Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment

Awareness, burden and treatment of uterine fibroids: a web-based Italian survey

Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age and one of the leading causes of hysterectomy in Italy. This survey aimed to report how Italian women perceive and approach UFs, in order to raise healthcare professionals (HCPs)', institutions' and women's awareness of UFs and their treatment options. 1508 Italian women aged 30-50 years completed a web-based survey, answering a structured questionnaire focused on UF prevalence, symptomatology and impact, management and awareness. UF self-reported prevalence was 28.8%. Most UF-diagnosed women had symptom(s) before diagnosis (79.0%), and more than a half of UF-diagnosed participants were symptomatic post-diagnosis (55.8%). The most common symptoms after diagnosis were heavy menstrual bleeding (73.1%), dysmenorrhea (50.4%) and pelvic pain (36.8%). UFs negatively affected the quality of life of most symptomatic women, as well as sexuality and employment. Private gynecologists were the key reference HCPs for consultation and UF diagnosis. The most common UF treatments for symptomatic women were surgery (49.2%), followed by oral contraceptives (39.3%). Surgery was also performed for 22.9% of asymptomatic participants. UF-diagnosed participants were not involved in therapeutic choices in 37.6% of cases. Women's knowledge about UFs was mostly superficial (58.7% of all participants), with gynecologists and family/friends as main information sources. Patient-physician communication was rather unsatisfactory, especially about UF therapeutic options and disease impact on sexuality, fertility and lifestyle. This survey highlights that there is still a need to promote patient's knowledge about UFs and empowerment in treatment decision.

Luteolin modulates the TGFB1/PI3K/PTEN axis in hormone-induced uterine leiomyomas: Insights from a rat model

Uterine leiomyomas (UL), or fibroids, are non-cancerous tumors of the uterine smooth muscle, affecting approximately 70% of women of reproductive age. They are the most prevalent solid tumors in the gynecological tract and a major indication for hysterectomy. The pathogenesis of UL involves uterine inflammation, uncontrolled cell division, and suppressed apoptosis. This study evaluated the protective effects of luteolin, a flavonoid known for its anti-inflammatory and antioxidant properties, against diethylstilbestrol and progesterone-induced UL in female rats. Twenty-four female Wistar rats were divided into four groups: (1) control, (2) luteolin (10 mg/kg, PO), (3) UL (diethylstilbestrol 1.35 mg/kg + progesterone 1 mg/kg, SC), and (4) UL + luteolin (10 mg/kg). The treatment duration was five weeks. Histological analyses were performed using hematoxylin and eosin (H&E) staining and Masson's Trichrome staining to evaluate uterine architecture and fibrosis. Histological results demonstrated normal uterine architecture in the control and luteolin groups, with marked neoplastic cell proliferation and fibrosis in the UL group, significantly mitigated by luteolin treatment. Luteolin reduced uterine weights and exhibited antioxidant, anti-inflammatory, pro-apoptotic, and anti-proliferative effects. Immunohistochemical analysis revealed that luteolin significantly reduced α-SMA protein expression, suggesting its role in modulating fibrotic pathways by inhibiting TGF-β1 and PI3K and enhancing PTEN production. These findings highlight luteolin's potential as a non-invasive therapeutic option for UL and suggest the need for further clinical studies to establish its efficacy, optimize dosage, and evaluate its safety profile in humans.

Drug likeliness, pharmacokinetics profiling and efficacy of Polyscias fulva bioactive compounds in the management of uterine fibroids; An integrative in silico and in vivo approach

Polyscias fulva is traditionally used in Uganda for the management of Uterine fibroids (UF). However, there is paucity of data regarding its efficacy, biological targets and potential mechanisms of action hence prompting scientific validation process through insilico and invivo approaches. In this study, we utilized network pharmacology, molecular docking, molecular dynamic simulations and invivo assays to investigate the drug likeliness, pharmacokinetics and efficacy of Polyscias fulva against Uterine fibroids. Four Polyscias fulva bioactive compounds; pinoresinol, lichexanthone, methyl atarate, β-sitosterol exhibited drug likeness properties with moderate safety profiles. Forty-eight (48) uterine fibroid targets were identified as potential targets for the eleven Polyscias fulva compounds. Protein-protein interaction (PPI) analysis revealed four key targets (HIF1A, ESR1, EGFR, and CASP3). The KEGG pathway and GO enrichment analyses revealed that these key targets play significant roles in regulating the positive regulation of cyclin-dependent protein serine/threonine kinase activity, positive regulation of nitric-oxide synthase activity and positive regulation of transcription, DNA-templated. β-sitosterol demonstrated the strongest binding affinity with the four targets, showing particularly strong affinities for EGFR (-9.75 kcal/mol) and HIF1A (-9.21 kcal/mol). Molecular dynamics (MD) simulations revealed high stability in these protein-ligand complexes, with CASP3 displaying the lowest deviation and most consistent RMSD (0.14 nm) of the protein, followed by EGFR (0.25), HIF1A (0.29), and ESR1 (0.79). In-vivo evaluation on female Wistar rats with Polyscias fulva ethanolic extract showed an ameliorative effect of the extracts against monosodium glutamate-induced (MSG) UF. Treated animals exhibited a decrease in serum proteins, cholesterol, estrogen, and progesterone levels (P < 0.05) and the extract preserved uterine tissue histoachitecture as compared to controls. In conclusion, Polyscias fulva demonstrates potential ameliorative activity against UF with promising pharmacokinetic properties and safety profiles.

Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) effectively reduces fibroid-related symptoms and improves quality of life-A prospective single-centre 12-month follow-up study

INTRODUCTION

Uterine fibroids are the most common benign tumors among women, and it is estimated that approximately 70% of women have one or multiple fibroids by the age of menopause. About 30% of these women suffer from symptoms related to the fibroids. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, non-invasive treatment method for symptomatic uterine fibroids.

MATERIAL AND METHODS

In this prospective, single-centre follow-up study, 175 women with symptomatic uterine fibroids were treated with MR-HIFU. The effect of MR-HIFU on fibroid symptoms and quality of life was evaluated using a uterine fibroid-specific quality of life questionnaire (UFS-QoL). The main outcome measure was the symptom severity score and quality of life (QoL) before the MR-HIFU and 3 and 12 months after the treatment. This study was registered at clinicaltrials.gov (NCT03937401).

RESULTS

The median symptom severity score decreased from 56 (IQR 44-69) at baseline to 28 (IQR 16-44) at 3 months (p < 0.01) and 25 (IQR 16-38) at 12 months (p < 0.01) after treatment. The QoL score increased from a median of 48 (IQR 33-66) at baseline to 73 (IQR 59-93) at 3 months (p < 0.01) and 78 (IQR 66-90) at 12 months after treatment (p < 0.01). The reintervention rate during the 12-month follow-up was 2%.

CONCLUSIONS

MR-HIFU significantly reduces the severity of fibroid-related symptoms in selected patients as early as 3 months after MR-HIFU. The effect persists at 12 months. There is also a significant improvement in the quality of life 3 months after treatment, which further increases at 12 months.

The efficacy of progestins in managing pain associated with endometriosis, fibroids and pre-menstrual syndrome: a systematic review

PURPOSE

Alongside being contraceptives, progestins have been investigated as potential anti-inflammatory and analgesic therapies for use in painful gynaecological conditions. This review aims to synthesise evidence pertaining to the efficacy of progestins as analgesics for use in endometriosis, fibroids and pre-menstrual syndrome (PMS).

METHODS

We conducted a systematic review of the extant literature investigating the analgesic efficacy of progestins compared to any comparator interventions for individuals with the three specified gynaecological conditions. The search was carried out across the PubMed and CENTRAL databases on 7 April 2024 for randomised control trials (RCTs) published in the peer-reviewed literature from 2000 onwards. Data pertaining to analgesic efficacy, assessed by changes in pain indices/scores before and after treatment, were synthesised narratively. Data pertaining to adverse effect frequency and changes in bone mineral density (BMD) were also synthesised narratively. Risk of bias was assessed using the Cochrane risk of bias 2 tool.

RESULTS

The primary search identified 1220 potentially eligible RCTs of which 21 were ultimately included; 19 RCTs related to endometriosis, two related to fibroids and zero related to PMS. Quality assessment identified nine studies to be at a low risk of bias, nine studies with some concerns surrounding bias and three studies to be at a high risk of bias. The included studies represented a total of 2745 participants of whom 1317 were treated with a progestin and 1428 received a comparator intervention. In 18 of the 19 studies concerning endometriosis, progestins produced a statistically significant reduction in pain, further, in five instances progestins were more efficacious in reducing pain than comparator interventions. In both studies on fibroids, progestins produced significant reductions in pain, however, statistically significant differences compared to comparator interventions were not demonstrated. The most frequently cited adverse effect of progestins was spotting/irregular bleeding whilst those receiving comparator interventions most often reported hot flushes; cited in 12 and seven studies respectively. Five studies assessed the impact of progestins and comparators on BMD. Three studies found progestins significantly reduced BMD, however, in these instances reductions were significantly lower than those produced by comparator interventions and in two studies were not statistically significant after 12 months of follow-up.

CONCLUSION

Our review demonstrates the potential scope for the use of progestins as analgesics in the management of pain associated with endometriosis. Further research will need to be conducted to identify their efficacy in the management of pain associated with fibroids and PMS.

Impact of endocrine disrupting chemicals (EDCs) on epigenetic regulation in the uterus: a narrative review

Endocrine disrupting chemicals (EDCs) are ubiquitous in the environment and have been shown to interfere with the endocrine system, leading to adverse effects on reproductive health. In females, EDC exposure has been linked to menstrual irregularities, infertility, and pregnancy complications. Epigenetic regulation, which involves modifications to DNA and histones that do not alter the underlying genetic code, plays a crucial role in female reproduction. EDCs have been shown to disrupt epigenetic mechanisms, leading to changes in gene expression that can have long-term effects on reproductive outcomes. Several EDCs, including bisphenol A (BPA) and phthalates, dioxins, and polychlorinated biphenyls (PCBs), have been shown to alter DNA methylation patterns and histone modifications in female reproductive tissues. These changes can lead to altered expression of genes involved in ovarian function, implantation, and placental development. Here, we integrate epidemiological and experimental evidence from the last 20 years to profile the types of diseases that EDCs trigger in the female reproductive system in relation to the uterus, and the corresponding molecular mechanisms that have been studied. In addition, this review will outline the state of knowledge of EDC epigenetic regulation in the uterus and how it impacts reproductive health, as well as identify areas for future research.

