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Hoffman SR, Smith JS, Funk MJ, Hudgens MG, Poole C, Nicholson WK, Baird DD, Harmon QE. Combined oral contraceptive utilization and uterine fibroid incidence: A prospective study in a cohort of African-American women. PLoS One 2024; 19:e0303823. [PMID: 38781223 PMCID: PMC11115284 DOI: 10.1371/journal.pone.0303823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Published associations between combined oral contraceptive use and uterine fibroid development have lacked prospective imaging with ultrasound to distinguish between incident and prevalent fibroids. The Study of Environment, Lifestyle, and Fibroids prospectively followed fibroid-free, African-American women (the group with the highest disease burden in the U.S.) to identify incident cases. We examined associations between combined oral contraceptive use and the 40-month cumulative risk of fibroids. History of hormonal contraceptive use was collected via telephone interview at enrollment. Fibroid identification was performed using transvaginal ultrasonography at enrollment, and at 20 and 40-months of follow-up. Inverse probability weights for exposures and censoring were used to construct weighted risk ratios (wRR) and weighted risk different (wRD) estimators which control for differences in fibroid risk factors between exposure groups. In addition, unweighted fully adjusted log-binomial regression models (aRR) were run for comparison. Of the 1,308 participants in the analysis sample, 70% had used combined oral contraceptives and 17% developed fibroids by 40 months. We observed an inverse association between ever use of combined oral contraceptives and cumulative fibroid incidence (wRR: 0.78; 95% Confidence Interval (CI): 0.60, 1.00; wRD: -0.05, 95% CI: -0.11, 0; aRR: 0.76, 95% CI: 0.60, 0.98). Fibroid incidence was greater in participants who started using combined oral contraceptives after age 17 years than among younger initiators, though the restriction to ever-users made this estimate less precise (wRR: 1.25; 95% CI: 0.89, 1.76; wRD: 0.04, 95% CI: -0.02, 0.10). No consistent patterns of fibroid incidence were seen among ever-users for duration of, or years since, last combined oral contraceptives use.
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Affiliation(s)
- Sarah R. Hoffman
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Michele Jonsson Funk
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Michael G. Hudgens
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Charles Poole
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Wanda K. Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- University of North Carolina Center for Women’s Health Research, Chapel Hill, North Carolina, United States of America
- Program on Women’s Endocrine and Reproductive Health, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- Center for Health Promotion and Disease Prevention, Chapel Hill, North Carolina, United States of America
| | - Donna D. Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Durham, Chapel Hill, North Carolina, United States of America
| | - Quaker E. Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Durham, Chapel Hill, North Carolina, United States of America
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Hanuman S, Pande G, Nune M. Current status and challenges in uterine myometrial tissue engineering. Bioengineered 2023; 14:2251847. [PMID: 37665570 PMCID: PMC10478746 DOI: 10.1080/21655979.2023.2251847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
The uterus undergoes significant modifications throughout pregnancy to support embryo development and fetal growth. However, conditions like fibroids, adenomyosis, cysts, and C-section scarring can cause myometrial damage. The importance of the uterus and the challenges associated with myometrial damage, and the need for alternative approaches are discussed in this review. The review also explores the recent studies in tissue engineering, which involve principles of combining cells, scaffolds, and signaling molecules to create functional uterine tissues. It focuses on two key approaches in uterine tissue engineering: scaffold technique using decellularized, natural, and synthetic polymer and 3D bioprinting. These techniques create supportive structures for cell growth and tissue formation. Current treatment options for myometrial damage have limitations, leading to the exploration of regenerative medicine and integrative therapies. The review emphasizes the potential benefits of tissue engineering, including more effective and less invasive treatment options for myometrial damage. The challenges of developing biocompatible materials and optimizing cell growth and differentiation are discussed. In conclusion, uterine tissue engineering holds promise for myometrial regeneration and the treatment of related conditions. This review highlights the scientific advancements in the field and underscores the potential of tissue engineering as a viable approach. By addressing the limitations of current treatments, tissue engineering offers new possibilities for improving reproductive health and restoring uterine functionality. Future research shall focus on overcoming challenges and refining tissue engineering strategies to advance the field and provide effective solutions for myometrial damage and associated disorders.
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Affiliation(s)
- Srividya Hanuman
- Manipal Institute of Regenerative Medicine, Bengaluru, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Gopal Pande
- Manipal Institute of Regenerative Medicine, Bengaluru, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Manasa Nune
- Manipal Institute of Regenerative Medicine, Bengaluru, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Musa B, Alswang JM, Di Ioia R, Grubic L, Naif A, Mbuguje EM, Vuong V, Newsome J, Shaygi B, Ramalingam V, Gaupp FML. Uterine artery embolization in Tanzania: a procedure with major public health implications. CVIR Endovasc 2023; 6:40. [PMID: 37548779 PMCID: PMC10406993 DOI: 10.1186/s42155-023-00384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment. METHODS From June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania's first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests. RESULTS During the study period, 92.1% (n = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% (n = 3/38) for adenomyosis. All (n = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) (p < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% (p = 0.109). CONCLUSIONS UAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region's leading cause of maternal mortality, postpartum hemorrhage.
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Affiliation(s)
- Balowa Musa
- Radiology and Imaging Department, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Jared Mark Alswang
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Rose Di Ioia
- Faculty of Medicine and Health Sciences, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1A3, Canada
| | - Lydia Grubic
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN, 46222, USA
| | - Azza Naif
- Department of Radiology and Imaging, Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Erick Michael Mbuguje
- Department of Radiology and Imaging, Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Victoria Vuong
- Department of Radiology, University of California San Diego Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Janice Newsome
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Behnam Shaygi
- Department of Radiology, London North West University Healthcare NHS Trust, A404 Watford Rd, Harrow, HA1 3UJ, UK
| | - Vijay Ramalingam
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Fabian Max Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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Mitro SD, Sundaram R, Chen Z, Peddada S, Buck Louis GM, Zhang C, Grewal J, Gleason JL, Sciscione AC, Grantz KL. Leiomyomata, neonatal anthropometry, and pregnancy outcomes in singleton pregnancies. Ann Epidemiol 2023; 80:43-52. [PMID: 36822279 PMCID: PMC10040437 DOI: 10.1016/j.annepidem.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the relationship of fibroids in pregnancy, preterm birth, and neonatal anthropometry. METHODS Pregnant women (n = 2578) in the National Institute of Child Health and Human Development Fetal Growth Studies-Singletons cohort had up to six ultrasounds across pregnancy. Sonographers recorded fibroid number and volume of the three largest fibroids. Trained personnel measured neonatal anthropometry. Linear and logistic regression compared neonatal anthropometry and pregnancy outcomes among pregnancies with versus without fibroids. Causal mediation analysis evaluated preterm birth as a mediator. RESULTS Average birthweight did not differ by fibroid status. However, compared with pregnancies without fibroids, neonates from pregnancies with single fibroids had 0.3- (95% confidence interval [CI], 0.0, 0.5) cm larger head circumferences; those with multiple fibroids had 0.3- (95% CI, 0.0, 0.6) cm larger arm circumferences; and those with small fibroid volume had 0.7- (95% CI, 0.3, 1.2) cm larger head, 0.4- (95% CI, 0.0, 0.8) cm larger arm, and 0.7- (95% CI, 0.1, 1.3) cm larger thigh circumferences. Presence versus absence of fibroids was associated with 1.73-2.65 times higher odds of preterm birth. Differences in preterm birth did not explain fibroid-anthropometry results. CONCLUSIONS We found no evidence that fibroids negatively impacted fetal growth; instead, fibroids were associated with increased head, arm, and thigh circumferences. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00912132.
