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Xholli A, Scovazzi U, Londero AP, Paudice M, Vacca I, Schiaffino MG, Kratochwila C, Cavalli E, Perugi I, Cagnacci A. Clinical and ultrasonographic characteristics of pregnancy-related enhanced myometrial vascularity: prospective cohort study. Ultrasound Obstet Gynecol 2024; 63:672-682. [PMID: 37984401 DOI: 10.1002/uog.27537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To assess the ultrasonographic, epidemiological, clinical and evolutive characteristics of enhanced myometrial vascularity (EMV) following a first-trimester termination of pregnancy (TOP) or management of non-viable pregnancy. METHODS This prospective study included women who underwent follow-up ultrasound examination 5-6 weeks after a first-trimester TOP or after management of a first-trimester non-viable pregnancy at the University Hospital Polyclinic San Martino of Genoa between March 2021 and March 2022. EMV was characterized using two- and three-dimensional ultrasound and Virtual Organ Computer-aided Analysis. Ultrasonographic diagnosis of EMV was made when an unusual, tortuous myometrial vessel structure, with high-velocity blood flow, protruding towards the endometrium was observed, while an abnormal junctional zone, absent endometrial midline and heterogeneous endometrium supported the diagnosis. Patients with EMV underwent expectant management with planned ultrasonographic follow-up every 2 weeks until resolution. RESULTS During the study period, 305 women underwent TOP, of whom 132 attended the initial follow-up 5-6 weeks later, at which 52 were diagnosed with EMV. Ninety-six women were managed for a non-viable pregnancy, of whom 32 presented for follow-up, at which six had a diagnosis of EMV. Thus, overall, 164 of 401 women were included in the study and EMV was identified in 58 (35%) of these. The prevalence of EMV 5-6 weeks after a TOP was therefore between 52/305 (17%) and 52/132 (39%), and that after management of a non-viable pregnancy was between 6/96 (6%) and 6/32 (19%). Bleeding/pelvic pain was present in half (29/58) of the women with EMV, and serum human chorionic gonadotropin was detectable in 29% (17/58) at the first follow-up examination. At ultrasound assessment, all cases with EMV presented abundant tortuous myometrial vessels with high-velocity flow projecting from the myometrium towards the endometrium, along with non-uniform heterogeneous endometrium in 97% of cases, which often (67% of these) contained cystic areas, absence of the endometrial midline in 98% of cases and an abnormal junctional zone in 97% of cases (64% interrupted, 33% irregular). Most (67%) women with EMV were parous and 90% of them had undergone TOP rather than management for a non-viable pregnancy. Medical management of the TOP or non-viable pregnancy was more frequent in women with than those without EMV (93% vs 77%, P = 0.023). Multiple regression analysis showed the risk of EMV to be increased following TOP vs non-viable pregnancy (odds ratio (OR), 3.67 (95% CI, 1.16-11.56), P = 0.026) and in parous compared with nulliparous women (OR, 2.95 (95% CI, 1.45-6.01), P = 0.002). All women with EMV underwent expectant management. Eleven women did not return for subsequent follow-up examinations and did not present to our outpatient or emergency facilities, so were lost to further follow-up. Spontaneous resolution of the lesion was observed within 7-16 weeks after the procedure in 96% (45/47) of the remaining cases. Two women chose to undergo surgery for pelvic discomfort, and histology showed the presence of neovessels mixed with retained chorionic villi. CONCLUSIONS EMV is a transient and common finding 5-6 weeks following first-trimester TOP or management of non-viable pregnancy. TOP and being parous are risk factors for EMV. Expectant management of EMV is appropriate, because, in almost all cases, this resolves spontaneously, without complications, within 2-4 months. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Xholli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - U Scovazzi
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - A P Londero
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - M Paudice
- Department of Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- University of Genoa, Genoa, Italy
| | - I Vacca
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - M G Schiaffino
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - C Kratochwila
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - E Cavalli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - I Perugi
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
| | - A Cagnacci
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health (DINOGMI), Genoa, Italy
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Brooks N, Irving SA, Kauffman TL, Vesco KK, Slaughter M, Smith N, Tepper NK, Olson CK, Weintraub ES, Naleway AL. Abnormal uterine bleeding diagnoses and care following COVID-19 vaccination. Am J Obstet Gynecol 2024; 230:540.e1-540.e13. [PMID: 38219855 DOI: 10.1016/j.ajog.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND There is evidence suggesting that COVID-19 vaccination may be associated with small, transitory effects on uterine bleeding, possibly including menstrual timing, flow, and duration, in some individuals. However, changes in health care seeking, diagnosis, and workup for abnormal uterine bleeding in the COVID-19 vaccine era are less clear. OBJECTIVE This study aimed to assess the impact of COVID-19 vaccination on incident abnormal uterine bleeding diagnosis and diagnostic evaluation in a large integrated health system. STUDY DESIGN Using segmented regression, we assessed whether the availability of COVID-19 vaccines was associated with changes in monthly, population-based rates of incident abnormal uterine bleeding diagnoses relative to the prepandemic period in health system members aged 16 to 44 years who were not menopausal. We also compared clinical and demographic characteristics of patients diagnosed with incident abnormal uterine bleeding between December 2020 and October 13, 2021 by vaccination status (never vaccinated, vaccinated in the 60 days before diagnosis, vaccinated >60 days before diagnosis). Furthermore, we conducted detailed chart review of patients diagnosed with abnormal uterine bleeding within 1 to 60 days of COVID-19 vaccination in the same time period. RESULTS In monthly populations ranging from 79,000 to 85,000 female health system members, incidence of abnormal uterine bleeding diagnosis per 100,000 person-days ranged from 8.97 to 19.19. There was no significant change in the level or trend in the incidence of abnormal uterine bleeding diagnoses between the prepandemic (January 2019-January 2020) and post-COVID-19 vaccine (December 2020-December 2021) periods. A comparison of clinical characteristics of 2717 abnormal uterine bleeding cases by vaccination status suggested that abnormal bleeding among recently vaccinated patients was similar or less severe than abnormal bleeding among patients who had never been vaccinated or those vaccinated >60 days before. There were also significant differences in age and race of patients with incident abnormal uterine bleeding diagnoses by vaccination status (Ps<.02). Never-vaccinated patients were the youngest and those vaccinated >60 days before were the oldest. The proportion of patients who were Black/African American was highest among never-vaccinated patients, and the proportion of Asian patients was higher among vaccinated patients. Chart review of 114 confirmed postvaccination abnormal uterine bleeding cases diagnosed from December 2020 through October 13, 2021 found that the most common symptoms reported were changes in timing, duration, and volume of bleeding. Approximately one-third of cases received no diagnostic workup; 57% had no etiology for the bleeding documented in the electronic health record. In 12% of cases, the patient mentioned or asked about a possible link between their bleeding and their recent COVID-19 vaccine. CONCLUSION The availability of COVID-19 vaccination was not associated with a change in incidence of medically attended abnormal uterine bleeding in our population of over 79,000 female patients of reproductive age. In addition, among 2717 patients with abnormal uterine bleeding diagnoses in the period following COVID-19 vaccine availability, receipt of the vaccine was not associated with greater bleeding severity.