Near-Infrared Spectroscopy Mapping for Uterine Cancer and Fibroid Detection

Endometrial cancer and uterine leiomyomas (fibroid) are common uterine pathologies that require early diagnosis to improve a patient's symptoms and increase the success rate of interventional procedures. In this work, we report on near-infrared spectroscopy (NIRS) spectral features of uterine cancer and fibroids from 69 surgical specimens obtained from 24 patients following hysterectomies. Normal uterus, cancer, and fibroid tissue were identified by NIR spectral contrast parameters based on the differences in spectrum morphology. Using the significant optical features and spectral principal components, a classification model was able to classify uterus tissue with a prediction accuracy higher than 70%, identifying cancer specimens with 70% sensitivity and 93% specificity, and fibroid samples with 86% sensitivity and 83% specificity. These results demonstrated NIRS mapping has promise as a complementary method for gynecologic imaging.

The global burden of polycystic ovary syndrome, endometriosis, uterine fibroids, cervical cancer, uterine cancer, and ovarian cancer from 1990 to 2021

BACKGROUND

Globally, common gynecological disorders such as Polycystic Ovary Syndrome (PCOS), endometriosis, uterine fibroids (non-malignant gynecological diseases), as well as cervical cancer, uterine cancer, and ovarian cancer (gynecological cancers), profoundly impact women's physical and mental health. The burden of these diseases exhibits significant geographical disparities across different countries and regions, making a comprehensive and precise assessment of the global burden of gynecological diseases particularly crucial. Such an assessment will facilitate the development of region-specific prevention and treatment strategies, contributing to a more effective response to these health challenges.

METHODS

Incidence, prevalence, mortality rates, and Disability-Adjusted Life Years (DALYs) data for the aforementioned gynecological conditions were obtained from the 2021 Global Burden of Disease (GBD) study and analyzed by age, location, and year. The burden associated with gynecological diseases was analyzed based on the Socio-demographic Index (SDI) and attributable risk factors. The Estimated Annual Percentage Change (EAPC) and its 95% Confidence Interval (CI) were used to assess temporal trends in burden.

RESULTS

In 2021, uterine fibroids were the leading non-malignant gynecological condition contributing to the highest Age-Standardized Incidence Rate (ASIR) and Age-Standardized Prevalence Rate (ASPR), with rates of 250.93 and 2841.07 per 100,000, respectively. Cervical cancer was the main contributor to the Age-Standardized Mortality Rate (ASMR) and Age-Standardized Disability Rate (ASDR) among the eight selected gynecological diseases, with rates of 6.62 and 226.28 per 100,000, respectively. From 1990 to 2021, the ASIR and ASPR for non-malignant gynecological conditions, such as PCOS and uterine fibroids, increased, while the ASDR for PCOS also rose. Among gynecological cancers, the ASIR for uterine cancer increased, while the ASPR for cervical cancer rose. However, the ASIR for cervical and ovarian cancers decreased, along with reductions in the ASMR and ASDR for these cancers and uterine cancer. There were notable regional disparities based on the SDI. In 2021, lower SDI regions had higher incidence, prevalence, mortality rates, and DALYs for endometriosis and cervical cancer, whereas higher SDI regions saw higher rates for PCOS, uterine fibroids, ovarian cancer, and uterine cancer, with more significant mortality and DALYs for ovarian and uterine cancers. The age distribution of these conditions varied. Non-malignant gynecological conditions, such as PCOS and uterine fibroids, primarily affect women aged 30-34 and 40-69. Endometriosis is most common in women aged 20-34, particularly between 25 and 29. Gynecological cancers, including cervical, uterine, and ovarian cancers, predominantly affect women over 35, especially between 40 and 69, with cervical cancer peaking at ages 50-54. Regarding attributable risk factors globally, 1% of cervical cancer deaths were linked to unsafe sexual behaviors, while a high Body Mass Index(BMI) contributed to 0.09% of ovarian cancer deaths and 0.34% of uterine cancer deaths.

CONCLUSION

The global burden of these six gynecological conditions poses a significant public health challenge. There is an urgent need for international collaboration to advance the development of age and regionally differentiated management strategies for gynecological diseases, including the development of effective diagnostic screening tools and the implementation of high-quality, targeted prevention and treatment strategies.

TAK-981 enhances antitumor activity in ELT3 uterine leiomyoma cells through the modulation of apoptosis, cell cycle arrest, and autophagy

Uterine leiomyomas, commonly known as fibroids, are the most prevalent benign tumors in women of reproductive age and are characterized by abnormal smooth muscle cell proliferation in the uterine wall. TAK-981 (subasumstat), an investigational drug that inhibits SUMOylation by targeting SUMO-activating enzymes, has demonstrated high potential for the treatment of various cancers. However, its effects on uterine leiomyomas remain largely unexplored. In this study, we evaluated the therapeutic effects of TAK-981 on ELT3 uterine leiomyoma cells. TAK-981 significantly decreased the viability of ELT3 uterine leiomyoma cells and inhibited colony formation. It also induced apoptosis and caused G2/M phase cell cycle arrest, demonstrating a strong effect on cell proliferation and survival. Notably, although TAK-981 enhances reactive oxygen species production, it also induces apoptosis through a reactive oxygen species-independent mechanism, as evidenced by increased apoptosis rates upon co-treatment with antioxidants such as N-acetylcysteine. Furthermore, western blot analysis revealed that treatment with TAK-981 downregulated MEK-1 expression and inhibited ERK phosphorylation, leading to enhanced cleavage of caspase-3 and PARP, thereby promoting apoptosis in ELT3 cells. Additionally, TAK-981 reduced extracellular matrix accumulation by suppressing Collagen I and Acta2 expression and promoted autophagy in ELT3 cells, as indicated by increased levels of LC3. These findings suggest that TAK-981 can be used as a therapeutic option for managing uterine leiomyomas through multiple mechanisms, including apoptosis induction and autophagy promotion.

Green synthesized Polyscias fulva silver nanoparticles ameliorate uterine fibroids in female Wistar Albino rats

Uterine fibroids affect a substantial proportion of women in their reproductive age. Despite their effectiveness, surgical options such as hysterectomy are invasive, costly, and associated with recurrences. Pharmacological treatments are non-curative, only alleviate symptoms, and associated with adverse effects. Polyscias fulva (Araliaceae) is traditionally used to manage uterine fibroids in East Africa. In this study we synthesized Polyscias fulva silver nanoparticles (PFAgNPs), evaluated their toxicity and activity against monosodium glutamate (MSG)-induced uterine fibroids in Wistar albino rats. The UV-visible spectroscopy showed maximal absorbance at 425 nm with adequate stability at varying temperatures, pH and storage conditions. Dynamic light scattering (DLS) analysis revealed an average hydrodynamic size of 107.4 d.nm, polydispersity index of 0.264, and zeta potential of -18.3 mV. X-ray diffraction (XRD) confirmed the crystalline nature of PFAgNPs with an average size of 25 nm while scanning electron microscopy (SEM) showed a spherical shape with an average size of 35 nm. The PFAgNPs caused lethargy, hyperventilation, and hyperactivity at a dose of 300 mg/kg BW, whereas 2000 mg/kg caused severe toxicity, resulting in death in acute toxicity testing. The no observed adverse effect level was 50 mg/kgBW, the lowest observed adverse effect level was 100 mg/kgBW, and median lethal dose (LD50) was 1000 mg/kg. The PFAgNPs significantly decreased (P < 0.05) serum proteins, cholesterol, estrogen and progesterone alongside preservation of the histoarchitecture of the uterus. Further research is needed to investigate the clinical safety of PFAgNPs in managing uterine fibroids.

Clinical comparison of laparoscopic and open surgical approaches for uterus-preserving myomectomy: a retrospective analysis on patient-reported outcome, postoperative morbidity and pregnancy outcomes

PURPOSE

Uterine fibroids pose clinical challenges due to varied symptoms and impact on fertility. Aim of this research is to compare open and laparoscopic myomectomy, with focus on evaluating their effects on patients' quality of life and analyzing their implications for pregnancy outcomes.

METHODS

This retrospective study compares open and laparoscopic myomectomy outcomes in 168 patients treated October 2017 and July 2023. Preoperative characteristics and postoperative outcomes in terms of symptoms and pregnancy outcomes were examined.

RESULTS

The patient cohort comprised patients with a high symptom burden. Only 51.2% expressing a desire for future pregnancies, highlighting diverse motivations for uterus-preservation. No significant differences were observed in preoperative symptoms. Larger and multiple myomas were associated with a higher likelihood of laparotomy. Recurrence rates were lower after laparoscopy (10.2% vs. 23.8%, p = 0.02). Cesarean section recommendations were more frequent post-laparotomy group (36.6% vs. 86.6%, p = 0.000). Morbidities and satisfaction showed no significant differences between approaches, with slightly better bleeding improvement after laparotomy. Despite similar pregnancy outcomes, a high proportion of patients did not conceive postoperatively (75.4%). Among patients who became pregnant postoperatively (n = 31), most patients conceived after one year or more, with no dependence on the surgical approach (p = 0.227).

CONCLUSION

Both open and laparoscopic myomectomy surgeries showed high patient satisfaction, symptom alleviation, and comparable pregnancy results. A preference emerged for laparoscopy in terms of cesarean section recommendations and recurrence risk. Laparoscopic procedures tended to offer higher operative satisfaction and fewer complications. The study emphasized the complexity of therapeutic decision-making.

Effect of mifepristone on uterine fibroids: A systematic review and meta-analysis

OBJECTIVE

Uterine fibroids are common benign tumors that cause symptoms like bleeding and pain, with mifepristone showing potential for treatment. This study examines the impact of mifepristone dosage on fibroid size and clinical outcomes to inform future research and treatment.

METHODS

A comprehensive search of databases including PubMed, Scopus, and Cochrane Library was conducted up to September 2024. Only randomized controlled trials (RCTs) studies were included, with data analyzed using a random-effects model. Subgroup analyses were performed based on dosage and treatment duration.

RESULTS

Sixteen RCTs were included in the analysis. The random-effects model showed that mifepristone, compared to placebo, resulted in a non-significant reduction in leiomyoma volume (SMD = -1.11, 95 % CI:2.63 to 0.40, P = 0.15). A daily dose of 25 mg mifepristone significantly reduced leiomyoma volume compared to 10 mg (SMD = -0.54, 95 % CI:1.06 to -0.02, P = 0.04). Extended use of 10 mg/day versus 5 mg/day also showed a non-significant reduction in leiomyoma volume (SMD = -0.05, 95 % CI:0.23 to 0.12, P = 0.56).