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Affiliation(s)
- Susanna D Mitro
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Rajeshwari Sundaram
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Zhen Chen
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Shyamal Peddada
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Department of Obstetrics and Gynecology, National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Jagteshwar Grewal
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Jessica L Gleason
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | | | - Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
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Seidel V, Wernecke KD, Bellingkrodt AL, Armbrust R, David M. Sonographic Monitoring of Growth of Uterine Myomas in Untreated Women and Respective Influence Factors. Geburtshilfe Frauenheilkd 2023; 83:446-452. [PMID: 37034415 PMCID: PMC10076097 DOI: 10.1055/a-1996-2980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/01/2022] [Indexed: 04/11/2023] Open
Abstract
Research Question What are the growth patterns of uterine myomas in untreated premenopausal women? Which factors influence the growth rate of uterine myomas in premenopausal women? Method All premenopausal women who presented to the outpatient myoma consultation clinic between January 2005 and March 2022 at least twice were screened. Exclusion criteria were hormonal therapy, pregnancy, and postmenopausal status. Results A total of 189 patients were included in our study which focused on the respective largest uterine myoma of each woman. An ideal linear growth over time was assumed. Most myomas (82%) increased in size. The mean annual growth of these myomas was 68.42 cm 3 . The most important prognostic factor for growth was the initial size of the myoma. The absolute annual growth of myomas measuring > 50 cm 3 at first presentation was higher compared to smaller myomas (p < 0.001). The relative annual growth rate was highest for myomas measuring between 20 and 50 cm 3 at the initial presentation (p = 0.003). The relative annual growth rate in women older than 40 years was significantly lower than that in women below the age of 40 years (p = 0.003). Conclusion Overall, it is difficult to make an individual prognosis about the growth pattern of a uterine myoma in a specific patient. It should be noted especially in asymptomatic patients that spontaneous regression of myoma size can also occur in premenopausal women.
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Affiliation(s)
- Vera Seidel
- Obstetrics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Klaus Dieter Wernecke
- Institut für Biometrie und Klinische Epidemiologie, Charité Universitätsmedizin Berlin, Berlin, Germany
- SOSTANA GmbH, Berlin, Germany
| | | | - Robert Armbrust
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias David
- Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
- Correspondence/Korrespondenzadresse Prof. Matthias David Charité Campus Virchow-KlinikumKlinik für GynäkologieAugustenburger
Platz 113353 BerlinGermany
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Harmon QE, Patchel SA, Denslow S, LaPorte F, Cooper T, Wise LA, Wegienka G, Baird DD. Vitamin D and uterine fibroid growth, incidence, and loss: a prospective ultrasound study. Fertil Steril 2022; 118:1127-1136. [PMID: 36150919 PMCID: PMC9771933 DOI: 10.1016/j.fertnstert.2022.08.851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Fibroid treatments that have few side-effects and can preserve fertility are a clinical priority. We studied the association between serum vitamin D and uterine fibroid growth, incidence, and loss. DESIGN A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds, measure 25-hydroxyvitamin D (25(OH)D), and update covariates. SETTING Detroit, Michigan area. PATIENTS Self-identified African American or Black women aged 23-35 at enrollment without previous clinical diagnosis of fibroids. INTERVENTION(S) Serum 25(OH)D measured using immunoassay or liquid chromatography-tandem mass spectrometry. MAIN OUTCOME MEASURE(S) The primary outcomes were fibroid growth, as measured by change in log volume per 18 months, and fibroid incidence (first detection of fibroid in previously fibroid-free uterus). Adjusted growth estimates from linear mixed models were converted to estimated difference in volume for high vs. low 25(OH)D. Incidence differences were estimated as hazard ratios from age-specific Cox regression. A secondary outcome fibroid loss (reduction in fibroid number between visits), was modeled using Poisson regression. Covariates (reproductive and hormonal variables, demographics, body mass index, current smoking) and 25(OH)D were modeled as time-varying factors. RESULT(S) At enrollment among 1,610 participants with ≥1 follow-up ultrasound, mean age was 29.2 years, 73% had deficient vitamin D (<20ng/mL), and only 7% had sufficient vitamin D (≥30ng/mL). Serum 25(OH)D ≥20ng/mL compared with <20ng/mL was associated with an estimated 9.7% reduction in fibroid growth (95% confidence interval [CI]: -17.3%, -1.3%), similar to the minimally adjusted estimate -8.4% (95% CI: -16.4, 0.3). Serum 25(OH)D ≥30ng/mL compared with <30ng/mL was associated with an imprecise 22% reduction in incidence (adjusted hazard ratio=0.78; 95% CI: 0.47, 1.30), similar to the unadjusted estimate of 0.84 (95% CI: 0.51, 1.39). The >30ng/mL group also had a 32% increase in fibroid loss (adjusted risk ratio=1.32; 95% CI: 0.95, 1.83). CONCLUSION(S) Our data support the hypothesis that high concentrations of vitamin D decrease fibroid development but are limited by the few participants with serum 25(OH)D ≥30ng/mL. Interventional trials that raise and maintain 25(OH)D concentrations >30ng/mL and then prospectively monitor fibroid development are needed to further assess supplemental vitamin D efficacy and determine optimal treatment protocols.
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Affiliation(s)
- Quaker E Harmon
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina.