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Affiliation(s)
- Neon Brooks
- Kaiser Permanente Center for Health Research, Portland, OR.
| | | | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, OR; Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR
| | | | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christine K Olson
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eric S Weintraub
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Kyejo W, Ismail A, Kitua A, Moshi B, Ntiyakunze G, Kaguta M, Mwanga A. Incidental actinomycosis in a 44-year-old female during total abdominal hysterectomy for abnormal uterine bleeding: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241248389. [PMID: 38655125 PMCID: PMC11036907 DOI: 10.1177/2050313x241248389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy in treating actinomycosis. The case underscores the importance of considering uncommon infections in pelvic pathology, particularly in patients with prolonged intrauterine contraceptive device usage. It prompts further exploration of actinomycosis in relation to intrauterine contraceptive device use and highlights the need for timely intervention and histopathological confirmation for optimal patient care.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Allyzain Ismail
- Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Abduel Kitua
- Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Brenda Moshi
- Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Gregory Ntiyakunze
- Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Ally Mwanga
- Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania
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Viganò S, Smedile A, Cazzella C, Marra P, Bonaffini PA, Sironi S. Abnormal Uterine Bleeding: A Pictorial Review on Differential Diagnosis and Not-So-Common Cases of Interventional Radiology Management. Diagnostics (Basel) 2024; 14:798. [PMID: 38667444 PMCID: PMC11049404 DOI: 10.3390/diagnostics14080798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Abnormal uterine bleeding (AUB) poses a multifaceted challenge in women's health, necessitating an integrated approach that addresses its diverse etiologies and clinical presentations. The International Federation of Gynecology and Obstetrics PALM-COEIN classification system provides a systematic approach to the diagnosis of AUB in non-pregnant women, based on clinical and imaging-based categorization of causes into structural (Polyps, Adenomyosis, Leiomyomas and Malignancy; PALM), and non-structural causes (Coagulopathies, Ovulatory disorders, primary Endometrial disorders, Iatrogenic and Not otherwise classified; COEIN). On the other hand, placental disorders, uterine rupture, ectopic pregnancy and retained products of conceptions are the main causes of uterine bleeding during pregnancy and in the peripartum period. Ultrasound is usually the first-line imaging technique for the differential diagnosis of causes of AUB. Computed Tomography may be useful if ultrasound findings are unclear, especially in emergency settings. Magnetic resonance imaging, when indicated, is an excellent second-line diagnostic tool for a better non-invasive characterization of the underlying cause of AUB. This pictorial review aims to illustrate the main causes of AUB from the point of view of diagnostic imaging and to show not-so-common cases that can be treated by means of interventional radiology.
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Affiliation(s)
- Sara Viganò
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Antonella Smedile
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Caterina Cazzella
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy; (A.S.); (C.C.); (P.M.); (P.A.B.); (S.S.)
- School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milano, Italy
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Al Shukri M, Said M, Nair A, Mathew M, Gowri V. Is there a difference in the clinical profile and outcome of women using levonorgestrel IUD for abnormal uterine bleeding and those using it for contraception?: A comparative cross-sectional study. Turk J Obstet Gynecol 2024; 21:7-14. [PMID: 38440962 PMCID: PMC10920973 DOI: 10.4274/tjod.galenos.2024.51460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/07/2024] [Indexed: 03/06/2024] Open
Abstract
Objective The most common indications for Levonorgestrel intrauterine device (LNG-IUD) are contraception and management of abnormal uterine bleeding (AUB). This study was conducted with the aim of exploring the differences in the clinical profile and outcome of women using LNG-IUD for contraception and AUB. Materials and Methods This was a retrospective comparative cross-sectional study of women who underwent LNG-IUD (52 mg) between 2012 and 2017. Their electronic health records were reviewed until the last documented follow-up or until December 2021. Results A total of 235 women had LNG-IUD with an age range of 21 to 62 years and a mean of (37.98 years±6.76). Of these women, 153/235 (65.1%) had it for contraception and 82/235 (34.89%) had it for AUB. The follow-up was 1-94 months with (mean ± SEM) follow-up for the AUB group of (21.48±2.31) months and for contraception group was (20.74±1.76) months (p-value of 0.80). There was a significant difference between the two groups in the age and body mass index (BMI), where women who had LNG-IUD for AUB were older (mean of 42.54±6.49 years, p-value <0.001) and had higher BMI (31.88±7.52 kg/m2, p-value =0.011). All LNG-IUDs that were indicated for contraception were inserted in an outpatient setting. However, 68.3% in the AUB, the insertion was in the operating theater in conjunction with hysteroscopy. After combining both expulsion and removal of LNG-IUD during the follow-up period, there was no significant difference between the 2 groups in the overall retention rate during the follow-up (p-value =0.998). Conclusion this study shows that women using LNG-IUD for the management of AUB are older and have a higher BMI compared with those using it for contraception. AUB women experienced more expulsion compared with the contraception group, but there was no difference between the 2 groups in the overall survival/retention of LNG-IUD.
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Affiliation(s)
- Maryam Al Shukri
- Department of Obstetrics and Gynecology; Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Maryam Said
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Asha Nair
- Department of Obstetrics and Gynecology; Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mariam Mathew
- Department of Obstetrics and Gynecology; Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Vaidyanatahn Gowri
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Kani V, A S, P J, Menon D. A Rare Case Report of Dedifferentiated Endometrioid Carcinoma. Cureus 2024; 16:e56329. [PMID: 38628996 PMCID: PMC11020603 DOI: 10.7759/cureus.56329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Dedifferentiated endometrioid carcinoma (DEC) is an exceptionally rare subtype of endometrial cancer characterized by a high-grade component juxtaposed with a low-grade endometrioid adenocarcinoma. This case report presents a unique instance of dedifferentiated endometrioid carcinoma in a 64-year-old female patient who presented with post-menopausal bleeding and abdominal pain. Diagnostic evaluation including imaging studies and histopathological examination revealed a mixed tumor comprising both high-grade and low-grade components. Management involved a multidisciplinary approach including surgical resection followed by adjuvant chemotherapy and radiation therapy. They are frequently mislabeled as endometrioid carcinomas of International Federation of Gynecology and Obstetrics (FIGO) Grade 2 or Grade 3. It is crucial to correctly differentiate these instances from traditional endometrioid carcinomas. This case underscores the importance of early recognition and comprehensive management strategies tailored to the unique characteristics of dedifferentiated endometrioid carcinoma. We report this case due to its rarity and complexity in diagnosis.
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Affiliation(s)
- Vallal Kani
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical Sciences, Saveetha University, Chennai, IND
| | - Sumithra A
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical Sciences, Saveetha University, Chennai, IND
| | - Jayaganesh P
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical Sciences, Saveetha University, Chennai, IND
| | - Dhanya Menon
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical Sciences, Saveetha University, Chennai, IND
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Patibandla S, Amanuddin SM, Ansari AZ, Saeed A, Kratz K. Iatrogenic Bladder Injury During Laparoscopic Hysterectomy: A Case Report and Discussion of Anatomic Variations. Cureus 2024; 16:e56556. [PMID: 38646348 PMCID: PMC11028013 DOI: 10.7759/cureus.56556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Hysterectomy, one of the most common surgical procedures performed in women worldwide, assumes a very important role in the definitive management of diverse gynecologic conditions. This case report presents a compelling instance of an iatrogenic bladder perforation that occurred during laparoscopically assisted vaginal hysterectomy in a 47-year-old woman with a high body mass index, extensive surgical history, and postural orthostatic tachycardia syndrome. Despite considerable preoperative planning and the use of minimally invasive techniques, the occurrence of physician-induced bladder perforation highlights the significance of understanding anatomical relationships and variations. The patient's previous abdominal surgeries including two cesarean sections, appendectomy, and cholecystectomy likely contributed to scar formation and adhesions, making dissection challenging. The case report and following discussion delve into anatomical variations, as well as the diagnosis and management of iatrogenic bladder injuries. The presented case serves as a valuable addition to the literature, contributing insights into the challenges and considerations surrounding urinary tract injuries during hysterectomy. This paper aims to review current research and guide practicing obstetricians and gynecologists in the management of intraoperative bladder injuries.