CONCLUSION

Mifepristone did not demonstrate a significant advantage over placebo in reducing uterine fibroid volume. While higher doses (25 mg daily) showed a statistically significant reduction compared to lower doses (10 mg daily), the overall clinical significance remains unclear. Further research is needed to clarify the optimal use of mifepristone in treating uterine fibroids.

The effect of intramyometrial injection of terlipressin versus carbetocin on hemoglobin and blood loss during open myomectomy operations without using haemostatic tourniquets: Double blinded randomized placebo-controlled trial

BACKGROUND

Uterine fibroids are a significant worldwide health problem due to their high prevalence among women during the reproductive period. Conservative surgery such as myomectomy has been of increasing interest. However, intraoperative blood loss represents a challenge to the surgeons. Therefore, the aim of this study was to assess the efficacy of Intramyometrial injection of terlipressin and carbetocin in reducing intraoperative bleeding and preserving the hemoglobin level.

METHODS

We conducted the randomized, double-blind, placebo-controlled trial from February 2022 to April 2024, in the El-Resala and Al-Aseema hospitals under the direction of the National Research Center.

RESULTS

A total of 99 eligible female patients out of 119 (13werenotmeetingtheinclusioncriteria) with uterine fibroid were recruited into the study and allocated into three groups (n = 33): terlipressin group (A), carbetocin group (B), and saline group (C). Blood loss was significantly different among groups (P < 0.001), being significantly lower in the Terlipressin group than the carbetocin group (mean = 321 vs 418 ml) and significantly lower in both groups than the saline (mean = 969 ml). The Terlipressin group required significantly less blood transfusion than the saline group (P < 0.05). The operative time and side effects were not statistically different among the three groups (P < 0.05). The operative time and side effects were not statistically different among the three groups.

CONCLUSIONS

Our study provided evidence that terlipressin is effective in reducing blood loss during myomectomy with advantages over carbetocin. Based on our results, we recommend the adoption of terlipressin to improve myomectomy outcomes and enhance patient safety, further studies with a larger sample size is recommended to confirm our findings.

Measurement of thiol/disulfide homeostasis and ischemic modified albumin levels in patients with uterine leiomyomas

OBJECTIVE

The aim is to contrast the serum levels of thiol-disulfide homeostasis and ischemic modified albumin between patients with leiomyoma and healthy individuals and to assess the impact of oxidative stress on the etiopathogenesis of leiomyoma.

METHODS

In this prospective case-control study, a total of 154 participants were included, consisting of 77 cases diagnosed with leiomyoma and 77 healthy individuals without leiomyoma. The demographic characteristics and ultrasonographic findings of the participants were recorded, and parameters such as albumin, ischemia-modified albumin, and thiol-disulfide homeostasis were evaluated. The results obtained from the analyses were compared between the two groups.

RESULTS

No significant differences were observed in the demographic characteristics between the groups. A significant difference was observed between the leiomyoma and control groups regarding serum albumin parameters, serum ischemic modified albumin, and serum dynamic thiol-disulfide parameters (P < 0.001). No significant difference was found in the ratios of disulfide/total thiol, disulfide/native thiol, native thiol/total thiol (P > 0.05).

CONCLUSION

There was a notable contrast in the levels of albumin, ischemic modified albumin, albumin/ischemic modified albumin ratio, total thiol, native thiol, and disulfide between individuals with uterine leiomyomas and healthy individuals in the control group. Oxidative stress is believed to play a causative role in the etiopathogenesis of uterine leiomyomas.

Genetic and biomarker approaches to uterine fibroids: toward precision medicine

Uterine fibroids (UFs) are the most common benign tumors of the female reproductive system, affecting 70%-80% of women by age 50. Early detection is challenging due to the absence of initial symptoms, and diagnosis primarily relies on ultrasound and magnetic resonance imaging (MRI). However, biomarker-driven approaches could enable earlier and more precise detection. This review explores emerging biomarkers and genetic factors in fibroid pathogenesis. Potential biomarkers, including PLP1, FOS, versican, LDH, and IGF-1, show promise for diagnosis and recurrence prediction. Genetic studies have identified key mutations in MED12, FH, HMGA2, and COL4A5-COL4A6, alongside genome-wide association studies (GWAS) that highlight fibroid risk loci. Interestingly, biomarkers may also be mutation-type specific, suggesting potential for more precise molecular classification. Gene therapy offers an innovative treatment approach but the genetic landscape of fibroids remains underexplored, limiting advancements in research and funding. Integrating biomarker-based diagnostics and genetic profiling could transform fibroid detection and management, reducing reliance on invasive procedures. This review highlights the urgent need for improved diagnostic tools, prognostic markers, and targeted therapies for uterine fibroids.

Do MRI structured reports with FIGO classifications of leiomyomas contain adequate information for clinical decision making?

OBJECTIVE

To evaluate if structured reports (SR) of pelvic magnetic resonance imaging (MRI) scans using the PALM-COEIN FIGO (the International Federation of Gynecology & Obstetrics) uterine leiomyomas classification (SR-FIGO) contain adequate information for clinical decision making compared with narrative reports (NR).

METHODS

Three reporting templates for pelvic MRI scans were compared: NR, SR without the PALM-COEIN FIGO classification of leiomyomas, and SR-FIGO, for presence of 19 key-features (KF) deemed relevant for leiomyoma management. Kruskal-Wallis test was used to evaluate KF distribution across the report types. One gynecologist and one gynecologist-in-training evaluated the reports and MRI scans to assess the presence of sufficient information to decide on: (1) treatment type (observation/medical treatment/surgery/uterine artery embolization); (2) surgical approach (hysteroscopic/laparoscopic/robotic/open); (3) surgery type (myomectomy/hysterectomy); (4) necessity to review MRI scans; and (5) time spent reviewing MRI scans. The responses of the gynecologist and gynecologist-in-training to points 1 to 5 among report types were compared using χ2 test.

RESULTS

Twenty NR, 20 SR, and 20 SR-FIGO were reviewed. The number of KF was significantly different among reports (P < 0.001): SR-FIGO had the highest number of KF, followed by SR, and NR. In pairwise comparison, significant differences were observed between NR and SR (P = 0.001) and between NR and SR-FIGO (P = 0.001), but not between SR and SR-FIGO (P = 0.063). There were significant differences in answers to question 1 between the gynecologist and gynecologist-in-training for SR (P = 0.007) and SR-FIGO (P = 0.024), with the gynecologist deeming SR and SR-FIGO to provide enough information for treatment decisions more commonly than the gynecologist-in-training.

CONCLUSION

Although this investigation revealed that SR offers a greater wealth of information in contrast to NR, additional investigation is required to ascertain whether the integration of the PALM-COEIN FIGO classification in SR enhances the clinical decision making capacity of gynecologists.

The efficacy and safety of Chinese herbal medicine Shugan Sanjie decoction in the treatment of uterine fibroids: a systematic review and meta-analysis

Background

Shugan Sanjie Decoction (SGSJ) is a commonly used Chinese medicine prescription for the treatment of uterine fibroids (UFs). However, there is still a lack of evidence for its effects and safety. To systematically assess the efficacy and safety of SGSJ in conjunction with Mifepristone [MFP] or Leuprolide acetate [LA] for the treatment of UFs, thereby providing a reference for clinical medication.

Objective

To systematically assess the efficacy and safety of SGSJ in combination with MFP or LA for the treatment of UFs, thereby providing a basis for clinical medication decisions.

Methods

Eight digital medical databases were systematically searched to identify randomized controlled trials (RCTs) evaluating the use of SGSJ combined with MFP or LA for the treatment of UFs. The search spanned from the inception of each database to July 2024. Risk of Bias (ROB) 2.0 and RevMan 5.3 software were utilized for systematic review and meta-analysis. Eligible studies comprised RCTs comparing SGSJ plus MFP or LA with MFP or LA alone. The primary outcome was the Clinical Effective Rate (CER). Secondary outcomes included (1) Uterine Fibroid Volume (UFV) (2), Uterine Volume (UV) (3), Serum Sex Hormone Levels [Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2), Progesterone (P)], and (4) Traditional Chinese Medicine Syndrome Scores (TSS).

Results

The meta-analysis comprised 12 RCTs with 952 participants. The results of meta-analysis showed that the total effective rate of SGSJ or combined with MFP or LA in the treatment of UFs [RR = 1.26, 95% CI (1.19, 1.34), P < 0.00001], which was statistically significant compared with the MFP or LA group and superior to the MFP or LA group (P < 0.05).

Conclusion

At present, there are evidence shows that SGSJ combined with MFP or LA improves CER, reduces UFV, and modulates sex hormone levels. However, due to the poor methodological quality and high heterogeneity of the included trials, our conclusions should be interpreted with caution. Future studies should prioritize rigorous RCTs with standardized treatment protocols, extended follow-up, and comprehensive safety assessments to identify SGSJ as a reliable treatment option for UFs.

Systematic Review registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024506017.

Blood Pressure, Cardiometabolic Traits, and Cardiovascular Events in Women With Uterine Fibroids: A Genetic Correlation and Mendelian Randomization Study

BACKGROUND

Uterine fibroids (UFs) are understudied uterus neoplasms, mainly affecting women of reproductive age and often leading to hysterectomy. Clinical series suggest impaired cardiometabolic features in UFs. We investigated potential genetic links between blood pressure (BP), several cardiometabolic traits, and UFs.

METHODS AND RESULTS

We used summary statistics of genome-wide association studies for UFs and 18 traits related to BP, obesity, lipids, and main vascular diseases. We applied linkage disequilibrium score regression to estimate genetic correlations and Genome-Wide Complex Trait Analysis-multitrait-based conditional and joint analysis to perform adjusted correlations. Univariate and bidirectional Mendelian randomization verified potential causal associations with UFs. We found UFs to significantly correlate with systolic BP (genetic correlation coefficient [rg]=0.08, P=8.7×10-5) and diastolic BP (rg=0.12, P=8.2×10-8), including after adjustment for body mass index. UFs also positively corelated with body mass index (rg=0.11, P=4.1×10-4), waist-to-hip ratio (rg=0.09, P=7.3×10-3), type 2 diabetes (rg=0.15, P=1.9×10-5), and triglycerides (rg=0.17, P=7.6×10-7). We identified a negative correlation with sex hormone-binding globulin (rg=-0.16, P=3×10-4), a marker of bioavailability of sex steroids. No evidence for shared genetic basis with vascular diseases was observed, except with migraine (rg=0.08, P=5.8×10-7). Mendelian randomization analyses confirmed higher body mass index to increase UF risk (beta-per-kg/m2=0.033, P=6.1×10-5), as did waist-to-hip ratio (beta-per-unit=0.193, P=3.3×10-5) and triglycerides (bet-per-mmol/L=0.163, P=1.9×10-5). Higher sex hormone-binding globulin decreased UF risk (beta-per-nmol/L=0.005, P=2.5×10-3). No causal effect was found for BP.