| | - Stacy A Patchel
- Public Health and Epidemiology Practice at Westat, Durham, North Carolina
| | - Sheri Denslow
- Social & Scientific Systems, Inc., a DLH Holdings company, Durham, North Carolina
| | - Frankie LaPorte
- Social & Scientific Systems, Inc., a DLH Holdings company, Durham, North Carolina
| | - Tracy Cooper
- Division of Ultrasound, Department of Diagnostic Radiology, Henry Ford Health, Detroit, Michigan
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
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Mitro SD, Peddada S, Chen Z, Buck Louis GM, Gleason JL, Zhang C, Grantz KL. Natural history of fibroids in pregnancy: National Institute of Child Health and Human Development Fetal Growth Studies - Singletons cohort. Fertil Steril 2022; 118:656-665. [PMID: 35981916 PMCID: PMC9529811 DOI: 10.1016/j.fertnstert.2022.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe the natural history of fibroids in pregnancy in a racially diverse cohort and explore whether fibroid changes were associated with participant characteristics. DESIGN Prospective cohort study. SETTING Twelve clinical sites. PATIENT(S) Pregnant women (n = 2774; 27% non-Hispanic White, 28% non-Hispanic Black, 29% Hispanic, 17% Asian/Pacific Islander) who had up to 6 obstetric ultrasounds in gestational weeks 10-41. INTERVENTION(S) Sonographers recorded fibroid number and volume of the 3 largest fibroids at each visit. Generalized linear mixed models estimated the trajectories of fibroid number and total volume (overall and stratified by total volume at first visualization: equivalent to a fibroid of <1 cm [small], 1 to <3 cm [medium], or ≥3 cm [large] in diameter). We tested the interactions between the trajectories and race/ethnicity, age (<26, 26-30, 31-34, and ≥35 years), body mass index (<25, 25-29.9, and ≥30 kg/m2), previous miscarriage, parity, and fetal sex, adjusted for total volume at first visualization. MAIN OUTCOME MEASURE(S) Average change in total fibroid volume during pregnancy. RESULT(S) Overall, 9.6% (266/2,774) of women had a visualized fibroid at any time during pregnancy, including 9% (67/745) of non-Hispanic White women, 14% (106/770) of non-Hispanic Black women, 6% (47/794) of Hispanic women, and 10% (46/465) of Asian or Pacific Islander women. The mean total fibroid volume decreased by 1.0% (95% confidence interval [CI], -1.9%, -0.2%) per week, with a variation in starting total volume. On average, the total volume increased by 2.0% (95% CI, -0.3%, 4.5%) per week among women with small volume; decreased by 0.5% (95% CI, -2.0%, 1.0%) per week among women with medium volume; and decreased by 2.2% (95% CI, -3.4%, -1.0%) per week among women with large volume at first visualization. The volume change also varied by race or ethnicity, parity, age, and miscarriage history. For example, non-Hispanic Black women's total fibroid volume decreased more than those of non-Hispanic White, Hispanic and Asian/Pacific Islander women (-2.6%, 0.1%, 0.5%, and 0.9% average change per week, respectively). The visualized fibroid number declined on an average by 1.2% per week (95% CI, -1.9%, -0.5%) without significant variation by demographic characteristics. CONCLUSION(S) The total fibroid volume declined on average throughout pregnancy. However, summarizing across all fibroids disguises substantial heterogeneity by starting total fibroid volume and maternal characteristics. The findings may be a useful reference for clinicians to anticipate how fibroids may change in obstetric patients. CLINICAL TRIAL REGISTRATION NUMBER NCT00912132.
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Affiliation(s)
- Susanna D Mitro
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Shyamal Peddada
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Zhen Chen
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | - Jessica L Gleason
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Cuilin Zhang
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Obstetrics and Gynecology, National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Katherine L Grantz
- Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
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Selter JH, Price TM, Harris BS. Fibroids in pregnancy: a growing or shrinking issue? Fertil Steril 2022; 118:666-667. [PMID: 36064663 DOI: 10.1016/j.fertnstert.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Jessica H Selter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Morrisville, North Carolina
| | - Thomas M Price
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Morrisville, North Carolina
| | - Benjamin S Harris
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Duke Fertility Center, Morrisville, North Carolina
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Depot Medroxyprogesterone Acetate Use and the Development and Progression of Uterine Leiomyoma. Obstet Gynecol 2022; 139:797-807. [PMID: 35576339 PMCID: PMC9015023 DOI: 10.1097/aog.0000000000004745] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Investigate the association between use of depot medroxyprogesterone acetate (DMPA) (an injectable progestin-only contraceptive) and leiomyoma development. METHODS We conducted a cohort study in the Detroit, Michigan, area that involved four clinic visits at 20-month intervals over 5 years (2010-2018) and used a standardized ultrasonography protocol to prospectively measure leiomyomas 0.5 cm or more in diameter. Participants were 1,693 self-identified Black women aged 23-35 years with no prior leiomyoma diagnosis and no hysterectomy. For this substudy, years since last use of DMPA was ascertained from questionnaire data at every visit. Leiomyoma incidence was defined as the first visit with an observed leiomyoma among women who were leiomyoma-free at enrollment. Depot medroxyprogesterone acetate associations were examined with Cox models. Leiomyoma growth was calculated as the change in log-volume for leiomyomas matched at successive visits and was modeled using linear mixed models accounting for clustered data. Leiomyoma loss, defined as a reduction in leiomyoma number in successive visits, was modeled using Poisson regression. All models used time-varying exposure and covariates. RESULTS Of participants with at least one follow-up visit (N=1,610), 42.9% had ever used DMPA. Participants exposed to DMPA within the previous 2 years experienced reduced leiomyoma development during the subsequent observation interval compared with never users, including lower leiomyoma incidence (5.2% vs 10.7%), adjusted hazard ratio 0.6 (95% CI 0.4-1.0), 42.0% lower leiomyoma growth (95% CI -51.4 to -30.7) and 60% greater leiomyoma loss (adjusted risk ratio 1.6, 95% CI 1.1-2.2). Excess leiomyoma loss was also seen for those who used DMPA 2-4 years before the visit compared with never users, 2.1-fold increase (95% CI 1.4-3.1). CONCLUSION Recent use of DMPA was associated with reduced leiomyoma development and increased leiomyoma loss. Such changes in early leiomyoma development in young women could delay symptom onset and reduce the need for invasive treatment.
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Manuel EC, Plowden TC, Valbuena FM, Bryce RL, Barick AA, Ramakrishnan A, Carnethon MR, Neff LM, Baird DD, Marsh EE. The Environment, Leiomyomas, Latinas, and Adiposity Study: rationale and design. Am J Obstet Gynecol 2022; 226:392.e1-392.e12. [PMID: 33974903 DOI: 10.1016/j.ajog.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Uterine leiomyomas, commonly known as fibroids, are benign tumors in postmenarchal females. By the age of 35 years, approximately 30% of females will have fibroids, and by the age of 50 years, the prevalence approaches 70% with some studies reporting >85% prevalence in African American females. Previous studies evaluating the prevalence of fibroids have largely relied on self-reported fibroid diagnoses, which could have falsely underestimated prevalence because many females with fibroids are asymptomatic. Despite known differences in fibroid prevalence by race, there are very limited data on fibroid prevalence by ethnicity. The Latino population is the largest ethnic minority in the United States, yet there is no large study that utilizes ultrasound to confirm the presence of fibroids in Latina/Latinx females. In addition, fibroids have been associated with obesity and with diabetes mellitus, but the data have been inconsistent and at times conflicting. OBJECTIVE The Environment, Leiomyomas, Latinas, and Adiposity Study was designed to quantify the prevalence of uterine fibroids among Latina/Latinx females and understand the relationships between obesity, glucose dysregulation, and fibroid prevalence and growth. This article presents the study's design and reports early enrollment data. STUDY DESIGN The Environment, Leiomyomas, Latinas, and Adiposity Study is a 5-year longitudinal cohort study based in Southeast Michigan with the goal of recruiting 600 Latina/Latinx females between the ages of 21 and 50 years. Given the recruitment goals, developing a respectful, transparent, and trusting relationship between the study investigators and the community was a major priority. Thus, a community-engaged research approach was utilized in the design of the Environment, Leiomyomas, Latinas, and Adiposity Study. A community advisory board containing community leaders, largely from the Latinx community, provided input and direction during the entirety of the Environment, Leiomyomas, Latinas, and Adiposity Study design and rollout process. A minimum of 3 visits (orientation and consent, baseline, follow-up) will be conducted for each participant, with baseline and follow-up visits approximately 18 to 30 months apart. At each visit, interviewer and self-administered surveys will assess sociodemographic factors, health behaviors, health history, and social determinants of health. In addition, participants undergo a pelvic ultrasound examination and biologic samples are collected. RESULTS Using community-engaged approaches, we have successfully enrolled 633 Latina/Latinx females. The mean participant age is 37.5±7.04 years. The mean body mass index is 30.0±6.54 kg/m2. First study visits have been initiated. CONCLUSION The objective of the Environment, Leiomyomas, Latinas, and Adiposity Study is to address the knowledge gap regarding uterine fibroids in the Latina/Latinx population. The Environment, Leiomyomas, Latinas, and Adiposity Study will generate ultrasound-confirmed evidence of the prevalence and growth patterns of uterine fibroids in this specific population while also examining the associations between obesity and laboratory-confirmed glucose dysregulation with uterine fibroid prevalence and growth patterns.