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Affiliation(s)
- Srihita Patibandla
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Syed Mohammed Amanuddin
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Ali Z Ansari
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Ali Saeed
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Kurt Kratz
- Pathology, Merit Health Wesley, Hattiesburg, USA
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Wang L, Quan S, Bai E, Yang X. Analysis of clinical data of different endometrial pathological types in perimenopausal women with abnormal uterine bleeding. Front Oncol 2024; 14:1370681. [PMID: 38487719 PMCID: PMC10937355 DOI: 10.3389/fonc.2024.1370681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Objective Early detection and diagnosis are important for improving the therapeutic effect and quality of life in patients with endometrial cancer (EC). This study aimed to analyze the clinical data of different endometrial pathological types in perimenopausal women with abnormal uterine bleeding (AUB) in order to provide evidence for the prevention and early diagnosis of EC. Methods A total of 462 perimenopausal women with AUB were enrolled in this prospective observational study. Endometrial biopsy was performed in patients with suspected endometrial lesions. According to the pathological examination results, the patients were divided into endometrial polyp group (EP) (n = 71), endometrial hyperplasia without atypia group (EH) (n = 59), atypical endometrial hyperplasia (AEH) (n = 36), and EC group (n = 27). The history risk factors and ultrasonic imaging characteristics of endometrium among the four groups were compared. Results Twenty-seven women were diagnosed with EC (5.84%). The prevalence rate of AEH and EC in the group of 51- to 55-year-old women was significantly higher than that in the groups of 40- to 45-year-old women and of 46- to 50-year-old women (P < 0.05). The age, body mass index, and history of diabetes gradually increased with the development of endometrial pathological types. In addition, the correlation index of endometrial blood flow increased gradually, and the proportion of uneven endometrial echo, unclear endometrial-myometrial junction (EMJ), and ovarian cyst also increased gradually. However, no statistically significant difference was found when comparing endometrial thickness (ET) and endometrial volume (EV) among endometrial pathological groups (P > 0.05). The ET, EV, endometrial vascularization index, endometrial flow index, and vascularization flow index in the ovarian cyst group were significantly higher (P < 0.05), and the proportion of uneven endometrium echo and unclear EMJ were significantly higher compared with that in the non-ovarian cyst group (P < 0.05). Conclusions The most common cause of perimenopausal women with AUB was benign endometrial lesions. However, women aged 51-55 years old with endometrial high risk factors and ovarian cyst should be alert to AEH and EC. Endometrial biopsy needs to be performed to determine endometrial malignancy in necessity.
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Affiliation(s)
| | | | | | - Xiaofeng Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Carrel-Lammert M, Parikh S, Devaiah CG, Patel NR, Crisp CC. Ultrasound Appearance of the Endometrium Post-Radiofrequency Ablation. J Ultrasound Med 2024. [PMID: 38385632 DOI: 10.1002/jum.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To describe the ultrasonographic appearance of the post-ablative endometrium to improve knowledge of its sonographic findings. METHODS This was an Institutional Review Board approved prospective study of patients who underwent second-generation endometrial ablation from 2016 to 2019 at a single health system. Patients had postoperative transvaginal ultrasounds at 2, 6, and 12 months. Ultrasound reports were analyzed for endometrial thickness, description of the endometrium and myometrium, presence of uterine fibroids, and uterine size. Statistical tests for repeated measures were utilized. RESULTS There were 68 patients with the average age of 42 (SD 6) years and a BMI of 33 (SD 8). Preoperatively the average endometrial thickness was 10 mm, uterine length was 9.7 cm, and 38.2% had leiomyoma. The average endometrial thickness decreased at each ultrasound: 8.4 mm (SD 3.4), 7.2 mm (SD 3.0), and 5.8 mm (SD 2.5) at 2, 6, and 12 months, respectively. When comparing endometrial thickness postoperatively there was a significant difference at 2 and 12 months (P = .041), and 6 and 12 months (P = .031). There was no change during the postoperative period in the presence of leiomyoma, hyperechoic endometrium, hypoechoic endometrium, heterogeneous endometrium, and cystic endometrium on the ultrasounds. CONCLUSION After ablation with a second-generation device, the endometrial thickness on ultrasound decreases with time following surgery. Additional studies correlating these findings to clinical outcomes would be useful.
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Affiliation(s)
| | - Shivani Parikh
- Department of Obstetrics & Gynecology, TriHealth Hospital System, Cincinnati, Ohio, USA
| | - C Ganga Devaiah
- Department of Obstetrics & Gynecology, TriHealth Hospital System, Cincinnati, Ohio, USA
| | - Nima R Patel
- Department of Obstetrics & Gynecology, TriHealth Hospital System, Cincinnati, Ohio, USA
| | - Catrina C Crisp
- Department of Obstetrics & Gynecology, TriHealth Hospital System, Cincinnati, Ohio, USA
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Biasioli A, Degano M, Restaino S, Bagolin M, Moro F, Ciccarone F, Testa AC, Greco P, Scambia G, Vizzielli G, Driul L. Innovative Ultrasound Criteria for the Diagnosis of Adenomyosis and Correlation with Symptoms: A Retrospective Re-Evaluation. Biomedicines 2024; 12:463. [PMID: 38398065 PMCID: PMC10886873 DOI: 10.3390/biomedicines12020463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
The 2022 Delphi revision of the MUSA (Morphological Uterus Sonographic Assessment) criteria for the ultrasound diagnosis of adenomyosis divides the ultrasound signs for diagnosis into direct and indirect ones, considering the presence of at least one direct sign as a mandatory criterion. This study aimed to reclassify the patients referred to the Pelvic Pain specialist outpatient clinic of the Gynecological Clinic of Udine according to the new criteria, evaluating the number of overdiagnoses and the possible correlation between the direct and indirect signs and the patients' symptoms. 62 patients affected by adenomyosis were retrospectively recruited. The patients were then re-evaluated by ultrasound and clinically. At least one direct sign of adenomyosis was found in 52 patients, while 16% of the population examined did not present any. There was no statistically significant difference between patients presenting direct signs and those presenting none for the symptoms considered. According to the new criteria, 16% of the patients examined were not affected by adenomyosis; applying the new consensus to symptomatic patients could increase false negatives. In a population of symptomatic patients, the diagnosis of adenomyosis is still highly probable even without direct ultrasound signs, given the clinical symptoms and having ruled out other causes of such symptoms.
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Affiliation(s)
- Anna Biasioli
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University-Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, 33100 Udine, Italy; (S.R.); (G.V.); (L.D.)
| | - Matilde Degano
- Department of Medicine, Università degli Studi di Udine, Via Palladio, 8, 33100 Udine, Italy;
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University-Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, 33100 Udine, Italy; (S.R.); (G.V.); (L.D.)
| | - Margherita Bagolin
- Department of Medicine, Università degli Studi di Udine, Via Palladio, 8, 33100 Udine, Italy;
| | - Francesca Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (F.M.); (F.C.); (A.C.T.)
| | - Francesca Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (F.M.); (F.C.); (A.C.T.)
| | - Antonia Carla Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (F.M.); (F.C.); (A.C.T.)