CONCLUSIONS

Our study shows that UFs share substantial genetic basis with traits related to BP, obesity, diabetes, and migraine, a predominantly female vascular disease. We provide Mendelian randomization-based evidence for central obesity, visceral fat traits, and sex-steroid bioavailability as relevant risk factors for UFs.

Anti-miRNA therapeutics for uterine fibroids

BACKGROUND

Uterine leiomyomas arise from altered uterine smooth muscle cell proliferation in the myometrium. Available treatments are limited and fraught with major side effects. Here, we leveraged data from a high-throughput screening using human microRNA mimics and selected miR-148a-3p as a therapeutic target. The study aimed to assess the therapeutic potential of a miR-148a-3p inhibitor in suppressing the proliferation of uterine leiomyoma cells and in a xenograft mouse model.

METHODS

Clinical samples of uterine leiomyoma were used to isolate primary uterine leiomyoma cells and develop a subcutaneous xenograft mouse model. Cells were transfected with both miR-148a-3p mimic and anti-miR-148a-3p to assess the effect of miR-148a-3p on-cell proliferation. Animals were administered anti-miR-148a-3p-LNA via both local (intra-tumoral) and systemic (intraperitoneal) routes. Tumor volume was measured using ultrasonography, followed by histological and immunofluorescence staining, and target gene expression analysis.

RESULTS

Transfection of primary cells with miR-148a-3p mimic resulted in increased smooth-muscle cell proliferation, whereas anti-miR-148a-3p LNA reduced their proliferation. Both local and systemic delivery of anti-miR-148a-3p LNA reduced tumor volume and cell proliferation. Anti-miR-148a-3p LNA also led to reduced levels of miR-148a-3p in vivo, paralleled by the up-regulation of its target genes TXNIP and Nrp1.

CONCLUSION

Anti-miR-148a-3p LNA inhibits the proliferation of patient-derived leiomyoma cells and tumor growth in vivo, by suppressing miR-148a-3p levels and increasing TXNIP and Nrp1 gene expression. The highest therapeutic effect was observed with systemic administration, positioning miR-148a-3p inhibition as a promising therapeutic strategy for uterine leiomyoma in humans.

Uterine fibroids at single-cell resolution: unveiling cellular heterogeneity to improve understanding of pathogenesis and guide future therapies

Uterine leiomyomas or fibroids are benign tumors of the myometrium that affect approximately 70% of reproductive-age women. Fibroids continue to be the leading cause of hysterectomy, resulting in substantial healthcare costs. Genetic complexity and lack of cellular and molecular understanding of fibroids have posed considerable challenges to developing noninvasive treatment options. Over the years, research efforts have intensified to unravel the genetic and cellular diversities within fibroids to deepen our understanding of their origins and progression. Studies using immunostaining and flow cytometry have revealed cellular heterogeneity within these tumors. A correlation has been observed between genetic mutations in fibroids and their size, which is influenced by cellular composition, proliferation rates, and extracellular matrix accumulation. Fibroids with mediator complex subunit 12 (MED12) mutation are composed of smooth muscle cells and fibroblasts equally. In contrast, the fibroids with high-mobility group AT-hook 2 (HMGA2) translocation are 90% composed of smooth muscle cells. More recently, single-cell RNA sequencing in the myometrium and MED12 mutation carrying fibroids has identified further heterogeneity in smooth muscle cells and fibroblast cells, identifying 3 different smooth muscle cell populations and fibroblast cell populations. Although both myometrium and fibroids have similar cellular composition, these cells differs in their transcriptomic profile and have specialized roles, underscoring the complex cellular landscape contributing to fibroid pathogenesis. Furthermore, not all smooth muscle cells in MED12-mutant fibroid carry the MED12 mutation, suggesting that MED12-mutant fibroids might not be monoclonal in nature. This review describes the intricacies of fibroid biology revealed by single-cell RNA sequencing. These advances have identified new cellular targets for potential therapies, provided insights into treatment resistance, and laid the groundwork for more personalized approaches to fibroid management. As we continue to unravel the cellular and molecular complexity of fibroids, we anticipate that this knowledge will translate into more effective and less invasive treatments, ultimately improving outcomes for the millions of women affected by this condition.

Vaginal Myomectomy for Large Intracervical Fibroids in Women Desirous of Preserving Their Uterus: A Case Series

Cervical fibroids are rare, benign tumors. The treatment of uterine fibroids is well-established, with standard treatment guidelines in place; however, there remains a lack of consensus on a standardized approach for cervical fibroids. A small prolapsing fibroid polyp may be removed vaginally, and a hysteroscope can be used in such cases to identify and ligate the pedicle. However, large cervical fibroids present a surgical challenge. Myomectomy is the cornerstone for the surgical management of cervical fibroids in women who wish to preserve their uterus. An enlarged cervix alters the anatomy of adjacent vital structures like the ureters, bladder, rectum, and uterine vessels, increasing the risk of injury to these structures. Due to the narrow operating field and the potential for injury, preoperative catheterization of the ureters through double-J (DJ) stenting is performed to delineate their course prior to surgery. Here, we report a series of cases in which intracervical fibroids, visible vaginally as a cervical protuberance, were enucleated vaginally using Bonney's principles. The base of the fibroid was clamped and ligated, followed by obliteration of the space and reconstruction of the cervix. Injection of vasopressin was unavailable in our resource-limited hospital; therefore, adrenaline was injected in a 1:200,000 dilution into the fibroid capsule intraoperatively to minimize blood loss. This method of enucleation minimizes the risk of injury to adjacent organs since the dissection occurs intracapsularly. Preoperative prophylactic DJ stenting was also not needed. Despite the lack of advanced medical options to reduce fibroid size and vascularity, such as preoperative gonadotropin-releasing hormone (GnRH) analogues and uterine artery embolization, in our low-resource setting, our technique of vaginal myomectomy effectively managed the challenges presented by large intracervical fibroids while preserving fertility. The only limitation was that fibroids that were not palpable through the cervical lips could not be enucleated using this approach.

Barbed suture in laparoscopic myomectomy

Uterine myomas are the most common benign gynecological tumors among women of reproductive age. The laparoscopic approach, when feasible, is considered the most suitable and safe technique for intervention. Typically, uterine muscular wall defects are sutured with absorbable filaments. However, performing intra-corporeal knots during laparoscopic procedures demands significant surgical abilities and experience. While laparoscopic myomectomies are often recommended, they pose a high risk of hemorrhage. Barbed sutures may address the challenges of laparoscopic knotting due to their inherent barbs, leading to filament cohesion with tissues. This characteristic could potentially reduce the total operative time and blood loss during surgery. In consideration of the latest literature meta-analysis on the topic, published in 2018 and cited in the present work, six papers were included in this review, excluding case reports, reviews and articles without a control group. The objective of this narrative review is to explore the literature and establish the safety profile of barbed suture compared to conventional laparoscopic sutures. Additionally, given the potential for postoperative adhesion formation with the use of barbed sutures, the review also emphasizes reproductive outcomes. Consistent with previous literature, patients undergoing barbed suture laparoscopic myomectomy experienced significantly lower suturing time and blood loss. Regarding obstetric outcomes, all studies analyzing this aspect concluded that barbed sutures in myomectomy are as safe as, and represent an easier alternative to, conventional sutures. Importantly, these findings did not adversely affect pregnancy outcomes.

Retrospective cohort study on the efficacy and safety of high-intensity focused ultrasound in non-invasive treatment of uterine leiomyomas and adenomyosis

OBJECTIVE

To assess the advantages of High-Intensity Focused Ultrasound (HIFU) in the treatment of uterine leiomyomas and adenomyosis.

METHODS

Patients with uterine leiomyomas (435 cases) and adenomyosis (78 cases) treated in our hospital from March 2020 to October 2023 were selected to receive non-invasive treatment with HIFU. Clinical symptom improvement and fibroid shrinkage were observed, and the incidence of complications and adverse reactions during and after treatment were analyzed.

RESULTS

The success rate of HIFU treatment in 435 cases of uterine leiomyomas was as high as 94.71%. The success rate of HIFU treatment was 96.15% in 78 cases of adenomyosis. Compared with before treatment, the improvement of clinical symptoms and the reduction of leiomyomas at one month, three months and six months after treatment were relatively better than those at the treatment period (P < 0.05). There were no serious adverse reactions in the patients during the treatment.

CONCLUSION

The noninvasive application of HIFU on leiomyomas and adenomyosis effectively improves the clinical symptoms of patients, and the volume of fibroids decreases significantly. At the same time, HIFU is safe and worthy of clinical application.

Bilateral massive leiomyomas in a bicornuate uterus, with torsion of the right horn

Uterine leiomyomas are the most common benign tumours of the female reproductive system, often asymptomatic, but can cause significant clinical issues such as abdominal pain. This case report highlights the rare occurrence of a unilateral uterine horn torsion in a bicornuate uterus caused by a massive subserosal leiomyoma. Surgical intervention with myomectomy revealed a previously undiagnosed bicornuate uterus, and the patient's recovery was uneventful. This finding shows the need for clinicians to consider leiomyoma torsion as well as uterine horn torsion in their differential diagnosis of acute abdominal pain.

Could let-7f, miR-10b, miR-34a, miR-181b, and miR-181d Be Useful Tools as a Target Therapy for Uterine Leiomyosarcoma?

