Rev Endocrinol 2022; 18:290-308. [PMID: 35136207 PMCID: PMC9098793 DOI: 10.1038/s41574-021-00629-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/16/2022]
Abstract
Menstruation is a physiological process that is typically uncomplicated. However, up to one third of women globally will be affected by abnormal uterine bleeding (AUB) at some point in their reproductive years. Menstruation (that is, endometrial shedding) is a fine balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction and, finally, repair and regeneration. An imbalance in any one of these processes can lead to the abnormal endometrial phenotype of AUB. Poor menstrual health has a negative impact on a person's physical, mental, social, emotional and financial well-being. On a global scale, iron deficiency and iron deficiency anaemia are closely linked with AUB, and are often under-reported and under-recognized. The International Federation of Gynecology and Obstetrics have produced standardized terminology and a classification system for the causes of AUB. This standardization will facilitate future research endeavours, diagnosis and clinical management. In a field where no new medications have been developed for over 20 years, emerging technologies are paving the way for a deeper understanding of the biology of the endometrium in health and disease, as well as opening up novel diagnostic and management avenues.
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Affiliation(s)
- Varsha Jain
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Rohan R Chodankar
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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15
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Gerema U, Kene K, Abera D, Adugna T, Nigussie M, Dereje D, Mulugeta T. Abnormal uterine bleeding and associated factors among reproductive age women in Jimma town, Oromia Region, Southwest Ethiopia. WOMEN'S HEALTH 2022; 18:17455057221077577. [PMID: 35168427 PMCID: PMC8855377 DOI: 10.1177/17455057221077577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Abnormal uterine bleeding is any bleeding that deviates from normal menstruations. It differs in terms of frequency of bleeding, duration, and the pattern of bleeding during menstrual cycle or menopause. It is a major gynecological problem for medical visits among women in the reproductive aged group. However, data on abnormal uterine bleeding in Ethiopia are limited. Therefore, this study aimed to assess the abnormal uterine bleeding and associated factors among reproductive age women in Jimma town, Southwest Ethiopia. Methods: Community-based cross-sectional study was employed from 1 January to 30 April 2020. Six hundred sixty women were selected by using systematic random sampling. Data were collected by using semi-structured questionnaires. Data were entered into EPI data version 3.1 and analyzed by using SPSS version 25 software. All predictor’s variables with p value <0.25 in bivariable analysis were entered into multivariable logistic regression analysis. Variables with a p value of less than 0.05 in the multivariable analysis were taken as statistically significant predictors of abnormal uterine bleeding. Results: Out of 660 participants, 225 (34.1%) had abnormal uterine bleeding. From women with abnormal uterine bleeding, the prevalence of metrorrhagia, heavy periods, oligomenorrhea, inter-menstrual bleeding, polymenorrhea, and amenorrhea was 59 (26.2%), 54 (24%), 53 (23.5%), 46 (20.4%), 35 (15.5%), and 25 (11.1%), respectively. History of abortion (adjusted odds ratio = 1.5, 95% confidence interval: 1.02–2.41), history of uterine fibroids (adjusted odds ratio = 3.83, 95% confidence interval: 1.85–7.94), history of sexually transmitted infection (adjusted odds ratio = 2.2, 95% confidence interval: 1.33–3.66), and the history of intrauterine device (adjusted odds ratio = 2.1, 95% confidence interval: 1.39–2.97) were significantly associated with abnormal uterine bleeding. Conclusion: The prevalence of abnormal uterine bleeding was higher in Jimma town.
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Affiliation(s)
- Urge Gerema
- Department of Biomedical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Kumsa Kene
- Department of Biomedical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Deriba Abera
- Department of Biomedical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Tesfaye Adugna
- Department of Biomedical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Mebrat Nigussie
- Department of Pathology, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Diriba Dereje
- Department of Biomedical Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Temesgen Mulugeta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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16
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Abstract
Uterine fibroids (leiomyomas) are present in >75% of women and can cause serious morbidity. They are by far the leading cause of hysterectomy. Fibroids are a complex mixture of cells that include fibroblasts and smooth muscle cells. Rich in extracellular matrix, they typically arise through somatic mutations, most commonly MED12. Their lack of growth inhibition and their ability to have facets of malignancy yet be histologically and biologically benign provide opportunities to explore basic processes. To date, the mechanisms responsible for growth and development of leiomyomas are an enigma. This review provides an overview of current understanding and future directions for clinical and basic research of fibroids.