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, 40121 Ferrara, Italy;
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (F.M.); (F.C.); (A.C.T.)
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University-Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, 33100 Udine, Italy; (S.R.); (G.V.); (L.D.)
- Department of Medicine, Università degli Studi di Udine, Via Palladio, 8, 33100 Udine, Italy;
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia University-Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria Della Misericordia, 15, 33100 Udine, Italy; (S.R.); (G.V.); (L.D.)
- Department of Medicine, Università degli Studi di Udine, Via Palladio, 8, 33100 Udine, Italy;
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Silva C, Monteiro C, Barbosa F, Cunha I, Coutada R, Carvalho A. Colouterine Fistula as a Rare Cause of Postmenopausal Abnormal Uterine Bleeding: A Case Report. J Clin Med 2024; 13:783. [PMID: 38337477 PMCID: PMC10856449 DOI: 10.3390/jcm13030783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/08/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Postmenopausal abnormal uterine bleeding is a common clinical problem addressed in gynaecological practice and should prompt clinical investigation due to the significant prevalence of malignant and premalignant lesions of the endometrium in this age group. Nevertheless, other causes should be considered, since its diagnostic and therapeutic management may differ considerably. Here, we present a case of a colouterine fistula due to chronic diverticulitis presenting with postmenopausal abnormal uterine bleeding. This is an infrequent occurrence and is caused by the rupture of a diverticular abscess into the uterine wall, resulting in an inflammatory adhesion of the colon and uterus, with necrosis and subsequent fistula formation. The clinical presentation is variable and may include abdominal pain, gastrointestinal tract symptoms, vaginal discharge, and abnormal uterine bleeding. The laboratory and imaging techniques may be not completely conclusive and definitive diagnosis can be made intraoperatively. There are different treatment options, with en bloc resection and primary anastomosis being used most often, allowing complete treatment. The prognosis for a colouterine fistula secondary to diverticulitis is excellent after surgery. This case highlights the importance of clinical suspicion of an unusual cause of uterine bleeding and an effective and multidisciplinary approach that allowed complete surgical treatment and patient recovery.
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Affiliation(s)
- Cátia Silva
- Gynecological Department, Coimbra Hospital and University Centre, 3000-075 Coimbra, Portugal
| | - Cristina Monteiro
- General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (C.M.); (F.B.)
| | - Fernando Barbosa
- General Surgery Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (C.M.); (F.B.)
| | - Inês Cunha
- Gastroenterology Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal;
| | - Rosália Coutada
- Gynecological Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (R.C.); (A.C.)
| | - Agostinho Carvalho
- Gynecological Department, Local Health Unit of Alto Minho, 4904-858 Viana do Castelo, Portugal; (R.C.); (A.C.)
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Ma J, Liu D, Mao X, Huang L, Ren Y, Xu X, Huang X, Deng C, Shi F, Sun P. Enhanced Diagnostic Efficiency of Endometrial Carcinogenesis and Progression in Women with Abnormal Uterine Bleeding through Peripheral Blood Cytokine Testing: A Multicenter Retrospective Cohort Study. Int J Med Sci 2024; 21:601-611. [PMID: 38464838 PMCID: PMC10920852 DOI: 10.7150/ijms.91506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024] Open
Abstract
Objective: This study aimed to evaluate the role of plasma cytokine detection in endometrial cancer screening and tumor progression assessment in patients with abnormal uterine bleeding. Methods: In this multicenter retrospective cohort study of 287 patients with abnormal uterine bleeding, comprehensive clinical information and laboratory assessments, including cytokines, routine blood tests, and tumor markers, were performed. Associations between the clinical indicators and endometrial carcinogenesis/progression were evaluated. The independent risk factors for endometrial cancer and endometrial cancer with deep myometrial invasion were analyzed using multivariate binary logistic regression. Additionally, a diagnostic model was used to evaluate the predictive efficacy of these identified risk factors. Results: In patients with abnormal uterine bleeding, low IL-4 and high IL-8 levels were independent risk factors for endometrial cancer (p < 0.05). Combining IL-4, IL-8, CA125, and menopausal status improved the accuracy of assessing endometrial cancer risk. The area under curve of the model is 0.816. High IL-6 and IL-8 levels were independent risk factors for deep myometrial invasion in patients with endometrial cancer (p < 0.05). Similarly, combining IL-6, IL-8, and Monocyte counts enhanced the accuracy of assessing endometrial cancer risk with deep myometrial invasion. The area under curve of the model is 0.753. Conclusions: Cytokines such as IL-4, IL-8, and IL-6 can serve as markers for monitoring endometrial cancer and its progression in women with abnormal uterine bleeding.
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Affiliation(s)
- Jincheng Ma
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Dabin Liu
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
| | - Xiaodan Mao
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Leyi Huang
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Yuan Ren
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
| | - Xiaozhen Xu
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian, China
| | - Xiaoli Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian, China
- Department of Obstetrics and Gynecology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, Fujian, China
| | - Caiping Deng
- The Second Hospital of Nanping City, Nanping 354200, Fujian, China
| | - Feifeng Shi
- Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, Fujian, China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
- Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital, Fuzhou 350001, Fujian, China
- Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian, China
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Koblížková M, Bretová P, Felsinger M, Minář L, Bednaříková M, Weinberger V. Ultrasound finding of endometrial polyp and factors increasing risk of malignancy. Ceska Gynekol 2024; 89:44-51. [PMID: 38418253 DOI: 10.48095/cccg202444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article presents a comprehensive review of factors that increase the risk of malignancy in ultrasound findings of an endometrial polyp. We collected original studies, reviews, and meta-analyses that dealt with the topic of endometrial polyps and the risk of developing endometrial cancer. Each presumed risk factor was analysed individually. According to searched studies, abnormal uterine bleeding, old age, and body mass index are valid risk factors for developing endometrial cancer in endometrial polyps. Lynch syndrome patients are also in a high-risk group for endometrial cancer. On the other hand, the number of polyps, their size, diabetes mellitus, hypertension, and positive family history are factors with inconclusive results. There are either not enough data or different results among several studies.
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Yang EJ, Sabri A, Awad S, Conrad LB, Cantu D. Disseminated Anaplastic Lymphoma Kinase (ALK)-Positive T-cell Lymphoma Involving the Uterus and Cervix: A Case Report. Cureus 2024; 16:e52815. [PMID: 38389588 PMCID: PMC10883764 DOI: 10.7759/cureus.52815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Primary or secondary non-Hodgkin lymphomas (NHLs) involving the female gynecologic tract are rare. T-cell subtypes are further rare and portend a worse prognosis. We present a case of a 23-year-old female presenting with a cervical mass accompanied by constitutional symptoms and abnormal vaginal bleeding. Immunohistochemistry studies revealed the presence of disseminated T-cell non-Hodgkin lymphoma that was anaplastic lymphoma kinase (ALK)-positive. The patient demonstrated a complete response to systemic chemotherapy initially and again after the relapse of the disease one year after diagnosis. To our knowledge, this is the first case of an ALK-positive T-cell lymphoma with secondary involvement of the uterus and cervix; all previously published cases of this histologic subtype in the gynecologic tract describe primary disease of the vagina. This case emphasizes the importance of immunohistochemistry studies inclusive of T-cell and B-cell markers when evaluating biopsies from cervical tumors to render the appropriate diagnosis and guide systemic therapy.
