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Wang Y, Zhao Y, Shi C, Li J, Huang X. Development and Validation of a Nomogram to Predict the Risk of Special Uterine Leiomyoma Pathological Types or Leiomyosarcoma in Postmenopausal Women: A Retrospective Study. Risk Manag Healthc Policy 2024; 17:1669-1685. [PMID: 38919406 PMCID: PMC11198023 DOI: 10.2147/rmhp.s461773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
Purpose The aim of this study was to investigate the risk factors of postmenopausal special uterine leiomyoma pathological types or leiomyosarcoma and to develop a nomogram for clinical risk assessment, ultimately to reduce unnecessary surgical interventions and corresponding economic expenses. Methods A total of 707 patients with complete information were enrolled from 1 August 2012 to 1 August 2022. Univariate and multivariate logistic regression models were used to analyse the association between variables and special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients. A nomogram for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients was developed and validated by bootstrap resampling. The calibration curve was used to assess the accuracy of the model and receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were compared with the clinical experience model. Results The increasing trend after menopause, the diameter of the largest uterine fibroid, serum carcinoembryonic antigen 125 concentration, Serum neutrophil to lymphocyte ratio, and Serum phosphorus ion concentration were independent risk factors for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients. We developed a user-friendly nomogram which showed good diagnostic performance (AUC=0.724). The model was consistent and the calibration curve of our cohort was close to the ideal diagonal line. DCA indicated that the model has potential value for clinical application. Furthermore, our model was superior to the previous clinical experience model in terms of ROC and DCA. Conclusion We have developed a prediction nomogram for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients. This nomogram could serve as an important warning signal and evaluation method for special uterine leiomyoma pathological types or leiomyosarcoma in postmenopausal patients.
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Affiliation(s)
- Yaping Wang
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
| | - Yiyi Zhao
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
| | - Chaolu Shi
- Cixi maternity&health Care Hospital, Department Obstet & Gynecol Ningbo, Ningbo, Zhejiang, People’s Republic of China
| | - Juanqing Li
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiufeng Huang
- Zhejiang University, Womens Hospital, Sch Med, Department Obstet & Gynecol, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
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Tian Y, Bai B, Wang L, Zhou Z, Tang J. Contributing factors related to abnormal uterine bleeding in perimenopausal women: a case-control study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:52. [PMID: 38637861 PMCID: PMC11025148 DOI: 10.1186/s41043-024-00540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
Abnormal uterine bleeding (AUB) during the menopausal transition results in reproductive endocrine disorders and both physiological and pathological changes, substantially impacting women's health. This study aimed to investigate the factors influencing AUB in perimenopausal women. Between April 2021 and June 2022, 120 perimenopausal women with AUB in the menopausal transition, diagnosed and treated at the Gynaecology Department of Kunming Tongren Hospital, were included in the case group. Concurrently, women undergoing routine health examinations at the same hospital were randomly selected as the control group. Univariate and multivariate logistic regression analyses identified factors related to AUB. The univariate analysis revealed significant associations (P < 0.05) between AUB and several factors, including age, body mass index (BMI), age at menarche, gravidity, and intrauterine device (IUD) placement in perimenopausal women. The multivariate regression analysis indicated that the independent risk factors for AUB include benign endometrial lesions (odds ratio [OR] 5.243, 95% confidence interval [CI] 3.082-9.458, P < 0.001), endometrial thickness ≥ 10 mm (OR 1.573, 95% CI 0.984-3.287, P < 0.001), age ≥ 50 years (OR 2.045, 95% CI 1.035-4.762, P = 0.001), BMI ≥ 25 kg/m2 (OR 2.436, 95% CI 1.43-4.86, P = 0.002), and IUD placement (OR 2.458, 95% CI 1.253-4.406, P < 0.001). Abnormal uterine bleeding during the menopausal transition is associated with several factors, including age, BMI, and IUD placement, highlighting the importance of early screening for these risk factors in the diagnosis and treatment of AUB.
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Affiliation(s)
- Yuan Tian
- Department of Obstetrics and Gynecology, Clinical Skill Experiment Center of Haiyuan College, Kunming Medical University, Kunming, China
| | - Bin Bai
- Department of Critical Medicine, The Third People's Hospital of Kunming, Kunming, China
| | - Li Wang
- Department of Gynaecology, Kunming Tongren Hospital, Kunming, China
| | - Zongchang Zhou
- Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Shuifu People's Hospital, 150 Meters West of the Intersection of Shanghai Road and Ping'an Road, Gaotan New District, Shuifu City, Zhaotong City, 657800, Yunnan Province, China.
| | - Jiahui Tang
- Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Shuifu People's Hospital, 150 Meters West of the Intersection of Shanghai Road and Ping'an Road, Gaotan New District, Shuifu City, Zhaotong City, 657800, Yunnan Province, China.