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Ghafarzadeh M, Shakarami A, Yari F, Marzban Rad Z. The role of anti-proliferative effects of atorvastatin on uterine fibroids: findings from a clinical study. Gynecol Endocrinol 2021; 37:721-724. [PMID: 33960277 DOI: 10.1080/09513590.2021.1922884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Uterine myomas/fibroids are one of the most common benign tumors of the reproductive system in women. Given pleiotropic effects of statins, the aim of this study is to evaluate the therapeutic effects of atorvastatin on uterine fibroids in women of reproductive age. MATERIALS AND METHODS This randomized clinical study included 90 women aged 35-45 years with uterine fibroids. The patients were randomly allocated into the intervention group (received one tablet, 20 mg of atorvastatin every day for three months) and placebo. Ultrasound was performed every month, and the change in the size of fibroids was recorded for each patient. At the end of the study, the data obtained were analyzed using SPSSv22 and a p value < .05 was considered statistically significant. RESULTS The mean age in the placebo and intervention group was 39.63 ± 36.3 and 40.35 ± 3.32 years, respectively. The number and location of the tumor was comparable for the two groups. We observed a statically significant reduction in fibroid size from the treatment initiation until completion of three months, (41.06 ± 6.68 mm3 vs 35.16 ± 6.67 mm3) p = .0001. However, the decrease in fibroid size from 1st month to the 3rd month was not statistically significant, p = .189 (36.71 ± 5.54 mm3 vs 35.16 ± 6.67 mm3). CONCLUSION This study shows that treatment with atorvastatin might positively reduce the size of fibroids. The decrease was only statistically significant during the first month. Further studies with a detailed analysis of the intervention's clinical impact are required to consider statins as a therapeutic tool.
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Affiliation(s)
- Masoumeh Ghafarzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Amir Shakarami
- Department of Cardiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Yari
- Department of Reproductive Health, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Marzban Rad
- Department of Obstetrics and Gynecology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
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12
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Hai N, Hou Q, Dong X, Guo R. Comparison between radiofrequency ablation combined with mifepristone and radiofrequency ablation for large uterine fibroids. Int J Hyperthermia 2021; 38:777-780. [PMID: 33980123 DOI: 10.1080/02656736.2021.1922763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of transvaginal ultrasound-guided (US-guided) radiofrequency ablation (RFA) combined with mifepristone for the treatment of large uterine fibroids. METHODS Between June 2016 and December 2018, a total of 30 patients with symptomatic uterine fibroids (≥5cm) who underwent transvaginal US-guided RFA combined with mifepristone were included in this retrospective study. A matching cohort of 30 patients underwent transvaginal US-guided RFA without mifepristone as controls. The technical efficacy, complications and mid-term treatment effectiveness were assessed and compared with the controls. RESULTS The mean volume of uterine fibroid was 168.3 ± 40.1 cm3. The mean ablation time was 23.5 ± 11.3 min in the combined treatment group, which was demonstrably less than that of the RFA group, which was 45.7 ± 6.8 min. The mean number of punctures was 2.2 ± 0.6 in the combined treatment group, which was significantly less than that of the RFA group. No major complications occurred. The mean percentages of regression of fibroid at 3 and 12 months after the course of the combined treatment were 73.3% and 90.1%, respectively, which were significantly more than those of the RFA group. Quality of life and symptom scores improved in both groups but to a greater extent in the combined treatment group. CONCLUSIONS US-guided RFA combined with mifepristone might be a simple, safe and effective alternative for the treatment of large uterine fibroids.
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Affiliation(s)
- Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, PR China.,Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Qingxiang Hou
- Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Xiangping Dong
- Department of Gynecology, the PLA Rocket Force General Hospital, Beijing, PR China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, PR China
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13
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Hai N, Hou Q, Guo R. Ultrasound-guided transvaginal radiofrequency ablation combined with levonorgestrel-releasing intrauterine system for symptomatic uterine adenomyosis treatment. Int J Hyperthermia 2021; 38:65-69. [PMID: 33472465 DOI: 10.1080/02656736.2021.1874063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of transvaginal ultrasound-guided radiofrequency ablation (RFA) combined with a levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of symptomatic uterine adenomyosis. METHODS Patients with symptomatic uterine adenomyosis treated with ultrasound-guided RFA in combined with an LNG-IUS from January 2013 to January 2016 and followed up for 3 years after treatment were selected. Assessment endpoints included the uterine volume reduction rate, dysmenorrheal score, symptom severity score and adverse events. RESULTS Among the 72 patients, 64 completed the 3-year follow-up evaluations after treatment. No LNG-IUS expulsion was reported. Dysmenorrhea and symptom severity scores statistically significantly declined after the combined treatment of RFA and LNG-IUS was administered. The uterine volume significantly decreased, and the average reduction rate was 55%. CONCLUSION Ultrasound-guided RFA combined with an LNG-IUS might be a simple, safe and effective alternative for the treatment of symptomatic adenomyosis.
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Affiliation(s)
- Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, China.,Department of Gynecology, The PLA Rocket Force General Hospital, Beijing, China
| | - Qingxiang Hou
- Department of Gynecology, The PLA Rocket Force General Hospital, Beijing, China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital Capital Medical University, Beijing, China
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14
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He C, Nelson W, Li H, Xu YD, Dai XJ, Wang YX, Ding YB, Li YP, Li T. Frequency of MED12 Mutation in Relation to Tumor and Patient's Clinical Characteristics: a Meta-analysis. Reprod Sci 2021; 29:357-365. [PMID: 33569750 DOI: 10.1007/s43032-021-00473-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023]
Abstract
Mediator complex subunit 12 (MED12) is the most frequently mutated gene in uterine leiomyomas (ULs)-with a frequency of up to 85%-suggesting that it plays key roles in the pathogenesis of ULs. However, there is no established relationship between genetic alteration and other risk factors of UL pathogenesis such as the patient's age, weight, and race. In this meta-analysis, we established an association between these risk factors and the frequency of MED12 mutation. We also established the relationship between MED12 mutation with the number and size of tumors in a patient. A systematic literature search was performed for studies published by May 2020 and performed a meta-analysis according to PRISMA guidelines. Twenty-five studies were included in the analysis, representing 3151 tissue samples. MED12 mutations were more common in Black (74.5%) as compared to White (65.8%) and Asian (53.2%) patients. There was no significant relationship between the patient's age and the frequency of mutations (OR 0.73, 95% CI 0.38 to 1.41). MED12 mutations were common in patients barring small-sized (OR 1.46, 95% CI 1.09 to 1.95) multiple (OR 0.39, 95% CI 0.17 to 0.92) tumors. For the patient's weight, studies were few and the outcome was not statistically significant. This meta-analysis provides valuable information on the relationship between the patient's clinical characteristics and frequency of MED12 mutation among patients barring ULs, which is relevant for understanding the pathogenesis of ULs.Protocol registration: The protocol was registered in PROSPERO with registration number CRD42019123439.