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Affiliation(s)
- Erin J Yang
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, USA
| | - Ahmed Sabri
- Department of Pathology, Creighton University School of Medicine, Omaha, USA
| | - Seifeldin Awad
- Department of Pathology, Creighton University School of Medicine, Omaha, USA
| | - Lesley B Conrad
- Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, USA
| | - David Cantu
- Department of Pathology, Creighton University School of Medicine, Omaha, USA
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Khattab S, Yu CH, Shah S. Prolactinoma and Adenomyosis - More than Meets the Eye: A Case Report. AACE Clin Case Rep 2024; 10:20-23. [PMID: 38303768 PMCID: PMC10829864 DOI: 10.1016/j.aace.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/03/2024] Open
Abstract
Background/Objective To report a case of adenomyosis in a woman with hyperprolactinemia which resolved after initiation of dopamine agonist therapy. Case Report A 35-year-old woman with a history of Graves' disease was referred for evaluation of hyperthyroidism in March 2020. She was started on methimazole and thyroid function normalized. The patient also had a history of a pituitary microadenoma and was previously treated with cabergoline which was stopped after 12 months as she became pregnant.In July 2020, the patient began to have polymenorrhea. Hyperprolactinemia was thought to be an unlikely cause as it most often causes hypogonadotropic hypogonadism with amenorrhea. A pelvic ultrasound demonstrated a bulky uterus with adenomyosis. Gynecology recommended treating adenomyosis by lowering her prolactin levels. She was started on cabergoline 0.25 mg weekly in October 2021. Within 2 months of initiation of cabergoline, she had resolution of symptoms and radiological resolution of adenomyosis. Discussion Prolactin has been implicated in the pathogenesis of adenomyosis, endometriosis and leiomyomas suggesting that a decrease in prolactin levels may suppress these lesions. The pathogenesis of adenomyosis has been related to direct prolactin effects in the promotion of gland/cell proliferation and function. Conclusion We conclude that prolonged elevation in prolactin may result in the development of adenomyosis and subsequent prolonged abnormal uterine bleeding. Dopamine agonists, like cabergoline, inhibit the synthesis and secretion of prolactin from the pituitary gland and may have a role in the management of adenomyosis in patients with hyperprolactinemia.
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Affiliation(s)
- Shereen Khattab
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Catherine H. Yu
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
- Division of Endocrinology & Metabolism, St. Michael's Hospital (Unity Health Toronto), Toronto, Ontario, Canada
| | - Sapna Shah
- Division of Endocrinology, Diabetes & Metabolism, University of Arizona College of Medicine, Tucson, Arizona
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Payne M, Bacal V, Bougie O, Nguyen V, Baier K, Gratton SM, Holubeshen Formerly Khair S, Medor MC, Mercier S, Choudhry AJ, Chen I. Validation of the Canadian Institute for Health Information Diagnostic Codes for Benign Gynaecologic Surgery. J Obstet Gynaecol Can 2023:102343. [PMID: 38160795 DOI: 10.1016/j.jogc.2023.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
We investigated the validity of the 10th Revision Canadian modification of International Statistical Classification of Disease and Related Health Problems (ICD-10-CA) diagnostic codes for surgery for benign gynaecologic conditions in the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD), the main source of routinely collected data in Canada. Reabstracted data from patient charts was compared to ICD-10-CA codes and measures of validity were calculated with 95% confidence intervals. A total of 1068 procedures were identified. More objective, structural diagnoses (fibroids, prolapse) had higher sensitivity and near-perfect Kappa coefficients, while more subjective, symptomatic diagnoses (abnormal uterine bleeding, pelvic pain) had lower sensitivity and moderate-substantial Kappa coefficients. Specificity, positive predictive values, and negative predictive values were generally high for all diagnoses. These findings support the use of CIHI-DAD data for gynaecologic research.
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Affiliation(s)
- Magdalene Payne
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Vanessa Bacal
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada
| | - Vincent Nguyen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Kristina Baier
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | - Abdul Jamil Choudhry
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Innie Chen
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Zhang Q, Lin C, Wu J, Xu D, Zhu S, Jiang B. Value and influencing factors of preoperative MRI evaluation for previous cesarean scar defect associated abnormal uterine bleeding in patients undergoing laparoscopic surgery. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:1316-1324. [PMID: 38044642 PMCID: PMC10929877 DOI: 10.11817/j.issn.1672-7347.2023.230123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES As the cesarean section rate increases year by year, the treatment of previous cesarean scar defects (PCSD) poses a significant challenge. This study aims to evaluate the clinical value of preoperative magnetic resonance imaging (MRI) technology and analyze relevant influencing factors for patients with abnormal uterine bleeding (AUB) associated with cesarean scar defects who underwent laparoscopic surgery. METHODS A retrospective cohort analysis was performed on women who underwent laparoscopic surgery for PCSD-related AUB at the Department of Gynecology, the Third Xiangya Hospital of Central South University from 2018 to 2022. A total of 57 patients who underwent laparoscopic surgery for the treatment of AUB associated with PCSD were divided into 2 groups based on their postoperative clinical cure status: The clinically-cured group (n=28, 49.1%) and the non-clinically-cured group (n=29, 50.9%). After a postoperative follow-up period of 3 months for all participants, logistic regression analysis was conducted to explore the correlation between the clinical cure rate of AUB associated with cesarean scar defects treated by laparoscopic surgery and various factors. These factors included patient age, clinical symptoms, obstetric history, history of cesarean section, basic clinical information, preoperative MRI parameters, and postoperative menstrual conditions. RESULTS There were no significant differences in many aspects, including the patient's age at the time of previous cesarean section, number of pregnancy, time since the previous cesarean section, the uterus position assessed by preoperative T2 signal MRI, defect length, defect width, residual muscle layer thickness, adjacent uterine muscle layer thickness, and distance from the defect to the external cervical os between the 2 groups (all P>0.05). However, the time of onset of AUB symptoms (P=0.036, OR=1.019, 95% CI 1.002 to 1.038) and the depth of the defect on the preoperative MRI (P=0.010, OR=5.793, 95% CI 1.635 to 25.210) were identified as risk factors affecting the clinical cure rate. CONCLUSIONS The time of onset of AUB symptoms and the depth of the defect on preoperative MRI are risk factors that influence the clinical cure rate of laparoscopic surgery for the treatment of AUB associated with PCSD, which could be helpful for evaluating the prognosis of disease.
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Affiliation(s)
- Qi Zhang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Changwei Lin
- Department of Gastrointestinal Surgery, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Jiaoyang Wu
- Department of Radiology, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Shujuan Zhu
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Bin Jiang
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013.
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Singh P, Patro SS, Singhal T, Parida GK, Agrawal K. Uterine Metastasis Presenting as Abnormal Uterine Bleeding in a Case of Primary Breast Cancer Identified on 18F-FDG PET/CT. J Nucl Med Technol 2023; 51:333-334. [PMID: 37699642 DOI: 10.2967/jnmt.123.266221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
Metastases to the female genital tract are rare, especially from extragenital primaries. The most common extragenital sites associated with genital metastasis are the gastrointestinal tract (37.6%) followed by the breast (34.9%). It is crucial to differentiate primary from metastatic involvement of the uterus for appropriate patient management. We present one such case of endometrial metastasis in a patient who presented clinically with abnormal uterine bleeding and was diagnosed with primary breast cancer via 18F-FDG PET/CT.