Background/Objectives: We have previously identified let-7f-5p, miR-10b-5p, miR-34a-5p, miR-181b-5p, and miR-181d-5p as differentially expressed between uterine leiomyoma (LM) and leiomyosarcoma (LMS) tissue samples. The present study aimed to characterize these miRNA expression profiles and to assess the functional role of miR-34a and miR-181b in uterine LM and LMS cells. Methods: All the selected miRNAs showed downregulation in LMS cells compared to LM cells, but only miR-34a and miR-181b expression patterns matched those of patient samples. Therefore, these two miRs were selected for further analyses. Results: Loss of function analysis demonstrated that miR-34a and miR-181b silencing inhibited LM cell proliferation and migration. MiR-34a silencing induced CCND1 and MDM4 expression and inhibited KMT2D, BCL2, and NOTCH2 in LM. Silencing of miR-181b promotes TIMP3 and FGFR1 expression in LM and diminishes BCL2, NOTCH2, ATM, IRS1, and PRLR. Gain of function analysis revealed that the introduction of miR-34a and miR-181b mimics suppressed proliferation and migration in malignant LMS cells. Additionally, transfection with a miR-34a mimic downregulated NOTCH2 and BCL2 expression and enhanced the expression of CCND1, KMT2D, and TP53 in LMS cells. Moreover, miR-181b overexpression decreased TIMP3, NOTCH2, ATM, and IRS1 expression and increased the expression of FGFR1 in this cell. Importantly, the single introduction of either a miR-34a or miR-181b mimic was able to decrease the invasion capacity of LMS cells. Conclusions: Our studies demonstrated that miR-34a or miR-181b may play an anti-oncogenic role in uterine tumors; further studies are needed to better understand the role and regulatory mechanism of these miRNAs in LMS cancer development, which will help provide prognostic and therapeutic options for patients with LMS.

Association between blood heavy metals exposure with uterine fibroids among American women: a cross-sectional analysis from NHANES data

BACKGROUND

Excessive exposure to heavy metals has been linked to various health problems, including organ damage, neurological disorders, and reproductive and developmental abnormalities. However, the relationship between heavy metals exposure and uterine fibroids remains uncertain. To explore this association, we conducted a cross-sectional study among American women.

METHODS

We utilized data from three cycles of the National Health and Nutrition Examination Survey (NHANES, 1999-2006) to evaluate the association between uterine fibroids and blood heavy metal levels, including lead (Pb), cadmium (Cd), and mercury (Hg). Weighted logistic regression, restricted cubic spline (RCS), Bayesian kernel machine regression (BKMR), and subgroup analyse were used to examine the potential relationships between blood heavy metals and uterine fibroids.

RESULTS

Of the 4502 American women studied, 542 (12.04%) had uterine fibroids. Elevated levels of all heavy metals were significantly more common in women with uterine fibroids (P < 0.001). Blood Hg levels were notably associated with uterine fibroid prevalence in the adjusted model (OR = 1.41, 95% CI: 1.06-1.89, p = 0.03). Similar patterns were partly observed for blood Pb and Cd. Age and marital status were significant interaction factors concerning Hg exposure (P for interaction < 0.05). A dose-response relationship with an inflection point at 7µmol/L was identified for Hg, and BKMR models indicated a positive association between mixed heavy metal exposure and uterine fibroid risk.

CONCLUSIONS

Exposure to blood heavy metals, particularly Hg, is significantly associated with an elevated risk of uterine fibroids. Further prospective studies are necessary to confirm these findings.

Integral Roles of the TGFβ Signaling Pathway in Uterine Function and Disease

The uterus is a complex organ that requires precise signaling networks to mediate functions necessary for homeostasis and reproductive processes. The transforming growth factor β (TGFβ) superfamily regulates integral signaling pathways throughout many physiological processes, including cell proliferation, differentiation, and development. In this review, we summarize the current understanding of how the TGFβ signaling family controls key uterine functions, with a specific focus on the endometrium. These uterine functions include endometrial receptivity, implantation, decidualization, placentation, remodeling, and regeneration. Improving our understanding of the signaling networks that regulate these processes is integral to identifying, diagnosing, and treating uterine and reproductive diseases such as endometriosis, adenomyosis, recurrent pregnancy loss, and recurrent implantation failure.

The influence of uterine leiomyomatosis on the onset of psoriasis: a nationwide population-based study of 2.5 million Korean females

BACKGROUND

Uterine leiomyomatosis and psoriasis are prevalent conditions and shared pathophysiological factors indicate a potential association. However, a direct correlation has not been established. We investigated the relationship between uterine leiomyomatosis and the risk of new-onset psoriasis in Korean females of reproductive age.

METHODS

This nationwide population-based study used data from the Korean National Health Insurance System database. Data from 2,755,790 Korean females 20-39 years of age who underwent health check-ups from 2009 to 2012 were analyzed. Monitoring began at the initial national health assessment within the time frame and continued until either the diagnosis of emerging psoriasis or until December 2018.

RESULTS

Among 2,503,769 females included, 1.96% were diagnosed with psoriasis and 0.72% with uterine leiomyomatosis. The incidence ratio for new-onset psoriasis was higher in uterine leiomyomatosis patients (3.13 per 1,000) than in subjects without uterine leiomyomatosis (2.72 per 1,000). The hazard ratio for psoriasis occurrence was 1.18 (1.07-1.31) in uterine leiomyomatosis patients, 1.22 (1.08-1.37) in subjects who did not undergo myomectomy, and 1.12 (0.94-1.33) in patients who underwent myomectomy.

CONCLUSIONS

Uterine leiomyomatosis patients, especially those not undergoing myomectomy, showed an increased risk of psoriasis. Lifestyle modifications and surgical intervention for uterine leiomyomatosis may also be beneficial for psoriasis occurrence.

Lipid-laden uterus: Investigating uterine fibroids and lipid association

Uterine Fibroids (UF) are the most common (about 70 % cases) benign gynecological smooth muscle tumors of the uterus in women of reproductive age, characterized by abnormal cholesterol, lipoproteins, and triglyceride levels, and are a major public health concern. Despite its high prevalence, this condition remains complex and poorly understood. These tumors are hormone-dependent and hormones and lipid levels are inversely related. This review delves into the existing literature and critically evaluates studies that explore the potential relationship between lipids in the pathogenesis of uterine fibroids. This review concludes by critically appraising the research gaps in the involvement of lipids and signaling pathways in the pathogenesis of uterine fibroids and future directions for investigating this intriguing biological connection. By elucidating the potential link between uterine fibroids and lipids, this review paves the way for an improved understanding of fibroid pathogenesis, personalized risk assessment, and novel lipid-lowering therapeutic strategies.

Sphingosine 1-phosphate acts as proliferative and fibrotic cue in leiomyoma cells

OBJECTIVE

To determine whether the bioactive sphingolipid sphingosine 1-phosphate (S1P) modulates cellular proliferation and synthesis of fibrotic proteins in leiomyoma differently than myometrial cells.

DESIGN

A basic science study using human leiomyoma and myometrial cells.

SUBJECTS

Not applicable. This is an in vitro study performed on cellular models.

EXPOSURE

Leiomyoma and myometrial cells were treated with S1P, as well as with selective antagonists for S1P-specific G protein-coupled receptors and secondarily with inhibitors of extracellular signal-regulated kinase 1/2 (ERK1/2) and ezrin.

MAIN OUTCOME MEASURES

The main outcome measures included cellular proliferation and fibrogenesis. Bromodeoxyuridine Cell Proliferation Assay was employed to measure deoxyribonucleic acid synthesis and proliferation, whereas western blot analysis was used to assess the expression of the fibrotic markers N-cadherin, α-smooth muscle actin, transgelin, and collagen type I alpha 1.

RESULTS

Sphingosine 1-phosphate stimulates cellular proliferation of leiomyoma but not myometrial cells. The mitogenic effect elicited by S1P relies on the engagement of its specific receptor S1P2 and is mediated by ERK1/2 and ezrin activation. Furthermore, S1P exerts a profibrotic effect in a S1P-specific G protein-coupled receptor-dependent manner in leiomyoma but not myometrial cells.

CONCLUSIONS

These results, besides extending the knowledge on the molecular mechanism underlying uterine leiomyoma development and fibrosis, demonstrate the pathogenetic role of S1P in leiomyoma and support the rationale for targeting S1P signaling pathway as innovative potential treatment.

The Association Between Physical Activity and Uterine Leiomyoma and Its Symptoms: A Systematic Review and Meta-Analysis

Background and Aims

Although many studies have focused on the impact of physical activity on hormone-mediated tumors, its effect on uterine leiomyomas (UL) remains unclear. This systematic review synthesizes the scientific evidence on the role of physical activity in the occurrence and symptomatology of UL while putting forward a research agenda.

Methods

The PubMed, Scopus, Web of Science, SciELO, and Cochrane Library databases were searched for studies published up to January 10, 2025. The Newcastle‒Ottawa Scale was used to assess study quality, and the GRADE tool was used to determine evidence certainty. Dear-Simonian and Laird random effects models were used to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) of the association between physical activity and UL. The PRISMA guidelines were followed.

Results

Fifteen studies were included (three cross-sectional, 6 case-control, and 6 cohort studies), of which 11 were considered in the meta-analysis. The difference between women who did and did not regularly practice physical activity (OR = 0.93; 95% CI: 0.82, 1.05; I 2 = 77.6%, n = 8 studies) in the likelihood of having UL did not meet conventional levels of statistical significance. Moreover, those women who engaged in more intense physical activity were less likely to have UL (OR = 0.86; 95% CI: 0.75, 0.99; I 2 = 80.5%, n = 5 studies) than those who engaged in less intense physical activity.

Conclusion

Increased physical activity is associated with a slight decrease in the risk of UL and may provide relief from associated symptoms. Since current evidence is still limited to supporting specific physical activity recommendations, a research agenda is proposed for future studies on this subject.

PROSPERO Registration

CRD42021247505.

Suicide by Firearm and Hormonal Imbalances: A Forensic Case Report With Literature Review

Hormonal imbalances play a crucial role in the development of various diseases, with a significant impact on the gynecological system, especially in the onset of uterine fibroids (UFs). UFs, also known as myomas or leiomyomas, are noncancerous uterine growths commonly observed in women, particularly during their reproductive years. By age 50, many women experience fibroids, though the condition's prevalence varies significantly across different ethnic groups. While most fibroids remain asymptomatic, those that are symptomatic can lead to several issues, such as irregular bleeding, pelvic discomfort, and complications during pregnancy. Receiving a diagnosis of fibroids can be distressing, particularly when concerns arise about their potential link to more serious conditions. This distress can adversely affect a woman's quality of life and mental health, sometimes contributing to emotional distress, depressive symptoms, or even suicidal ideation. The management of UFs encompasses a spectrum of approaches, from careful monitoring to medical or surgical interventions, which are chosen based on the severity of symptoms and the patient's preferences. Psychological support can be valuable in helping women manage the anxiety and fears associated with the diagnosis and treatment process. Consequently, the impact of UFs on women's mental health warrants attention. This paper aims to review the existing scientific literature on the potential link between UFs, hormonal imbalances, and an increased risk of psychiatric disorders.