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Tang Q, Chen X. Curative effect of motherwort combined with ethinylestradiol-cyproterone acetate on dysfunctional uterine bleeding. Expert Rev Hematol 2024; 17:165-171. [PMID: 38613836 DOI: 10.1080/17474086.2024.2343878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/13/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE This study aimed to investigate the curative effect of motherwort combined with ethinylestradiol-cyproterone acetate (EE/CPA) on dysfunctional uterine bleeding (DUB). METHODS Atotal of 68 patients with DUB were divided into a single medication group (treated with EE/CPA) and a combination medication group(treated with motherwort and EE/CPA). The clinical efficacy, uterine hemodynamic parameters, sex hormone levels, coagulation index levels, blood routine test levels, and adverse reactions of patients were evaluated. RESULTS After three months of treatment, total treatment response rate of the combination medication group was significantly higher than that of the single medication group. Decreased uterine volume, endometrial thickness and resistance index (RI), increased pulsatility index(PI), average flow rate, and uterine artery blood flow, as well asreduced follicle-stimulating hormone (FSH), luteinizing hormone (LH),estradiol (E2), progesterone (P), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen (FIB), thrombin time(TT), platelet count (PLT), red blood cell (RBC), and hemoglobin (Hb)levels were witnessed in patients of the two groups. In thecombination medication group, there exhibited reduced uterine volume, endometrial thickness and RI, elevated PI, average flow rate, and uterine artery blood flow, reduced P, E2, FSH, LH, aPTT, PT, FIB, TT,PLT, RBC, and Hb levels in comparison to the single medication group. CONCLUSION The combination of motherwort and EE/CPA is clinically effective in the treatment of DUB.
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Affiliation(s)
- Qiaoyun Tang
- Department of Gynaecology, Zhejiang Province WuYi County First People's Hospital, Jinhua, China
| | - Xueyuan Chen
- Department of Gynaecology and Obstetrics, Traditional Chinese Medical Hospital of Yongkang, Yongkang, China
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Yanli Y, Mei WT, Cong L. Analysis of Characteristics of Endometrial Carcinoma in Peri- and Postmenopausal Women with Abnormal Uterine Bleeding. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6509171. [PMID: 38435540 PMCID: PMC10908568 DOI: 10.1155/2024/6509171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/21/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
Objective To analyze the menstrual characteristics of endometrial carcinoma and investigate whether abnormal uterine bleeding in the perimenopausal period differs from postmenopausal bleeding. Methods We conducted a retrospective analysis of 928 cases of endometrial carcinoma in patients admitted from January 2016 to December 2022. We gathered fundamental clinical data and analyzed distinct clinical risk factors between the perimenopausal and postmenopausal groups. Furthermore, we computed the statistical variances in menarche, regular menstrual cycles, and the duration of abnormal uterine bleeding. Results Perimenopausal patients with endometrial carcinoma exhibit similar factors to postmenopausal patients, especially if they have a history of menstrual cycles lasting more than 30 years, hypertension, abnormal uterine bleeding for over 1 year, and a high risk of endometrial carcinoma. Early intervention for abnormal uterine bleeding during the perimenopausal stage can prevent up to 80% of women from developing endometrial carcinoma. Conclusion Perimenopause women experiencing abnormal uterine bleeding should be mindful of the risk of endometrial carcinoma, as this awareness can substantially decrease the occurrence of the disease.