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Affiliation(s)
- Chao He
- Joint International Research Laboratory of Reproduction and Development, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - William Nelson
- Joint International Research Laboratory of Reproduction and Development, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.,Department of Environmental and Occupational Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Hui Li
- Xiangya School of Medicine, Central South University, Changsha, 410000, Hunan, China.,Reproductive Department of Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.,The Third Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Ya-Dong Xu
- Xiangya School of Medicine, Central South University, Changsha, 410000, Hunan, China.,The Third Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Xue-Jiao Dai
- Xiangya School of Medicine, Central South University, Changsha, 410000, Hunan, China.,The Third Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China
| | - Ying-Xiong Wang
- Joint International Research Laboratory of Reproduction and Development, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yu-Bin Ding
- Joint International Research Laboratory of Reproduction and Development, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yan-Ping Li
- Reproductive Department of Xiangya Hospital, Central South University, Changsha, 410000, Hunan, China.
| | - Tian Li
- Joint International Research Laboratory of Reproduction and Development, Department of Reproductive Biology, School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China. .,The Department of Reproductive Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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15
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Orta OR, Wesselink AK, Bethea TN, Claus Henn B, Weuve J, Fruh V, McClean MD, Sjodin A, Baird DD, Wise LA. Brominated flame retardants and organochlorine pesticides and incidence of uterine leiomyomata: A prospective ultrasound study. Environ Epidemiol 2021; 5:e127. [PMID: 33778359 PMCID: PMC7939431 DOI: 10.1097/ee9.0000000000000127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/08/2020] [Indexed: 10/28/2022] Open
Abstract
Uterine leiomyomata (UL) are hormone-responsive benign neoplasms. Brominated flame retardants and organochlorine pesticides (OCPs) can disrupt hormones involved in UL etiology. METHODS The Study of Environmental, Lifestyle, and Fibroids is a Detroit-area prospective cohort of 1693 Black women 23-35 years of age. At baseline and approximately every 20 months for 5 years, women completed questionnaires and underwent transvaginal ultrasounds. Using a case-cohort study design, we selected 729 UL-free participants at baseline and analyzed baseline plasma samples for polybrominated diphenyl ethers (PBDEs), a polybrominated biphenyl ether (PBB-153), and OCPs. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Compared with total PBDE plasma concentrations <50th percentile, adjusted HRs for the 50th-74th, 75th-89th, and ≥90th percentiles were 1.00 (95% CI = 0.68, 1.47), 1.04 (95% CI = 0.63, 1.68), and 0.85 (95% CI = 0.48, 1.50), respectively. HRs for PBB-153 plasma concentrations were generally similar to total PBDE plasma concentrations. Compared with total OCP plasma concentrations <50th percentile, HRs for the 50th-74th, 75th-89th, and ≥90th percentiles were 0.86 (95% CI = 0.57, 1.29), 0.73 (95% CI = 0.43, 1.22), and 0.58 (95% CI = 0.32, 1.04), respectively. HRs for individual PBDEs and OCPs were similar to their respective totals. CONCLUSION We found little support for an association between brominated flame retardant plasma concentrations and UL incidence, and some evidence of lower UL incidence with the highest OCP plasma concentrations.
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Affiliation(s)
- Olivia R. Orta
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Traci N. Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Jennifer Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Victoria Fruh
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Michael D. McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Andreas Sjodin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donna D. Baird
- National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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16
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Wise LA, Wesselink AK, Bethea TN, Brasky TM, Wegienka G, Harmon Q, Block T, Baird DD. Intake of Lycopene and other Carotenoids and Incidence of Uterine Leiomyomata: A Prospective Ultrasound Study. J Acad Nutr Diet 2021; 121:92-104. [PMID: 33350944 PMCID: PMC7768815 DOI: 10.1016/j.jand.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/23/2020] [Accepted: 08/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Uterine leiomyomata (UL) are the leading indication for hysterectomy in the United States. Dietary supplementation with lycopene was associated with reduced size and incidence of oviduct leiomyoma in the Japanese quail. Two US prospective cohort studies of women reported little association between intake of lycopene, or other carotenoids, and UL incidence. However, these studies relied on self-reported physician-diagnosed UL, which is prone to misclassification. OBJECTIVE This study examines the association between dietary intake of carotenoids and UL incidence. DESIGN Data were derived from the Study of the Environment, Lifestyle, and Fibroids, a prospective cohort study. Women completed self-administered baseline questionnaires on demographic characteristics, reproductive history, and lifestyle, including a 110-item validated food frequency questionnaire, from which dietary intakes of carotenoids-including alpha carotene, beta carotene, cryptoxanthin, lutein-zeaxanthin, and lycopene-and vitamin A were estimated. PARTICIPANTS/SETTING One thousand two hundred thirty Black women aged 23 to 35 years who did not have a previous diagnosis of UL, cancer, or autoimmune disease were eligible for enrollment (2010-2012). Participants were residents of the Detroit, MI, metropolitan area. MAIN OUTCOME MEASURES Transvaginal ultrasound was used to assess UL at baseline and 20, 40, and 60 months of follow-up. STATISTICAL ANALYSES PERFORMED Cox regression was used to estimate hazard ratios and 95% CIs, adjusted for energy intake, age at menarche, education, body mass index, parity, age at first birth, years since last birth, current use of oral contraceptives or progestin-only injectables, alcohol intake, and cigarette smoking. RESULTS Among 1,230 women without prevalent UL at baseline, 301 incident UL cases during follow-up were identified. Intakes of lycopene, other carotenoids, and vitamin A were not appreciably associated with UL incidence. Hazard ratios comparing quartiles 2 (2,376 to 3,397 μg/day), 3 (3,398 to 4,817 μg/day), and 4 (≥4,818 μg/day) with quartile 1 (<2,376 μg/day) of lycopene intake were 1.03 (95% CI 0.72 to 1.47), 1.22 (95% CI 0.86 to 1.72), and 0.95 (95% CI 0.67 to 1.36), respectively. CONCLUSIONS Study findings do not support the hypothesis that greater carotenoid intake is associated with reduced UL incidence.