Lichong decoction improves inflammatory microenvironment and alleviates fibrosis in uterine leiomyoma via targeting CXCL8

ETHNOPHARMACOLOGICAL RELEVANCE

Lichong decoction (LD) is extensively employed in the treatment of uterine leiomyoma (ULM), demonstrating remarkable clinical effectiveness with an absence of notable adverse reactions. Its composition aligns with the traditional Chinese medicine (TCM) etiology of ULM, making it a highly suitable therapy. Nonetheless, the precise mechanisms underlying its therapeutic actions remain to be fully elucidated.

AIM OF THE STUDY

The objective of this study was to clarify the therapeutic mechanism of LD improving ULM.

MATERIALS AND METHODS

The effects of LD on ULM cell viability, proliferation, and apoptosis were assessed using CCK-8, crystal violet staining, EdU incorporation, TUNEL, and Annexin V-FITC/PI assays. Gene microarray was used to profile differential gene expression after LD treatment. A rat ULM model was created to evaluate LD's anti-tumor efficacy, measuring body weight, uterine weight index, and sex hormone levels. Histopathological changes were analyzed with hematoxylin and eosin staining, Masson's trichrome staining, and transmission electron microscopy. Protein and RNA expression changes were analyzed via immunohistochemistry, western blotting, and qPCR. UHPLC-QE-MS enabled a detailed non-targeted LD analysis. Key components were identified through their correlation with serum sex hormones and inflammatory cytokines, and then examined by molecular docking studies.

RESULTS

Experiments showed that LD reduced ULM cell viability and induced apoptosis. Gene expression profiling identified 313 differentially expressed genes. Enrichment analysis combined with experimental validation demonstrated that LD can reduce ULM fibrosis and inflammation by inhibiting the CXCL8/PI3K/AKT pathway. The analysis identified 494 primary compounds and 87 serum components in LD. Key compounds such as formononetin, palmatine, curcumenol, and hecogenin, which exhibit high affinity for CXCL8, may contribute to the anti-inflammatory and anti-tumor properties of LD.

CONCLUSION

This study demonstrates that LD effectively inhibits ULM proliferation and fibrosis by improving the inflammatory microenvironment, primarily through the inhibition of CXCL8. These findings highlight the therapeutic potential of LD for ULM and provide new insights into its mechanisms.

Licochalcone A Induces Uterine Leiomyoma Cell Apoptosis via the ROS-Mediated JNK Activation of the GRP78/NRF2 Pathway In Vitro and In Vivo

Licochalcone A (LicoA) possesses anti-tumor properties. However, the potential therapeutic effect of LicoA on uterine leiomyomas (ULs) remains unknown. In this study, the effects of LicoA on the proliferation of ULs and its underlying mechanism were explored. LicoA treatment significantly decreased the viability of uterine smooth muscle cells (UtSMCs) and ELT3 cells in a dose-dependent manner. The induction of ELT3 cell apoptosis by LicoA was accompanied by the increased generation of reactive oxygen species (ROS), elevated endoplasmic reticulum (ER) stress (GRP78/IRE1α/ATF6/CHOP), and the increased expression of proapoptotic proteins (c-caspase-3, c-caspase-9, and c-PARP). The ability of Z-VAD-FMK (a caspase inhibitor) and n-acetylcysteine (NAC; a cell membrane permeable antioxidant) to reverse LicoA-induced ROS-mediated ER stress pathways also observed. Furthermore, GRP78 or JNK knockdown was involved in LicoA-induced ROS-mediated ER stress and apoptosis in ELT3 cells. In immunodeficient mice, LicoA significantly suppressed the growth of ELT3 tumor cells, without toxicity. This study is the first to show that LicoA exerts anti-leiomyoma effects via the modulation of ROS-mediated ER stress-induced apoptosis through the JNK/GRP78/NRF2 signaling pathway.

Comparison of the lower genital tract microbiome composition in patients with benign gynecological disease

Objective

Lower genital tract microbiome dysbiosis has been associated with several gynecological diseases. However, the differences in microbiome composition among patients with several gynecological diseases, such as endometrial polyps and uterine myoma, are poorly understood. Studying the lower genital tract microbiome composition in patients with benign gynecological diseases could provide new insights for interpreting the complex interplay between the microbiome and pathogenesis and finding new targets for preventive measures.

Methods

A total of 16 patients with endometrial polyps (EPs), 11 patients with uterine myoma (UM), 6 patients with ovarian cysts (OC) and 36 healthy women (HWs) were recruited for this study. Samples were obtained from vaginal secretions. The DNA was isolated from the samples, and the V3-V4 regions were amplified. The sequencing libraries were generated and sequenced on an Illumina NovaSeq 6000 platform.

Results

Firmicutes, Actinobacteria and Bacteroidota were the most common phyla in all four groups, whereas OC presented the highest abundance of Firmicutes and the lowest abundance of Bacteroidota. At the genus level, Lactobacillus in the OC group was significantly greater than that in the HW group, and Atopobium in the UM group was significantly lower than that in the HW group. The abundance of Gardnerella was greater in the UM group than in the EP group, and the abundance of Streptococcus was greater in the EP group. The richness and evenness of the microbiome were generally consistent among the HW, EP, UM, and OC groups. Principal component analysis (PCA), principal coordinate analysis (PCoA) and nonmetric multidimensional scaling (NMDS) revealed no distinct separation trends among the four groups. According to ANOSIM, there was no significant difference in community structure among the four groups.

Conclusions

A nonsignificant result was obtained from the microbiome diversity comparison among the different groups. However, we demonstrated that the OC group had a greater abundance of Lactobacillus and that the UM group had a lower abundance of Atopobium, which might contribute to the occurrence of diseases, providing new clues for preventive measures.

GLI1-Rearranged Enteric Tumors: Updates on Clinicopathologic and Molecular Genetics Features

Recent advances in molecular genetics, particularly in identifying and characterizing genetic abnormalities within mesenchymal neoplasms, have led to a more comprehensive and evolving classification system. Modern technological developments in cytogenetics and next-generation sequencing have enabled the analysis of small clinical samples, expanded our understanding of tumor biology, and improved the diagnostic, prognostic, and predictive precision by identifying targeted genetic alterations, confirming the presence of fusion transcripts, and/or revealing the overexpression of specific genes and their targets. In this review, we focus specifically on the GLI1-rearranged enteric tumor, a recent clinicopathological entity that has emerged within the expanding classification of mesenchymal tumors. Herein, we aim to explore the histopathological features, molecular genetic characteristics, and clinical outcomes in these tumors. Due to their rarity and the extensive overlapping in their histopathological and molecular features with other neoplasms, continued research and systematic documentation of GLI1-rearranged enteric tumors is necessary to better understand their biological behavior, develop more accurate prognostic indicators, and establish optimal treatment strategies.

The feasibility of high-resolution organ-axial T2-weighted MRI when combined with federation of gynecology and obstetrics (FIGO) classification of uterine fibroid patients

PURPOSE

Correctly classifying uterine fibroids is essential for treatment planning. The objective of this study was to assess the accuracy and reliability of the FIGO classification system in categorizing uterine fibroids via organ-axial T2WI and to further investigate the factors associated with uterine compression.

METHODS

A total of 130 patients with ultrasound-confirmed fibroids were prospectively enrolled between March 2023 and May 2024. These patients underwent MR examinations, including body-axial T2W (sagittal and axial) and organ-axial T2W (high resolution with oblique coronal and double oblique axial). For postprocessing, the interobserver agreements between two radiologists and the interagreements between two MR examinations and operational descriptions were evaluated via kappa statistics. The accuracy of axial and organ-axial T2W assessments in the FIGO classification of uterine fibroids was compared when surgical outcomes were used as the gold standard. The Kruskal‒Wallis test was used to compare the differences in cavity deformation across various FIGO classifications. Spearman's rank correlation test was used to analyze the correlation between the FIGO classification and the parameters of uterine cavity deformation.

RESULTS

In total, 170 fibroids from 130 patients were included. Compared with body-axial T2WI, organ-axial T2WI showed better interobserver agreement and greater interagreements with operational descriptions, with kappa values of 0.877 (P = 0.04) and 0.932 (P = 0.037), respectively. The accuracy of the organ-axial T2WI assessment in determining the FIGO classification of uterine fibroids was greater than that of the body-axial T2WI assessment, with an accuracy of 92.9% (P < 0.01). Thirty-two (38.1%) fibroids showed cavity deformation according to organ-axial T2WI, including fibroids with FIGO types 0-7 and 2-5. Among these factors, the size of the fibroids (S), base width (B), depth of compression (D), D/B, D/S, and compression angle (A) significantly differed among the different FIGO types of fibroids (P < 0.05). Compression angle exhibited a linear correlation with the FIGO type (P < 0.001).

CONCLUSION

Compared with body-axial T2WI, organ-axial T2WI provides greater accuracy on the basis of the FIGO classification, which is more consistent with surgical outcomes. Given the excellent reliability and accuracy of the preoperative FIGO classification, organ-axial T2WI can contribute to treatment planning.

Comparative efficacy of uterine artery embolization versus laparoscopic myomectomy in treating uterine fibroids: a propensity score matched analysis

OBJECTIVE

The aim of this study was to comparatively analyze the therapeutic effects of uterine artery embolization (UAE) and laparoscopic myomectomy (LM) on uterine fibroids to determine which treatment method is more beneficial for patients.

MATERIALS AND METHODS

A retrospective study was conducted on 396 patients who underwent UAE (n = 153) or LM (n = 243) treatment from April 2010 to September 2019. After 1:1 propensity score matching (PSM), a comparative analysis was conducted on surgical trauma magnitude, postoperative recovery time, improvement in associated symptoms and quality of life, surgical adverse events, recurrence rates, and further interventions.