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Affiliation(s)
- Ye Yanli
- Department of GynecologyNanan People's Hospital of Chongqing, Chongqing 400060, China
| | - Wang Tian Mei
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400060, China
| | - Li Cong
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400060, China
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Matsushima T, Suzuki S. Three cases of heavy menstrual bleeding with uniform thickening of the junctional zone endometrium. SAGE Open Med Case Rep 2023; 11:2050313X231182803. [PMID: 37359282 PMCID: PMC10288407 DOI: 10.1177/2050313x231182803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Heavy menstrual bleeding is a type of abnormal uterine bleeding. Abnormal uterine bleeding includes the poorly characterized "not otherwise classified" category. Here, we report three abnormal uterine bleeding-not otherwise classified cases with uniform thickening of the junctional zone endometrium. Case 1: A 33-year-old nullipara with heavy menstrual bleeding presented with severe anemia (hemoglobin: 4.7 g/dL) and an 8.4-mm junctional zone endometrium on magnetic resonance imaging. Her condition improved with iron and low-dose estradiol-progestins. Case 2: A 36-year-old nulligravida had heavy menstrual bleeding, anemia (hemoglobin: 9.5 g/dL), and a 9.4-mm junctional zone endometrium; her anemia improved with iron supplementation. Case 3: A 39-year-old multipara had heavy menstrual bleeding, anemia (hemoglobin: 9.6 g/dL), and a 12.3-mm junctional zone endometrium, and was managed with a levonorgestrel-releasing intrauterine system. Pelvic examination, transvaginal sonography, and uterine size on magnetic resonance imaging were normal in all cases. In those without uterine abnormalities, uniform thickening of the junctional zone endometrium (⩾8 mm) may trigger heavy menstrual bleeding; hence, magnetic resonance imaging may be warranted in abnormal uterine bleeding-not otherwise classified cases.
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Affiliation(s)
- Takashi Matsushima
- Department of Obstetrics and Gynecology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
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Nguyen PN, Nguyen VT. Additional value of Doppler ultrasound to B-mode ultrasound in assessing for uterine intracavitary pathologies among perimenopausal and postmenopausal bleeding women: a multicentre prospective observational study in Vietnam. J Ultrasound 2023; 26:459-469. [PMID: 36284050 PMCID: PMC10247932 DOI: 10.1007/s40477-022-00732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the role of Doppler ultrasonography when combined with B-mode ultrasonography in diagnosing uterine intracavitary pathologies (UIPs) in perimenopausal and postmenopausal bleeding women. METHODS This multicentre prospective observational study included 150 women aged > 40 years with abnormal uterine bleeding (AUB), who were hospitalised at Hospital X and Hospital Y between June 2016 and June 2019. All participants underwent transvaginal B-mode ultrasound and transvaginal Doppler ultrasound, and the results of sonography were compared to histopathological endpoint. RESULTS The morphological features, structure, margin, border line of the endometrial-mass lesion, intracavitary uterine fluid, and Doppler signal clearly differed between benign and malignant intracavitary pathologies (p < 0.0001). However, echogenicity had a limited value in differentiating among UIPs (p = 0.1). The sensitivity and specificity of the pedicle sign in diagnosing endometrial polyps were 50.0% and 97.6%; for the circular pattern in endometrial fibroids were 46.2% and 100.0%; for the multiple vessel pattern in endometrial cancer were 64.0% and 96.0%; and for the scattered vessel pattern in endometrial hyperplasia were 43.96% and 56.43%, respectively. The additional value of Doppler ultrasound was greater than that of separate B-mode ultrasound in assessing UIPs in our study. CONCLUSIONS B-mode ultrasound used in combination with Doppler as a noninvasive tool was significantly valuable in the diagnostic procedures for UIPs in perimenopausal and postmenopausal bleeding women. Doppler ultrasound and B-mode transvaginal ultrasound should be used together routinely for discrimination between malignant diseases and benign endometrial changes. Further studies are needed to better understand the benefits of combining Doppler ultrasound and B-mode ultrasound in routine sonographic practice.