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Affiliation(s)
- Lauren A Wise
- (1)Department of Epidemiology, Boston University School of Public Health, Boston, MA.
| | - Amelia K Wesselink
- (1)Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Traci N Bethea
- (2)Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Theodore M Brasky
- (3)Division of Medical Oncology, The Ohio State University College of Medicine; Columbus, OH
| | - Ganesa Wegienka
- (4)Department of Public Health Sciences, Henry Ford Health System; Detroit, MI
| | - Quaker Harmon
- (5)Epidemiology Branch, Women's Health Group, National Institute for Environmental Health Sciences, Research Triangle, NC
| | | | - Donna D Baird
- (5)Epidemiology Branch, Women's Health Group, National Institute for Environmental Health Sciences, Research Triangle, NC
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17
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Brasky TM, Bethea TN, Wesselink AK, Wegienka GR, Baird DD, Wise LA. Dietary Fat Intake and Risk of Uterine Leiomyomata: A Prospective Ultrasound Study. Am J Epidemiol 2020; 189:1538-1546. [PMID: 32556077 DOI: 10.1093/aje/kwaa097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/22/2023] Open
Abstract
Uterine leiomyomata (UL) are associated with severe reproductive morbidity and are the primary indication for hysterectomy in the United States. A recent prospective cohort study of Black women reported positive associations between intakes of marine-sourced ω-3 fatty acids and UL risk. We examined whether intakes of dietary fat were associated with UL incidence in a 5-year prospective study of premenopausal Black women living in Detroit who underwent serial ultrasound. At baseline (2010-2012) and 20, 40, and 60 months of follow-up, participants underwent transvaginal ultrasound. Among 1,171 UL-free women at baseline, incident UL were detected in 277 women. Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of dietary fat and UL incidence. Intakes of total fat and saturated, monounsaturated, polyunsaturated, and trans-fat were not appreciably associated with UL incidence. Intake of the marine ω-3 polyunsaturated fatty acid, docosahexaenoic acid, was associated with 49% higher UL incidence (quartile 4 vs. 1: hazard ratio = 1.49, 95% confidence interval: 1.04, 2.14; P for trend = 0.01). Intakes of total marine ω-3 polyunsaturated fatty acids were similarly associated with elevated UL incidence (hazard ratio = 1.35, 95% confidence interval: 0.94, 1.93; P for trend = 0.03). It remains unclear whether the fatty acids or persistent environmental pollutants drive the association.
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18
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Baird DD, Patchel SA, Saldana TM, Umbach DM, Cooper T, Wegienka G, Harmon QE. Uterine fibroid incidence and growth in an ultrasound-based, prospective study of young African Americans. Am J Obstet Gynecol 2020; 223:402.e1-402.e18. [PMID: 32105679 DOI: 10.1016/j.ajog.2020.02.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Uterine fibroids are common. Symptoms are debilitating for many, leading to high medical and societal costs. Indirect data suggest that compared with white women, African Americans develop fibroids at least 10 years earlier on average, and their higher health burden has been well documented. OBJECTIVE The objective of the study was to directly measure fibroid incidence and growth in a large, community-based cohort of young African-American women. STUDY DESIGN This observational, community-based, prospective study enrolled 1693 African-American women, aged 23-35 years with no prior diagnosis of fibroids. Standardized transvaginal ultrasound examinations at enrollment and after approximately 18 months were conducted to identify and measure fibroids ≥0.5 cm in diameter. Fibroid growth (change in natural log volume per 18 months) was analyzed with mixed-model regression (n = 344 fibroids from 251 women whose baseline ultrasound revealed already existing fibroids). RESULTS Among the 1123 fibroid-free women with follow-up data (88% were followed up), incidence was 9.4% (95% confidence interval, 7.7-11.2) and increased with age (Ptrend < .0001), from 6% (confidence interval, 3-9) for 23-25 year olds to 13% (confidence interval, 9-17) for 32-35 year olds. The chance of any new fibroid development was greater than twice as high for women with existing fibroids compared with women who were fibroid free at baseline (age-adjusted relative risk = 2.3 (confidence interval, 1.7-3.0). The uterine position of most incident fibroids (60%) was intramural corpus. Average fibroid growth was 89% per 18 months (confidence interval, 74-104%) but varied by baseline fibroid size (P < .0001). Fibroids ≥2 cm in diameter had average growth rates well under 100%. In contrast, small fibroids (<1 cm diameter) had an average growth rate of nearly 200% (188%, confidence interval, 145-238%). However, these small fibroids also had a high estimated rate of disappearance (23%). CONCLUSION This is the first study to directly measure age-specific fibroid incidence with a standardized ultrasound protocol and to measure fibroid growth in a large community-based sample. Findings indicate that very small fibroids are very dynamic in their growth, with rapid growth, but a high chance of loss. Larger fibroids grow more slowly. For example, a 2-cm fibroid is likely to take 4-5 years to double its diameter. Detailed data on fibroid incidence confirm an early onset in African-American women.
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Nakayama K, Razia S, Ishikawa M, Yamashita H, Ishibashi T, Sasamori H, Sawada K, Kurose S, Sato S, Kyo S. Comparison between bidirectional Stratafix ® barbed suture and conventional suture in laparoscopic myomectomy: a retrospective study. BMC WOMENS HEALTH 2020; 20:164. [PMID: 32758222 PMCID: PMC7405452 DOI: 10.1186/s12905-020-01030-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
Background Laparoscopic myomectomy (LM) is one of the techniques feasible for the treatment of intramural myoma. This technique is reported to be difficult when large fibroids are involved because of excessive blood loss during surgery. Skillful and fast suturing appears to be associated with reduced blood loss during LM. In this study we compared the surgical outcomes of using bidirectional Stratafix® barbed suture versus conventional suture during LM. Methods This retrospective study included all patients who underwent LM for the treatment of intramural myoma in our institution between 2015 and 2020. The patients were divided into 2 groups according to the technique of suturing during LM: Group 1 comprised patients in whom Stratafix® barbed suture was used (n = 29), and group 2 comprised those in whom conventional suture was used (n = 15). Data of patient age, myoma size, the number of myoma nodes, hemoglobin levels, total operation time, total suturing time, and blood loss during surgery were compared between the 2 groups. Results No significant differences in age (p = 0.463) or myoma size (P = 0.373) were observed between the 2 groups. Operation time (P = 0.0104), suturing time (P = 0.007), and blood loss (P = 0.0375) during surgery were significantly less with Stratafix® barbed suture than with conventional suture. No patient required intraoperative transfusion or conversion to laparotomy. Conclusion The use of bidirectional barbed suture reduces operation time, suturing time, and blood loss. As these new sutures have barbs, no knot-tying is required; thus, continuous suturing becomes very simple and maintaining hemostasis is easy. Unskilled gynecological surgeons who apply this suture technique can also perform LM easily. As the bidirectional barbed suture has multiple points of fixation, this suture technique can reapproximate tissue securely, which reduces the chances of reoperation because of proper suture knotting. Therefore, bidirectional Stratafix® barbed sutures could be an optimal and efficient alternative to conventional sutures for use by gynecological surgeons in Japan.