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Affiliation(s)
- Elizabeth A. Stewart
- 1Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota,2Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota,3Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota,4Department of Surgery, Mayo Clinic, Rochester, Minnesota,5Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
| | - Romana A. Nowak
- 6Department of Animal Sciences, University of Illinois, Urbana, Illinois,7Institute for Genomic Biology, University of Illinois, Urbana, Illinois
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17
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Brehm E, Flaws JA. Prenatal exposure to a mixture of phthalates accelerates the age-related decline in reproductive capacity but may not affect direct biomarkers of ovarian aging in the F1 generation of female mice. ENVIRONMENTAL EPIGENETICS 2021; 7:dvab010. [PMID: 34707890 PMCID: PMC8543146 DOI: 10.1093/eep/dvab010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Phthalates are used in many consumer products, leading to daily human exposure. Although many studies focus on single phthalates, humans are exposed to mixtures of phthalates. Our laboratory created a phthalate mixture consisting of six different phthalates and found that it negatively affected female reproduction and accelerated some biomarkers of reproductive aging. However, it was unknown if prenatal exposure to the mixture accelerates the natural decline in reproductive capacity and ovarian aging in mice. Therefore, we tested the hypothesis that prenatal exposure to a phthalate mixture accelerates the age-related decline in reproductive capacity and biomarkers of ovarian aging in the F1 generation of mice. Pregnant CD-1 dams were orally dosed with control or phthalate mixture (20 µg/kg/day-200 mg/kg/day) daily from gestational day 10-birth. The F1 female pups were aged to 11-13 months, and then estrous cyclicity and breeding trials were conducted at 11 and 13 months. Ovaries were collected from the F1 females at 13 months to examine biomarkers of ovarian aging. Prenatal exposure to the phthalate mixture decreased the time the F1 females spent in proestrus and the ability of the F1 females to give birth at 11 and 13 months of age compared to control. In contrast, prenatal exposure to the mixture did not affect biomarkers of direct aging of the ovary in the F1 generation. Collectively, our data show that prenatal phthalate mixture exposure accelerates the natural age-related decline in reproductive capacity but may not affect some biomarkers of ovarian aging in the F1 generation.
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Affiliation(s)
- Emily Brehm
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, 2001 S. Lincoln Ave. Urbana, IL 61802, USA
| | - Jodi A Flaws
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, 2001 S. Lincoln Ave. Urbana, IL 61802, USA
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18
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Dolmans MM, Cacciottola L, Donnez J. Conservative Management of Uterine Fibroid-Related Heavy Menstrual Bleeding and Infertility: Time for a Deeper Mechanistic Understanding and an Individualized Approach. J Clin Med 2021; 10:4389. [PMID: 34640407 PMCID: PMC8509802 DOI: 10.3390/jcm10194389] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/17/2022] Open
Abstract
(1) Background: Uterine fibroids are the most common form of benign uterine tumors, causing heavy menstrual bleeding (HMB), pelvic pain, infertility and pressure symptoms. Almost a third of women with uterine fibroids seek treatment. The objective of this review is to understand the mechanisms linking fibroids to these symptoms and evaluate different options for their management, particularly the place of gonadotropin-releasing hormone (GnRH) antagonist. (2) Methods: We gathered the most recent and relevant papers on the main fibroid-related symptoms and medical and surgical therapy for their treatment. Those reporting use of oral GnRH antagonists were investigated in detail. (3) Results: The mechanisms explaining myoma-related HMB and infertility were reviewed, as they are essential to a deeper mechanistic understanding and oriented approach. The choice of treatment depends on the number, size, and location of fibroids, and is guided by the patient's age and desire to preserve her fertility. Economic impacts of myomas in terms of direct costs, lost workdays, and complications were found to be significant. Medical, surgical, and non-surgical strategies were analyzed in this context. Novel medical approaches with GnRH antagonist were explored and found to represent an effective new option. (4) Conclusion: The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. New options now exist, with GnRH antagonists proven to treat fibroid symptoms effectively, opening the door to novel strategies for the management of myomas.
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Affiliation(s)
- Marie-Madeleine Dolmans
- Gynecology Department, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium;
| | - Luciana Cacciottola
- Gynecology Research Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium;
| | - Jacques Donnez
- Université Catholique de Louvain, 1200 Brussels, Belgium
- Société de Recherche pour l’Infertilité (SRI), 143 Avenue Grandchamp, 1150 Brussels, Belgium
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