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Affiliation(s)
- Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, 284 Cong Quynh, Pham Ngu Lao ward, District 1, Ho Chi Minh City, 730000 Vietnam
- Clinical Research Unit, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Van Tuan Nguyen
- Hue Medical College, Hue University, Thua Thien Hue, Vietnam
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El Sokkary HH, Farahat AAE. Studying Doppler Ultrasound Indices of Uterine Artery in Cases of Endometrial Cancer in Al Shatby University Hospital Patients. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2023. [DOI: 10.1007/s40944-022-00689-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Nguyen PN, Nguyen VT. Assessment of paraclinical characteristics in peri- and postmenopausal bleeding women: is there a correlation between hemoglobin levels and ultrasonic indices? J Taibah Univ Med Sci 2022; 18:488-498. [PMID: 36818167 PMCID: PMC9906015 DOI: 10.1016/j.jtumed.2022.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/04/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Vaginal bleeding is a common symptom of uterine intracavitary pathologies in perimenopausal and postmenopausal women, which leads to anemia. However, findings regarding the relationship between hemoglobin level and sonographic parameters remain limited. The aim of this study was (1) to investigate the histopathological findings of uterine intracavitary pathologies, hemoglobin concentrations and basic sonographic parameters, and (2) to evaluate their correlation among Vietnamese women with perimenopausal and postmenopausal bleeding. Methods This was a prospective study at Hue University Hospital and Hue Central Hospital from June 2016 to June 2019. The study enrolled 150 women older than 40 years with abnormal uterine bleeding. All patients underwent blood count testing and transvaginal ultrasound. Results Moderate to severe anemia was observed at a higher frequency in women with perimenopausal bleeding (58.1%) than postmenopausal bleeding (10.0%). The most common abnormality resulting in severe anemia was endometrial hyperplasia (70.8%), which was followed by endometrial cancer (4.2%). The uterine size, intrauterine mass, and endometrial thickness differed substantially between the benign and malignant groups. The study found significantly a weak negative correlation between hemoglobin concentration (g/L) and uterinelength, the anteroposterior diameter of uterine corpus in the overall study (r = -0.37, r = -0.32, respectively, P < 0.05); a moderate negativecorrelation between hemoglobin concentration and the largest diameter of intracavitary mass‑shaped lesion in the perimenopausal group (r = -0.4, P < 0.05). Conclusion Overall, histopathological results, hemoglobin concentration and basic sonographic parameters should be combined in evaluating intrauterine abnormalities in women with perimenopausal and postmenopausal bleeding. Ultrasonic indices of uterine size may be used to determine the prognosis of anemia in uterine intracavitary pathologies. However, further studies are needed to confirm these findings.
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Affiliation(s)
- Phuc N. Nguyen
- Department of High-risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Viet Nam
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Viet Nam
- Corresponding address: Department of High-risk Pregnancy, Tu Du Hospital, 284 Cong Quynh Street, Pham Ngu Lao ward, District 1, Ho Chi Minh city, Viet Nam.
| | - Van T. Nguyen
- Department of Obstetrics and Gynecology, Hue Medical College, Hue University, Thua Thien Hue, Viet Nam
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Nguyen PN, Nguyen VT. Evaluating Clinical Features in Intracavitary Uterine Pathologies among Vietnamese Women Presenting with Peri-and Postmenopausal Bleeding: A Bicentric Observational Descriptive Analysis. J Midlife Health 2022; 13:225-232. [PMID: 36950211 PMCID: PMC10025815 DOI: 10.4103/jmh.jmh_81_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 03/24/2023] Open
Abstract
Background Intracavitary uterine pathologies (IUPs) may be resulting in vaginal bleeding in perimenopausal and postmenopausal women. Especially, malignant disease needed to be investigated due to its adverse impact on the quality of mid-life women as well as the burden of health-care costs in low- and middle-income countries such as Vietnam. Objective Thereby, through this study, we aimed to assess the major clinical features of IUPs in women with perimenopausal and postmenopausal bleeding women. Materials and Methods This was a cross-sectional observational study at Hue University Hospital and Hue Central Hospital from June 2016 to June 2019. The study enrolled 150 women above 40 years old involving with intrauterine bleeding. Results The mean age of the study population was 51.51 ± 7.65. The most common symptom in perimenopausal women was menorrhagia, up to 62.2% of cases. In addition to intrauterine bleeding, there were 54.7% of cases had at least one other functional symptom, they were pale skin (35.9%), and lower abdominal pain (31.3). Endometrial hyperplasia (EH) was the most common pathology in both groups with perimenopausal and postmenopausal bleeding (PMB), respectively, 66.7% and 51.7%. In PMB group, endometrial cancer (EC) occupied approximately 38.3% following EH. Our study revealed age, menstrual characteristics, and diabetes in relation to malignant disease. Other factors seemed to be less associated with EC. Conclusions Menorrhagia was the most common type of abnormal uterine bleeding in perimenopausal women. Besides vaginal bleeding, others symptoms such as pale skin, pelvic pain, and fatigue were also common. Length day and blood loss before hospitalization in perimenopausal women were greater significantly than that in postmenopausal women. Age, menstrual characteristics, and diabetes increased the risk of EC in women with PMB.
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Affiliation(s)
- Phuc Nhon Nguyen
- Department of High-Risk Pregnancy and Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Van Tuan Nguyen
- Department of Obstetrics and Gynecology, Hue Medical College, Thua Thien Hue, Vietnam
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