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Affiliation(s)
- Kentaro Nakayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan.
| | - Sultana Razia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Masako Ishikawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Hitomi Yamashita
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Tomoka Ishibashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Hiroki Sasamori
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Kiyoka Sawada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Sonomi Kurose
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Seiya Sato
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shimane University, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
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Cleemann L, Holm K, Fallentin E, Møller N, Kristensen B, Skouby SO, Leth-Esbensen P, Jeppesen EM, Jensen AK, Gravholt CH. Effect of Dosage of 17ß-Estradiol on Uterine Growth in Turner Syndrome-A Randomized Controlled Clinical Pilot Trial. J Clin Endocrinol Metab 2020; 105:5587948. [PMID: 31613320 DOI: 10.1210/clinem/dgz061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 10/08/2019] [Indexed: 01/15/2023]
Abstract
CONTEXT Most Turner syndrome (TS) girls need exogenous estrogen treatment to induce puberty and normal uterine growth. After puberty, the optimal estrogen treatment protocol has not been determined. OBJECTIVE To compare 2 doses of oral 17ß-estradiol on uterine size. DESIGN A double-blind, 5-year randomized controlled clinical trial. SETTING Ambulatory care. PARTICIPANTS Twenty young TS women (19.2 ± 2.5 years, range 16.0-24.9) participated. Sixteen patients completed the study. No patients withdrew due to adverse effects. INTERVENTION The lower dose (LD) group took 2 mg 17ß-estradiol/d orally and placebo. The higher dose (HD) group took 4 mg 17ß-estradiol/d orally. MAIN OUTCOME MEASURE(S) Uterine volume evaluated by transabdominal ultrasound yearly. RESULTS Uterine size increased significantly more in the HD group compared with the LD group (P = 0.038), with a gain in uterine volume within the first 3 years of treatment of 19.6 mL (95% confidence interval [CI] = 4.0-19.0) in the HD group compared with 11.5 mL (95% CI = 11.2-27.9) in the LD group. The difference in 3-year gain was 8.1 mL (95% CI = 0.7-15.9). At the last visit, there were no significant differences in uterine volume between the groups. CONCLUSION HD oral 17ß-estradiol induces a steeper increase in uterine volume within the first years of treatment compared with the LD. However, the uterine growth potential seems to be the same in most young TS women making the duration of treatment equally significant as estrogen dose, although a few TS women did not experience sufficient uterine growth on 2 mg of estradiol. CLINICALTRIALS.GOV NCT00134745Abbreviations: BMI, body mass index; BSA, body surface area; DHEAS, dihydroepiandrosteronesulfate; HD, higher dose; HRT, hormone replacement therapy; LD, lower dose; TS, Turner syndrome; US, ultrasound.
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Affiliation(s)
- Line Cleemann
- Department of Pediatrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Kirsten Holm
- Department of Pediatrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Eva Fallentin
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nini Møller
- Department of Gynecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Bent Kristensen
- Department of Radiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Sven O Skouby
- Department of Gynecology and Obstetrics, Herlev University Hospital, Herlev, Denmark
| | | | - Eva M Jeppesen
- Department of Pediatrics, Herlev University Hospital, Herlev, Denmark
| | - Andreas K Jensen
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen
| | - Claus H Gravholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Abstract
Purpose of Review This review aims to update our understanding of the radiological life cycle of fibroids, so that we may better counsel patients making difficult treatment decisions. Evidence for both pregnant and non-pregnant women have been considered separately. Recent Findings Recent findings have shown that fibroids can undergo both growth and regression in non-gravid uterus. In pregnant women, fibroid growth is non-linear fashion, with the greatest growth occurring in the first 7 weeks of pregnancy. Growth in the later trimesters was significantly slower. Summary Fibroid growth, both in the intra- and inter-gravid states, is variable and can range from 18 to 120% per year. In the inter-gravid state, fibroids can grow or undergo spontaneous regression. Factors that can predict fibroid growth include the starting volume of fibroid, type of fibroid and age of patient. In the gravid state, fibroids appears to grow in a non-linear pattern, with the most rapid growth occurring in the first trimester. Factors affecting fibroid growth in pregnancy include the size of fibroids and number of fibroids.
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Moore KR, Baird DD. Self-reported bacterial vaginosis and risk of ultrasound-diagnosed incident uterine fibroid cases in a prospective cohort study of young African American women. Ann Epidemiol 2017; 27:749-751.e1. [PMID: 29066031 DOI: 10.1016/j.annepidem.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/15/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Kristen R Moore
- Epidemiology Branch A3-05, National Institute of Environmental Health Sciences, Research Triangle Park, NC.
| | - Donna D Baird
- Epidemiology Branch A3-05, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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Ciavattini A, Clemente N, Delli Carpini G, Saccardi C, Borgato S, Litta P. Laparoscopic uterine artery bipolar coagulation plus myomectomy vs traditional laparoscopic myomectomy for "large" uterine fibroids: comparison of clinical efficacy. Arch Gynecol Obstet 2017; 296:1167-1173. [PMID: 28956149 DOI: 10.1007/s00404-017-4545-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Laparoscopic myomectomy is the uterus-preserving surgical approach of choice in case of symptomatic fibroids. However, it can be a difficult procedure even for an experienced surgeon and can result in excessive blood loss, prolonged operating time and postoperative complications. A combined approach with laparoscopic uterine artery occlusion and simultaneous myomectomy was proposed to reduce these complications. The aim of this study was to evaluate the safety and efficacy of the combined laparoscopic approach in women with symptomatic "large" intramural uterine fibroids, compared to the traditional laparoscopic myomectomy alone. METHODS Prospective nonrandomized case-controlled study of women who underwent a conservative surgery for symptomatic "large" (≥ 5 cm in the largest diameter) intramural uterine fibroids. The "study group" consisted of women who underwent the combined approach (laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy), while women who underwent the traditional laparoscopic myomectomy constituted the "control group". A comparison between the two groups was performed, and several intraoperative and postoperative outcomes were evaluated. RESULTS No significant difference in the overall duration of surgery between women of the "study group" and "control group" emerged; however, a significantly shorter surgical time for myomectomy was observed in the "study group". The intraoperative blood loss and the postoperative haemoglobin drop were significantly lower in the "study group". No difference in the postoperative pain between groups emerged, and the postoperative hospital stay was similar in the two groups. CONCLUSIONS The laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy is a safe and effective procedure, even in women with symptomatic "large" intramural uterine fibroids, with the benefit of a significant reduction in the intraoperative blood loss when compared to the traditional laparoscopic myomectomy.
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Affiliation(s)
- Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Via F. Corridoni 11, 60123, Ancona, Italy.
| | - Nicolò Clemente
- Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Via F. Corridoni 11, 60123, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Via F. Corridoni 11, 60123, Ancona, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, Università di Padova, Padua, Italy
| | - Shara Borgato
- Department of Woman and Child Health, Università di Padova, Padua, Italy
| | - Pietro Litta
- Department of Woman and Child Health, Università di Padova, Padua, Italy
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24
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Iversen H, Dueholm M. Radiofrequency Thermal Ablation for Uterine Myomas: Long-term Clinical Outcomes and Reinterventions. J Minim Invasive Gynecol 2017; 24:1020-1028. [DOI: 10.1016/j.jmig.2017.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/07/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022]
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25
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Cancer Measurement at Ultrasound: State of the Art. Ultrasound Q 2016; 33:116-124. [PMID: 27984513 DOI: 10.1097/ruq.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reliable and reproducible tumor measurement is fundamental in the oncologic decision making. In this article, we first highlight the importance of a precise tumor measurement, reviewing the correct modality of measuring tumor lesions at ultrasound. Then we analyze the measurement discrepancies between ultrasound and pathology as well as the discrepancies reported between ultrasound and other imaging modalities. Thereafter, basing on the existent literature and on our experience, we discuss the factors influencing the tumor size measurements at ultrasound. Finally, we illustrate the current strategies to improve the effectiveness of cancer lesions measurement.