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Affiliation(s)
- Parneet Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sai Sradha Patro
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Tejasvini Singhal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Paul P, Shah M, Sridivya Chowdary V, Anusha Raaj A, Paul G. Suture-fixation of a levonorgestrel-releasing intrauterine device under hysteroscopic guidance. Facts Views Vis Obgyn 2023; 15:355-358. [PMID: 38128094 PMCID: PMC10832649 DOI: 10.52054/fvvo.15.4.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Abnormal uterine bleeding (AUB) is a common gynaecological condition. The levonorgestrel-releasing Intrauterine device (LNG-IUD) is an effective medical treatment. option which carries a small risk of device expulsion. For those who experience expulsion, some may benefit from a more robust surgical approach. Objectives To demonstrate the technique for suture fixation of an LNG-IUD under hysteroscopic guidance. Materials and methods: Stepwise video demonstration of the technique using a 5mm hysteroscope and a 3mm laparoscopic needle holder. The Institutional Ethical Committee was consulted, and the requirement for approval was waived because the video described a modified surgical technique. Informed consent was obtained from the patient. Main outcome measures A 35yr old parous woman with a nine-month history of AUB and severe dysmenorrhoea had an LNG-IUD sited with effective symptom relief. Unfortunately, the device was expelled six months after insertion, and she responded poorly to other medical treatments. Transvaginal ultrasonography (TVUS) suggested posterior wall adenomyosis. Considering her relief of symptoms with the LNG-IUD and history of expulsion, the patient was counselled regarding suture-fixation of the LNG-IUD. Results She was followed-up at 6 months post insertion. The LNG-IUD was noted in the uterine cavity without displacement or expulsion. Conclusion Hysteroscopy-guided suture fixation of an LNG-IUD is a minimally invasive, effective option for patients with a history of expulsion of an IUD. However, further studies are required to establish the safety and efficacy of this approach. Learning Objective To demonstrate LNG -IUD suture fixation technique using hysteroscopy for patients diagnosed with AUB and a history of device expulsion.
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Affiliation(s)
- P.G. Paul
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - M Shah
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - V Sridivya Chowdary
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - A Anusha Raaj
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
| | - G Paul
- Paul’s Hospital, Centre for Advanced Endoscopy and Infertility, Vattekkattu Road, Kaloor, Kochi, Kerala, India
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Qi B, Sun Y, Lv Y, Hu P, Ma Y, Gao W, Li S, Zhang X, Jin X, Liou Y, Liu P, Liu S. Hypermethylated CDO1 and CELF4 in cytological specimens as triage strategy biomarkers in endometrial malignant lesions. Front Oncol 2023; 13:1289366. [PMID: 38107069 PMCID: PMC10722236 DOI: 10.3389/fonc.2023.1289366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Objective Developing a non-invasive and reliable triage test for endometrial malignant lesions is an important goal, as it could help to reduce the number of invasive diagnostic procedures required and improve patient survival. We aimed to estimate the diagnostic value of DNA methylation levels in cervical cytological samples of endometrial cancer (EC) and endometrial atypical hyperplasia (AH). Methods A total of 607 women who had indications for endometrial biopsy in the Department of Obstetrics and Gynecology of Cangzhou Central Hospital from October 2022 to April 2023 were enrolled in this study. The cervical exfoliated cells were collected for gene methylation before endometrial biopsy. Clinical information, tumor biomarkers, and endometrial thickness (ET) of transvaginal ultrasonography (TVS) were also collected. With endometrial histopathology as the gold standard, multivariate unconditional logistic regression was applied to analyze the risk factors of endometrial malignant lesions. The role of cysteine dioxygenase type 1 (CDO1) and CUGBP Elav-like family member 4 (CELF4) gene methylation as a triage strategy biomarker in endometrial malignant lesions was specifically explored. Results Multivariate logistic regression analysis showed that premenopausal ET ≥ 11 mm or postmenopausal ET ≥ 5 mm, CDO1 ΔCt ≤ 8.4, or CELF4 ΔCt ≤ 8.8 were the risk factors for AH and EC, with odds ratios (ORs) (95%CI) of 5.03 (1.83-13.82) and 6.92 (1.10-43.44), respectively (p-values < 0.05). The sensitivity and specificity of CDO1/CELF4 dual-gene methylation assay for AH and EC reached 84.9% (95%CI: 75.3%-94.5%) and 86.6% (95%CI: 83.8%-89.5%), respectively. ET combined with DNA methylation detection further improved the specificity to (94.9%, 95%CI: 93.1%-96.8%). Conclusion The accuracy of cervical cytology DNA methylation is superior to that of other clinical indicators in the non-invasive examination of endometrial malignant lesions. DNA methylation combined with TVS can further improve the specificity and is a promising biomarker triage strategy in women with suspected endometrial lesions.
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Affiliation(s)
- Bingli Qi
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Ye Sun
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yaohua Lv
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Pei Hu
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yanli Ma
- Department of Pharmacy, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Wenying Gao
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Shumei Li
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xin Zhang
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xitong Jin
- Department of Medical Laboratory, Beijing Origin-Poly Bio-Tec Co., Ltd., Beijing, China
| | - Yuligh Liou
- Department of Medical Laboratory, Beijing Origin-Poly Bio-Tec Co., Ltd., Beijing, China
| | - Pei Liu
- Department of Medical Laboratory, Beijing Origin-Poly Bio-Tec Co., Ltd., Beijing, China
| | - Shikai Liu
- Department of Gynecologic Oncology and Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China
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21
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Cai J, Parnall T, Tomassetti S, Qing X. Diffuse large B-cell lymphoma presenting as postmenopausal bleeding. Clin Case Rep 2023; 11:e8173. [PMID: 37965185 PMCID: PMC10641298 DOI: 10.1002/ccr3.8173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
Key Clinical Message Endometrial lymphoma is a rare etiology of abnormal uterine bleeding and endometrial thickening, and often shares similar clinical and imaging characteristics with other uterine malignancies such as endometrial carcinoma. Chemotherapy appears adequate for treating primary endometrial lymphoma. Abstract We report a case of primary endometrial diffuse large B-cell lymphoma to increase awareness of this condition which is essential for correct diagnosis and treatment.