RESULTS

In PSM, 66 pairs (132 patients) were successfully matched. Both treatments significantly alleviated symptoms and enhanced quality of life. Compared to the LM group, the UAE group had less intraoperative bleeding (P < 0.001), a lower rate of hemoglobin decrease (P < 0.001), shorter operation, postoperative, and overall hospital stays (P < 0.001), and a lower postoperative recurrence rate (P < 0.05), all statistically significant. Moreover, the UAE group showed notable advantages in postoperative activities (P < 0.05). However, UAE patients faced higher hospitalization costs (P < 0.001). Adverse event rates (7.6% vs. 9.1%) and postoperative reintervention rates (7.6% vs. 7.6%) were relatively low and not significantly different between groups (P > 0.05).

CONCLUSION

Both UAE and LM can significantly improve patient symptoms and enhance their quality of life, and both treatment methods have low rates of adverse events and reinterventions. Compared to LM, UAE treatment for uterine fibroids presents advantages such as less trauma, faster recovery, and lower recurrence rate, but has higher treatment costs.

Targeting Bromodomain-Containing Protein 9 in Human Uterine Fibroid Cells

Bromodomain (BRD)-containing proteins are evolutionarily conserved protein-protein interaction modules involved in many biological processes. BRDs selectively recognize and bind to acetylated lysine residues, particularly in histones, and thereby have a crucial role in the regulation of gene expression. BRD protein dysfunction has been linked to many diseases, including tumorigenesis. Previously, we reported the critical role of BRD-containing protein 9 (BRD9) in the pathogenesis of UFs. The present study aimed to extend our previous finding and further understand the role of the BRD9 in UFs. Our studies demonstrated that targeted inhibition of BRD9 with its potent inhibitor TP-472 inhibited the pathogenesis of UF through increased apoptosis and proliferation arrest and decreased extracellular matrix deposition in UF cells. High-throughput transcriptomic analysis further and extensively demonstrated that targeted inhibition of BRD9 by TP-472 impacted the biological pathways, including cell cycle progression, inflammatory response, E2F targets, ECM deposition, and m6A reprogramming. Compared with the previous study, we identified common enriched pathways induced by two BRD9 inhibitors, I-BRD9 and TP-472. Taken together, our studies further revealed the critical role of BRD9 in UF cells. We characterized the link between BRD9 and other vital pathways, as well as the connection between epigenetic and epitranscriptome involved in UF progression. Targeted inhibition of BRD proteins might provide a non-hormonal treatment strategy for this most common benign tumor in women of reproductive age.

Clinical and molecular risk factors for repeat interventions due to symptomatic uterine leiomyomas

BACKGROUND

Repeat leiomyoma occurrence or even reintervention is common after myomectomy. Little is known about the factors related to repeat interventions.

OBJECTIVE

This study aimed to determine the frequency of leiomyoma-related reintervention after an initial laparoscopic or abdominal myomectomy and to analyze both clinical and molecular risk factors for reinterventions. Another objective was to define the frequency of clonally related tumors from repeat operations.

STUDY DESIGN

This retrospective cohort study included 234 women who had undergone laparoscopic or abdominal myomectomy in 2009 to 2014. Information on repeat leiomyoma-related interventions as well as on other clinical factors was collected from medical records after a median follow-up time of 11.4 years (range 7.9-13.8 years) after the index procedure. The effect of clinical risk factors on the risk of reintervention was analyzed by the Kaplan-Meier estimator and the Cox proportional hazards model. For molecular analyses, we examined the mutation profiles of 133 formalin-fixed paraffin-embedded leiomyoma samples from 33 patients with repeat operations. We screened the tumors for the 3 primary leiomyoma driver alterations-mediator complex subunit 12 mutations, high mobility group AT-hook 2 overexpression, and fumarate hydratase-deficiency-utilizing Sanger sequencing and immunohistochemistry. To further assess the clonal relationship of the tumors, we executed whole-exome sequencing for 52 leiomyomas from 21 patients who exhibited the same driver alteration in tumors obtained from multiple procedures.

RESULTS

Reintervention rate at 11.4 years after myomectomy was 20% (46/234). Number of leiomyomas removed at the index myomectomy was a risk factor (hazard ratio 1.21; 95% confidence interval 1.09-1.34). Age at index myomectomy (hazard ratio 0.94; 95% confidence interval 0.89-0.99) and postoperative parity (hazard ratio 0.23; 95% confidence interval 0.09-0.60) were protective factors. Molecular characterization of tumors from index and nonindex operations confirmed a clonal relationship of the tumors in 3/33 (9%) patients. None of the leiomyomas harboring a mediator complex subunit 12 mutation-the most common leiomyoma driver-were confirmed clonally related. Fumarate hydratase-deficiency was detected in repeat leiomyomas from 3/33 (9%) patients. All these patients harbored a germline fumarate hydratase mutation, which is distinctive for the hereditary leiomyomatosis and renal cell cancer syndrome. Finally, we identified 3 (3/33; 9%) patients with 2 tumors each displaying somatic mutations in a recently identified novel leiomyoma driver gene, YEATS domain-containing protein 4. All YEATS domain-containing protein 4 mutations were different and thus the tumors were not clonally related.

CONCLUSION

Our study shows that reintervention is common after surgical myomectomy. Uterine leiomyomas typically develop independently, but some share a clonal origin. Repeat leiomyoma occurrence may be due to genetic predisposition, such as a germline fumarate hydratase mutation. Distinct somatic YEATS domain-containing protein 4 mutations identified in multiple leiomyomas from the same patient indicate a possible role for YEATS domain-containing protein 4 in repeat leiomyomas.

Hair Straightener Use in Relation to Prevalent and Incident Fibroids in the Sister Study with a Focus on Black Women

BACKGROUND

Uterine fibroids disproportionately affect Black women, and exposure to chemicals from hair relaxers or straighteners ("straighteners") may contribute to fibroid development.

OBJECTIVES

We examined the association between straightener use and prevalent young-onset uterine fibroids (diagnosed before age 36 y), as well as incident fibroids (diagnosed age 36-60 y), with a focus on Black women. We also examined differences in associations across birth cohorts as proxies for formulation changes.

METHODS

Data from 4,162 Black women in the Sister Study, a prospective cohort of women 35-74 y of age (enrolled 2003-2009), were analyzed. We used logistic regression to estimate odds ratios (ORs) for the association of straightener use at 10-13 y of age and self-reported young-onset fibroids. We used Cox regression to assess hazard ratios (HRs) for straightener use (age 10-13 y and in 12 months before enrollment) and incident fibroids among 779 premenopausal Black women. Similar analyses were conducted in 40,782 non-Hispanic White women.

RESULTS

Over 70% of Black women used straighteners. In comparison with no use, any [OR = 1.15 ; 95% confidence interval (CI): 0.96, 1.36] and frequent use (OR = 1.18 ; 95% CI: 0.99, 1.42) of straighteners at 10-13 y of age were associated with young-onset fibroids. This association was most apparent among those born between 1928 and 1945 (OR = 1.78 ; 95% CI: 1.15, 2.74) and 1965-1974 (OR = 1.64 ; 95% CI: 0.82, 3.29). Fibroid incidence from 36 to 60 y of age was modestly associated with use of straighteners at 10-13 y of age [hazard ratio ( HR ) = 1.14 ; 95% CI: 0.81, 1.63] and in the 12 months prior to enrollment (HR = 1.32 ; 95% CI: 0.88, 2.00). Among non-Hispanic White women, straightener use at 10-13 y of age was similarly associated with young-onset fibroids (OR = 1.23 ; 95% CI: 1.03, 1.47) despite lower use (≤ 5 % ) of straighteners. Sensitivity analyses indicated a potential for bias due to fibroid misclassification, with an overestimation of the effect likely if nulliparous women or women from households with lower education reported their fibroid status less accurately.

DISCUSSION

Hair straightener use may be positively associated with fibroid risk. https://doi.org/10.1289/EHP14493.

Clinico-radio-histopathological Correlation of Leiomyoma Variant, STUMP, and Sarcoma: A Retrospective Study

Objectives

We sought to compare the epidemiological and clinical features of variant leiomyoma, smooth muscle tumors of uncertain malignant potential (STUMP), and sarcoma to classical leiomyoma and assess the radio-histological correlation.

Methods

This retrospective, observational study was conducted in Royal Hospital, Muscat, Oman. We included all patients who underwent surgical treatment for uterine fibroids from 1 January 2011 to 31 December 2016. Data was retrospectively collected from electronic patient records, pictures archiving system, and histopathology reports, and analyzed using SPSS version 29 and MedCalc Statistical Software.

Results

Out of the 14269 patients who attended the gynecology outpatient department, 19.5% were clinically diagnosed with uterine fibroids. Surgical procedures were performed in 545 (19.6%) women. Diagnosis from histopathology reports was classical leiomyoma in 508 (93.2%) cases, variant leiomyoma in 35 (6.4%), and sarcomas in two (0.4%); there were no cases of STUMP. Magnetic resonance imaging (MRI) correctly identified 125 (89.9%) cases of classical leiomyoma and 2/11 (18.2%) cases of variants. The sensitivity and specificity of MRI to predict non-classical varieties was 22.22% and 88.65%, respectively. MRI had a strong negative predictive value (94.7%) for leiomyoma variants. The area under the curve for classical and variant leiomyoma was 0.63 (0.55-0.71) and 0.55 (0.47-0.64). The accuracy of MRI in predicting classical leiomyoma was 86.00 (79.40-91.12) and 84.67 (77.87-90.03) the non-classical varieties.

Conclusions

Epidemiological and clinical features were not helpful in distinguishing between classical leiomyoma and non-classical varieties. MRI had weak discriminatory power to distinguish between classical and non-classical varieties.

In Vitro Effect of Estrogen and Progesterone on Cytogenetic Profile of Uterine Leiomyomas

In the present study, we aimed to investigate intratumoral karyotype diversity as well as the estrogen/progesterone effect on the cytogenetic profile of uterine leiomyomas (ULs). A total of 15 UL samples obtained from 15 patients were cultured in the media supplemented with estrogen and/or progesterone and without adding hormones. Conventional cytogenetic analysis of culture samples revealed clonal chromosomal abnormalities in 11 out of 15 ULs. Cytogenetic findings were presented by simple and complex chromosomal rearrangements (64% and 36% of cases, respectively) verified through FISH and aCGH. In most ULs with complex chromosomal rearrangements, the breakpoints did not feature clusterization on a single chromosome but were evenly distributed across rearranged chromosomes. The number of breakpoints showed a strong positive correlation with the number of rearranged chromosomes. Moreover, both abovementioned parameters were in a linear dependency from the number of karyotypically different clones per UL. This suggests that complex chromosomal rearrangements in ULs predominantly originate through sequential events rather than one hit. The results of UL cytogenetic analysis depended on the presence of estrogen and/or progesterone in the culture medium. The greatest variety of cytogenetically different cell clones was detected in the samples cultured without hormone supplementation. Their counterparts cultured with progesterone supplementation showed a sharp decrease in clone number, whereas such a decrease induced by estrogen or estrogen-progesterone supplementation was insignificant. These findings suggest that estrogen-progesterone balance is crucial for forming a UL cytogenetic profile, which, in turn, may underlie the unique response of the every karyotypically abnormal UL to medications.