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26
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Dueholm M, Hjorth IMD. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol 2016; 40:23-43. [PMID: 27818130 DOI: 10.1016/j.bpobgyn.2016.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/23/2016] [Indexed: 12/11/2022]
Abstract
The aim in the diagnosis of abnormal uterine bleeding (AUB) is to identify the bleeding cause, which can be classified by the PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system. In a gynecologic setting, the first step is most often to identify structural abnormalities (PALM causes). Common diagnostic options for the identification of the PALM include ultrasonography, endometrial sampling, and hysteroscopy. These options alone or in combination are sufficient for the diagnosis of most women with AUB. Contrast sonography with saline or gel infusion, three-dimensional ultrasonography, and magnetic resonance imaging may be included. AIM The aim of this article is to describe how a simple structured transvaginal ultrasound can be performed and implemented in the common gynecologic practice to simplify the diagnosis of AUB and determine when additional invasive investigations are required. Structured transvaginal ultrasound for the identification of the most common endometrial and myometrial abnormalities and the most common ultrasound features are described. Moreover, situations where magnetic resonance imaging may be included are described. This article proposes a diagnostic setup in premenopausal women for the classification of AUB according to the PALM-COEIN system. Moreover, a future diagnostic setup for fast-track identification of endometrial cancer in postmenopausal women based on a structured evaluation of the endometrium is described.
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Affiliation(s)
- Margit Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark.
| | - Ina Marie D Hjorth
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark
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27
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Abstract
A debate among gynecologic and reproductive surgeons is whether or not there is a clinical need to treat all intramural myomas. Considerations include myoma size and number, ability to access them, whether or not they compromise the endometrium, and treatment effect on gynecologic, reproductive, and obstetric outcomes. We conducted a detailed study regarding intramural myomas, their prevalence in subject populations, the imaging methods used to detect them, their growth rate, their suspected adverse effects on gynecologic, fertility, and obstetric outcomes, and the effectiveness of various treatment methods. The growing body of evidence reported in the literature supports the need to manage intramural myomas and to treat them appropriately.
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Affiliation(s)
- Mayra J Thompson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce R Carr
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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28
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Baird DD, Harmon QE, Upson K, Moore KR, Barker-Cummings C, Baker S, Cooper T, Wegienka G. A Prospective, Ultrasound-Based Study to Evaluate Risk Factors for Uterine Fibroid Incidence and Growth: Methods and Results of Recruitment. J Womens Health (Larchmt) 2015; 24:907-15. [PMID: 26334691 DOI: 10.1089/jwh.2015.5277] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Uterine fibroids are common, benign, smooth-muscle tumors that can cause major morbidity for reproductive-age women, often requiring invasive treatment. Despite this personal and public health burden, no prior study has attempted to periodically screen fibroid-free women with ultrasound to detect incident disease and identify risk factors. METHODS We designed a study to prospectively investigate development of fibroids by enrolling women without a clinical diagnosis of fibroids and screening for fibroids with ultrasound at baseline. Enrollment procedures included extensive questionnaires and specimen collection (blood, urine, vaginal swabs). The cohort is followed at approximately 20-month intervals. At each follow-up there are updates to the questionnaire data, further specimen collection, and an ultrasound examination. We identify incident disease and measure tumor growth. The two exposures of primary interest are vitamin D insufficiency and reproductive tract infections. This manuscript provides a detailed description of the study methods, recruitment results, and participant characteristics. RESULTS The Study of Environment, Lifestyle and Fibroids enrolled 1,696 African American women aged 23-34 years. "Family and friends" was a leading recruitment source. More than 95% of participants contributed all the requested biological specimens at baseline. Study ultrasound examinations revealed undiagnosed fibroids in 378 women (22% of participants). The retention rate for the first follow-up was 87%. CONCLUSIONS Study design aspects likely to be important for long-term studies in young African Americans include personalized recruitment, multiple steps to the enrollment process that rely on the initiative of the participant, and methods for tracing highly mobile study subjects.
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Affiliation(s)
- Donna D Baird
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park, North Carolina
| | - Quaker E Harmon
- 2 Social and Scientific Systems, Inc. , Durham, North Carolina
| | - Kristen Upson
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park, North Carolina
| | - Kristen R Moore
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park, North Carolina
| | | | - Susan Baker
- 2 Social and Scientific Systems, Inc. , Durham, North Carolina
| | - Tracy Cooper
- 3 Department of Radiology, Division of Ultrasound, Henry Ford Health System , Detroit, Michigan
| | - Ganesa Wegienka
- 4 Department of Public Health Sciences, Henry Ford Hospital , Detroit, Michigan
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29
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Moore KR, Cole SR, Dittmer DP, Schoenbach VJ, Smith JS, Baird DD. Self-Reported Reproductive Tract Infections and Ultrasound Diagnosed Uterine Fibroids in African-American Women. J Womens Health (Larchmt) 2015; 24:489-95. [PMID: 25901468 DOI: 10.1089/jwh.2014.5051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For decades, it has been hypothesized that reproductive tract infections (RTIs) are risk factors for uterine fibroids. However, only two recent studies have been conducted. We aimed to investigate the relationship between RTIs and fibroids in a large study using ultrasound screening for fibroids. METHODS We used cross-sectional enrollment data from African American women ages 23-34 years with no previous fibroid diagnosis. RTI history was measured by self-report and fibroid status by standardized ultrasound. Secondary fibroid outcomes were size, number, and total volume. Age- and multivariable-adjusted logistic regression were used to estimate odds ratios (ORs). RESULTS In total, 1,656 women were included; 22% had fibroids. Bacterial vaginosis (BV) was associated with a 21% increased odds of fibroids [aOR 1.21, 95% confidence interval (CI) 0.93-1.58]. Chlamydia infection and pelvic inflammatory disease were associated with a 38% (aOR 0.62, 95% CI 0.40-0.97) and a 46% (aOR 0.54, 95% CI 0.25-1.17) reduced odds of having two or more fibroids, respectively. Those with a previous BV diagnosis had a 47% increased odds of having 2 or more fibroids (aOR 1.47, 95% CI 0.98-2.21) and a 41% increased odds of having a larger total fibroid volume (aOR 1.41, 95% CI 0.98-2.04). CONCLUSIONS Our study was the first to explore the relationship between RTIs and fibroid size, number, and total volume. There appeared to be no strong associations between self-reported RTIs and fibroids. Studies using serology, a biochemical measure of past infection, are needed to better investigate associations between RTIs and fibroids.
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Affiliation(s)
- Kristen R Moore
- 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Epidemiology Branch, National Institute of Environmental Health Sciences , National Institutes of Health, Research Triangle Park, North Carolina
| | - Stephen R Cole
- 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Dirk P Dittmer
- 3 Department of Microbiology and Immunology, Program in Global Oncology at the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Victor J Schoenbach
- 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jennifer S Smith
- 1 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Donna D Baird
- 2 Epidemiology Branch, National Institute of Environmental Health Sciences , National Institutes of Health, Research Triangle Park, North Carolina
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