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Affiliation(s)
- Jennifer Cai
- Department of PathologyHarbor‐UCLA Medical CenterTorranceCaliforniaUSA
- University of CaliforniaIrvineCaliforniaUSA
| | - Taylor Parnall
- Department of RadiologyHarbor‐UCLA Medical CenterTorranceCaliforniaUSA
| | - Sarah Tomassetti
- Division of Hematology and OncologyHarbor‐UCLA Medical CenterTorranceCaliforniaUSA
- The David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Xin Qing
- Department of PathologyHarbor‐UCLA Medical CenterTorranceCaliforniaUSA
- The David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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22
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Chang DH, Dumanski SM, Brennand EA, Ruzycki SM, Ramage K, Gantar T, Shah S, Ahmed SB. Female Reproductive Health and Contraception Use in CKD: An International Mixed-Methods Study. Kidney Med 2023; 5:100713. [PMID: 37719717 PMCID: PMC10502408 DOI: 10.1016/j.xkme.2023.100713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Rationale & Objective Female reproductive health is recognized as a predictor of morbidity, mortality, and quality of life, although data in the setting of chronic kidney disease (CKD) are limited. Study Design A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey. Phase 2 was semistructured interviews offered to all respondents upon survey completion. Setting & Participants The survey was disseminated internationally from October 4, 2021, to January 7, 2022, to individuals aged 18-50 years with both a uterus and CKD diagnosis. Outcomes Menstrual health and contraceptive use by CKD stage (dialysis, nondialysis CKD, and transplant). Analytical Approach Survey data were analyzed using descriptive statistics. Interview data were analyzed using the framework method of analysis. Results Of 152 respondents, 98 (mean age 33 ± 0.7 years; n = 20 dialysis, n = 59 nondialysis CKD, n = 19 transplant) satisfied the inclusion criteria, representing 3 continents. The most common causes of CKD among survey respondents were hereditary causes in dialysis (n = 6, 30%) and glomerulonephritis in nondialysis CKD (n = 22, 37%) and transplant (n = 6, 32%). The majority reported heavy menstrual bleeding (n = 12, 86% dialysis; n = 46, 94% nondialysis CKD; n = 14, 100% transplant). Less than half of participants were consistently able to afford period products. Condoms were the most common contraceptive reported. Most participants reported no contraceptive use (n = 10, 50% dialysis; n = 37, 63% nondialysis CKD; n = 7, 37% transplant), primarily because of "fear". Interviews (n = 6) revealed a perception of a relationship between kidney function and menstrual health, concerns about contraceptive use, and a desire for greater multidisciplinary care to improve kidney and reproductive health. Limitations Self-reported outcomes, need for internet access and a device. Conclusions Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population. Plain-Language Summary Chronic kidney disease (CKD) in female individuals is accompanied by menstrual disorders and low contraceptive use. However, most data are limited to the dialysis and transplant populations. Therefore, this mixed-methods study aimed to describe self-assessed menstruation and contraceptive use across all stages of CKD. People aged 18-50 years with a uterus and CKD diagnosis were invited to participate in an online survey shared internationally as well as an optional telephone interview. Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population.
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Affiliation(s)
- Danica H. Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Sandra M. Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Shannon M. Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Kaylee Ramage
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn Gantar
- Kidney Health Strategic Clinical Network, Alberta, Canada
| | - Silvi Shah
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Sofia B. Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
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23
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Zhang HL, Zhu JE, Deng EY, Li JX, Sun LP, Peng CZ, Xu HX, Yu SY. Ultrasound-guided percutaneous microwave ablation for adenomyosis with abnormal uterine bleeding: clinical outcome and associated factors. Int J Hyperthermia 2023; 40:2249274. [PMID: 37751897 DOI: 10.1080/02656736.2023.2249274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE To investigate the factors affecting the efficacy of ultrasound (US)-guided percutaneous microwave ablation (PMWA) for adenomyosis with abnormal uterine bleeding (AUB-A). METHODS Baseline data of patients with AUB-A who underwent US-guided PMWA treatment between October 2020 and October 2021, including demography characteristics, laboratory and imaging examination results were retrospectively analyzed. 3D reconstruction of magnetic resonance imaging (MRI) was applied to quantitatively assess the local treatment responses, including ratio of non-perfusion volume to adenomyosis volume (NPVr), ablation rate of the endometrial-myometrial junction (EMJ), and surface area (SA) of the ablated part of the EMJ. Patients were followed up at 3, 6, and 12 months after treatment, and divided into two groups: group with complete relief (CR), and group with partial relief (PR) or no relief (NR). Data were compared between them. RESULTS Thirty-one patients were analyzed with a mean age of 38.7 ± 6.8 years (range: 24-48): 48.4% (15/31), 63.3% (19/30), and 65.5% (19/29) achieved CR at 3, 6, and 12 months, respectively. In univariate analysis, compared with the PR/NR group, serum CA125 levels were significantly lower in CR group at 3 months, while ablation rates of EMJ and SA of the ablated part of the EMJ were significantly higher at the three time points. Other baseline characteristics and NPVr did not differ between the two groups. CONCLUSION Baseline CA125 and ablation rate of the EMJ and SA of the ablated part of the EMJ are associated with the outcome of AUB-A patients after US-guided PMWA treatment.
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Affiliation(s)
- Hui-Li Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Jing-E Zhu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Er-Ya Deng
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Jia-Xin Li
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Cheng-Zhong Peng
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
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24
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Zamarripa Leyva JM, Kway VB, Zamora Zamora KY, Jimenez Esquivel RM, Ling Garcia JP, Martinez Martinez R, Gomez Hernandez NJ, Martinez Trejo Z, Gonzalez Garcia GK, Mendoza Huerta M. Abnormal uterine bleeding in a 2-month-old infant: Workup, instrumentation, and endoscopic management-A case report. Int J Gynaecol Obstet 2023; 162:1108-1110. [PMID: 37309257 DOI: 10.1002/ijgo.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
SynopsisA case report of a 2‐month‐old patient with severe abnormal uterine bleeding and vascular neoplastic malformation who was diagnosed and managed by endoscopic and vessel embolization therapy.
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Affiliation(s)
- Jose Manuel Zamarripa Leyva
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | - Venance Basil Kway
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | | | - Jose Pablo Ling Garcia
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | - Raul Martinez Martinez
- Department of Radiology, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | - Zulema Martinez Trejo
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
| | | | - Manuel Mendoza Huerta
- Department of Gynecology and Obstetrics, Central Hospital Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico
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25
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Saenz D, Fernández JD, Cóbar JP. Challenges in diagnosis and treatment: a case report on a mixed malignant Müllerian tumor. J Surg Case Rep 2023; 2023:rjad523. [PMID: 37724065 PMCID: PMC10505514 DOI: 10.1093/jscr/rjad523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/26/2023] [Indexed: 09/20/2023] Open
Abstract
Mixed malignant Müllerian tumors (MMMTs) are rare and aggressive neoplasms made up of both carcinomatous and sarcomatous components that primarily appear in the female reproductive tract. The cellular origin of this malignancy has eluded advancements in molecular and immunohistochemical techniques contributing to the limited diagnostic and therapeutic strategies. This case report presents a 41-year-old female with a history of abnormal uterine bleeding and dysmenorrhea who was later diagnosed with an MMMT. This case highlights the importance of considering MMMTs in patients with a long-standing history of abnormal uterine bleeding because the prompt recognition and diagnosis of this condition may lead to an improved overall survival for these patients.