The Burden of Pain Symptoms in Individuals with Uterine Fibroids-Results from a Prospective Observational Study in the USA

Purpose

To characterize the burden of uterine fibroids (UF) in individuals experiencing heavy menstrual bleeding (HMB) and moderate-to-severe UF-associated pain in terms of symptoms experienced, impact on work and activities, and pain medication use both on menstrual and non-menstrual days.

Patients and Methods

This prospective, real-world, observational study enrolled 350 participants in the USA with a self-reported UF diagnosis, HMB, and moderate-to-severe pain due to UF. Data collection took place from February 9 to July 19, 2021. Over 4 months, participants used an online platform to self-report daily menstrual status, bleeding intensity, UF-associated pain severity, and pain medication use, and to complete weekly work and productivity questionnaires. Results were analyzed descriptively and are reported for the overall population, by pain medication subgroups-defined based on the most potent medication taken-and menstrual versus non-menstrual days/weeks.

Results

The analysis population consisted of 307 participants with ≤5 consecutive missing days of daily survey responses or ≥75% completion rate of the daily surveys. Mean age of participants (standard deviation; SD) was 37.2 (6.3) years. At baseline, 54.1% of participants reported not currently taking medication for treatment of HMB. Over the study period, mean UF-associated pain scores (SD; scale range 0-10) were higher on menstrual days (3.5 [2.7]) than non-menstrual days (1.0 [1.8]), and this was consistent across medication use subgroups. Pain medications were used more frequently on menstrual days than non-menstrual days (22.9% versus 3.7% days of pain medication use, respectively). Participants reported 31.5% work impairment on menstrual weeks versus a 12.7% work impairment on non-menstrual weeks.

Conclusion

In this study, UF-associated pain symptoms coincided with a reduction in individuals' ability to take part in both work and non-work activities and an increase in pain medication use, particularly during menstrual weeks. These results highlight the need for improved diagnosis and pain management strategies in UF.

Small bowel obstruction secondary to uterine fibroids: a case presentation

Small bowel obstruction (SBO) is a serious condition with distinct symptoms such as constipation, vomiting, and abdominal distension. It is commonly caused by well-recognised factors. Recent advancements in imaging techniques and minimally invasive procedures have significantly improved our ability to accurately select patients for surgical intervention and promptly identify common SBO causes. Nonetheless, it is crucial to recognise that diagnosing rare SBO causes remains a challenge. We present a rare case of mechanical bowel obstruction caused by massive uterine fibroids in a 44-year-old woman. Large uterine fibroids can cause mechanical small intestine obstruction, although this is not a common cause. Diagnostic imaging, particularly computed tomography, plays a crucial role in diagnosing and determining appropriate management plans. Accurate monitoring and imaging can lead to improved patient outcomes by avoiding unnecessary surgical intervention and reducing morbidity and mortality rates. Treatment options include both medical and surgical methods. Both approaches have proven effective, with surgical procedures being the last resort if medical treatments are unsuccessful. The accuracy and efficacy of these surgical methods have shown promising results and significant prognostic benefits. It is critical to identify and report rare causes of bowel obstruction to improve future recognition and enhance patient outcomes.

68 Ga-FAPI PET/CT Visualized Benign Metastasizing Leiomyoma With Bone Invasion

ABSTRACT

Benign metastasizing leiomyoma (BML) is a rare disease associated with pelvic leiomyoma. We report 18 F-FDG and 68 Ga-FAPI PET/CT findings in a 51-year-old woman with multiple BMLs. The mass in the abdominopelvic cavity and other metastatic lesions showed highly increased 68 Ga-FAPI uptake, whereas uptake of 18 F-FDG in those lesions was low. Our report demonstrates that 68 Ga-FAPI PET/CT showed a different result in detecting BML to 18 F-FDG PET/CT, and 68 Ga-FAPI PET/CT may be a promising method for whole-body evaluate metastases.

Mechanism of Endometrial Receptivity Affected by Fibroids

Fibroids are the most common benign tumors of the female reproductive system. Most patients with fibroids are asymptomatic, but the presence of fibroids can still cause some abnormal clinical symptoms, such as increased menstrual volume, abnormal uterine bleeding, pelvic pain, urinary tract and gastrointestinal tract compression symptoms, etc. The impact of fibroids on pregnancy is worth discussing. At present, it is believed that submucosal myoma and intramural myoma affecting uterine cavity shape affect the pregnancy outcome of patients, while the impact of type III intramural myoma on pregnancy is still controversial. A number of studies have found that in addition to direct contact with the endometrial compression, uterine myoma also affects the endometrial flexibility through other ways. In this review, we summarized the effects of fibroids on endometrial receptivity and discussed in depth the mechanisms of such effects, including secretion of cytokines, changes in endometrial blood flow and angiogenesis, effects on endometrial peristalsis and mechanical stress conduction, changes in uterine microecological environment, and abnormal signal transduction pathways. Understanding the mechanism of endometrial receptivity affected by fibroids is significant for exploring the treatment of fibroids, improving the pregnancy outcome of patients with fibroids and increasing the clinical pregnancy rate.

Efficacy and safety of different doses of mifepristone in the treatment of uterine fibroids: A meta-analysis

OBJECTIVE

To systematically assess the safety and effectiveness of mifepristone at doses of 2.5 mg, 5 mg, 10 mg, 25 mg, and 50 mg in the treatment of uterine fibroids.

METHODS

The protocol is registered with INPLASY (registration number is INPLASY202460075). Computer retrieval PubMed, the Cochrane Library, Embase database related (mifepristone group) compared to placebo and mifepristone or conventional treatment (control group) in the treatment of uterine fibroids randomized controlled trial (RCT), retrieve the time limit for a Library to in October 2023, Refer to the Cochrane faced the quality evaluation of the literature of included in the 6.0 and uses the RevMan 5.4.1 software Meta-analysis and sensitivity analysis.

RESULTS

There were 18 studies with a total of 2066 patients as participants. A meta-analysis found that the patients in the mifepristone group had lower uterine volume or uterine fibroid volume than the control group, with a statistically significant difference. Mifepristone treatment for 3 months uterine volume smaller is better than 6 months the difference is statistically significant. Compared with the control group, mifepristone can improve pelvic pain, pelvic pressure, bladder pressure, urinary symptoms, lower back pain, dyspareunia, rectal pain, menorrhagia, hypermenorrhea, and other clinical symptoms. The Mifepristone group had hot flashes, endometrium thickness increases, the incidence of hepatic transaminases associated is significantly higher than the control group, the patients in the 10 mg/d mifepristone group had endometrial thickness that was greater than those in the 5 mg/d mifepristone group.

CONCLUSIONS

Mifepristone reduces fibroid volume and improves clinical symptoms, and 5 mg/day of mifepristone for three months may be the optimal clinical regimen.

Ultrasound-guided microwave, radiofrequency, and high intensity focused ultrasound (HIFU) ablation in treating uterine leiomyoma: A systemic review and meta-analysis of retrospective studies

To retrospectively evaluate the efficacy and safety of ultrasound-guided microwave (MWA), radiofrequency (RF), and high-intensity focused ultrasound (HIFU) ablation in the treatment of uterine leiomyoma and to provide a suggestion for the selection of clinical treatment of uterine leiomyoma. The retrospective cohort studies on the efficacy of high-intensity focused ultrasound in treating uterine leiomyoma was collected through a literature search in Pubmed, Embase, Cochrane library, Scopus, and Web of Science, and selected according to the specified inclusion criteria and exclusion criteria. Evaluate the study quality, extract relevant data, and RevMan 5.4.1 was used to conduct this meta-analysis. Compared with HIFU therapy, the complete or partial ablation rate and recurrence rate of uterine leiomyoma treated with RFA/MWA were statistically different (P < 0.05). Compared with RF, the overall efficacy of HIFU in treating uterine leiomyoma was not as good as that of RF. There was no significant difference between the RFA therapy and the MWA. HIFU still has mild and short-term complications, such as abdominal pain, bloody vaginal discharge, sacral pain, and fever. Although myomectomy is usually the first choice for uterine preservation, RFA/MWA and HIFU have also been shown to relieve clinical symptoms significantly, shorten treatment time, reduce complications, and improve prognosis.

HMGA2 overexpression induces plasticity in myometrial cells and a transcriptomic profile more similar to that of uterine fibroids

OBJECTIVE

To study the possible role for HMGA2 overexpression in differentiated myometrial cells and its potential to induce a stem cell-like or dedifferentiating phenotype and drive fibroid development.

DESIGN

Myometrial cells were immortalized and transduced with an HMGA2 lentivirus to produce HMGA2hi cells. In vitro stem cell assays were conducted, and ribonucleic acid from HMGA2hi and control cells as well as fibroid-free myometrial and HMGA2 fibroid (HMGA2F) tissues were submitted for ribonucleic acid sequencing.

SETTING

University research laboratory.

PATIENT(S)

Women who underwent hysterectomy for symptomatic uterine fibroids or other gynecological conditions.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

In vitro stem cell-like properties from myometrial cell lines. Ribonucleic acid sequencing and collagen production of HMGA2-overexpressing primary leiomyoma tissue and cell lines.

RESULT(S)

HMGA2hi cells had enhanced self-renewal capacity, decreased proliferation, and a greater ability to differentiate into other mesenchymal cell types. HMGA2hi cells exhibited a stem cell-like signature and shared transcriptomic similarities with HMGA2F. Moreover, dysregulated extracellular matrix pathways were observed in both HMGA2hi cells and HMGA2F.

CONCLUSION(S)

Our findings show that HMGA2 overexpression may drive myometrial cells to dedifferentiate into a more plastic phenotype and provide evidence for an alternative mechanism for fibroid etiology, suggesting that fibroids arise not only from a mutated stem cell but also from a mutated differentiated myometrial cell.