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Affiliation(s)
- Daniela Saenz
- Department of Medical Research, Universidad Francisco Marroquín, Guatemala City 01010, Guatemala
| | - Jorge D Fernández
- Department of Medical Research, Universidad Francisco Marroquín, Guatemala City 01010, Guatemala
| | - Juan P Cóbar
- Department of Medical Research, Universidad Francisco Marroquín, Guatemala City 01010, Guatemala
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26
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Kontogiannis A, Matsas A, Valsami S, Livanou ME, Panoskaltsis T, Christopoulos P. Primary Hemostasis Disorders as a Cause of Heavy Menstrual Bleeding in Women of Reproductive Age. J Clin Med 2023; 12:5702. [PMID: 37685769 PMCID: PMC10488471 DOI: 10.3390/jcm12175702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Heavy menstrual bleeding (HMB) is a common clinical condition affecting adolescent and adult women and compromising their quality of life. Primary hemostasis disorders, affecting platelet plug formation, can be the underlying cause of HMB. They comprise a heterogeneous group of diseases with Von Willebrand disease (VWD) being the most commonly diagnosed; other disorders in this group that have been linked to HMB include (a) Glanzmann thrombasthenia, (b) Bernard-Soulier syndrome, (c) Hermansky-Pudlak syndrome, (d) immune thrombocytopenia (ITP), and (e) Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD). Diagnosing these diseases can be challenging, as the basic laboratory investigations can be within the normal range. Thus, identification of specific clinical features and a thorough hematologic workup can be very important, providing the correct diagnosis. Proper diagnosis of the underlying disorder is important, as management may vary accordingly. Although disease-specific management guidelines exist for some of these disorders such as VWD and ITP, due to the rarity of most primary hemostasis disorders, the best approach for the management of HMB in these women remains elusive. The goal of this study was to create an informative, comprehensive review of the primary hemostasis disorders that have been linked to HMB. This study provides a summary of the basic published information regarding epidemiology, pathophysiology, clinical phenotype, diagnosis, and treatment of HMB in those diseases and serves as a reference guide for further reading.
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Affiliation(s)
- Athanasios Kontogiannis
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Alkis Matsas
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Serena Valsami
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Effrosyni Livanou
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, “Aretaieion” Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
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27
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Maurer J, Ramani S, Xu B, Gallousis S, Clark M, Andikyan V. Delayed presentation of placenta accreta following a first-trimester medical abortion. Clin Case Rep 2023; 11:e7849. [PMID: 37636882 PMCID: PMC10457480 DOI: 10.1002/ccr3.7849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Placenta accreta can rarely present as a uterine mass on imaging months after a first trimester medical abortion, even in patients at low-risk for abnormal placentation. Early and accurate diagnosis can be crucial to reduce morbidity and mortality associated with this disease, particularly for those desiring fertility preservation.
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Affiliation(s)
- Jenna Maurer
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
| | - Sangeeta Ramani
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
| | - Bo Xu
- Department of PathologyStamford HospitalStamfordConnecticutUSA
| | - Stephen Gallousis
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
| | - Mitchell Clark
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenConnecticutUSA
| | - Vaagn Andikyan
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenConnecticutUSA
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28
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Lu QP, Wu ML, Li HL, Zhou Y, Xian MH, Huang WZ, Piao XH, Ge YW. Combined Metabolite Analysis and Network Pharmacology to Elucidate the Mechanisms of Therapeutic Effect of Melastoma dodecandrum Ellagitannins on Abnormal Uterine Bleeding. Chem Biodivers 2023; 20:e202300646. [PMID: 37358391 DOI: 10.1002/cbdv.202300646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 06/27/2023]
Abstract
The abnormal uterine bleeding (AUB) is complex and usually leads to severe anemia. Melastomadodecandrum (MD) is clinically used for the treatment of metrorrhagia bleeding. The MD ellagitannins (MD-ETs) had been evidenced being effective at hemorrhage, and exerts biological activities upon their metabolites including ellagic acid and urolithins. In this study, the blood-permeated metabolites from theMD-ETs were analyzed using LC-MS approach, and 19 metabolites including ellagic acid and urolithin A derivatives were identified. Furthermore, a network pharmacology analysis including the target prediction analysis, AUB target analysis, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were conducted to reveal the relationships between "metabolites-targets-pathways", which was further verified by molecular docking analysis. The results showed that methyl ellagic acid, urolithin A and isourolithin A produced from MD-ETs can be absorbed into the blood, and might act on the core targets of VEGFA, SRC, MTOR, EGFR and CCND1. And the hemostatic effects were exerted through PI3K-Akt, endocrine resistance and Rap 1 signaling pathways. These results implied the potential effective constituents and action mechanism of MD-ETs in the therapy of AUB, which will promote the application of MD-ETs as natural agent for the treatment of gynecological bleeding diseases.
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Affiliation(s)
- Qiu-Ping Lu
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of National Administration of TCM, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Miao-Li Wu
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of National Administration of TCM, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Hui-Lin Li
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of National Administration of TCM, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yu Zhou
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of National Administration of TCM, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Ming-Hua Xian
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of National Administration of TCM, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Wei-Zhong Huang
- Guangdong Luofushan Sinopharm Co., Ltd., Huizhou, 516133, China
| | - Xiu-Hong Piao
- School of Life Sciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Yue-Wei Ge
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica of National Administration of TCM, Guangdong Pharmaceutical University, Guangzhou, 510006, China
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29
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Abbott JA, Munro MG. Evidence gaps for the global problem of iron deficiency and iron deficiency anemia in women and girls of reproductive age. Int J Gynaecol Obstet 2023; 162 Suppl 2:89-92. [PMID: 37538009 DOI: 10.1002/ijgo.14952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The symptom of heavy menstrual bleeding and the frequently associated condition of iron deficiency (ID) individually and collectively adversely impact the lives of women and girls of reproductive age in various ways. The insidious but sometimes profound effects of periconceptual ID on the developing fetus may continue throughout the individual's life with consequences that are also felt by families, friends, and society at large. Unfortunately, in most instances, current healthcare policies are not designed to address the plethora of issues in a fashion that will result in meaningful improvement in health and other outcomes that affect both individuals and society. Identification and prioritization of the many evidence gaps will be an essential component of the strategy for change. This article identifies and describes the evidence gaps and provides direction for investigators and those involved in healthcare policy.
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Affiliation(s)
- Jason A Abbott
- Department of Obstetrics and Gynecology, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, University of California, Los Angles, Los Angeles, California, USA
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30
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Munro MG. Heavy menstrual bleeding, iron deficiency, and iron deficiency anemia: Framing the issue. Int J Gynaecol Obstet 2023; 162 Suppl 2:7-13. [PMID: 37538011 DOI: 10.1002/ijgo.14943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
For girls and women in their reproductive years, the symptom of heavy menstrual bleeding (HMB) is the most common cause of iron deficiency (ID), including the extreme manifestation of iron deficiency anemia (IDA). It is recognized that these two clinical entities are not only ubiquitous, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both HMB and ID/IDA adversely impact quality of life-HMB during the episodes of bleeding and ID daily as long as the ID exists. These combined issues undermine the lives of reproductive-aged girls and women of all ages, from menarche to menopause. At the same time, pervading culture and the often insidious nature of these disorders frequently lead to societal normalization, including by healthcare professionals. The effects on cognitive function as well as the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence suggesting that ID, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders-effects that can have widespread impacts on society. Collectively, this critically important evidence begs the implementation of diagnostic and management guidelines aimed at identifying iron-deficient girls and women, repleting their iron stores, and, when present, effectively treating the most common reason for the problem-the various causes of the symptom of HMB.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Abstract
Abnormal uterine bleeding (AUB) is common, often debilitating, and may affect over 50% of reproductive-aged women and girls. Whereas AUB is a collection of symptoms that include intermenstrual bleeding and abnormalities in period duration, cycle length, and regularity, it is heavy menstrual bleeding (HMB) that is most contributory to iron deficiency and related anemia. It is apparent that AUB, in general, and HMB, in particular, remain underrecognized and underreported. FIGO created two systems for assessing and classifying AUB. FIGO System 1 defines the bleeding pattern using four primary descriptors: frequency, duration, regularity, and flow volume. FIGO System 2 provides a structured classification system of possible causes of AUB, using the acronym PALM-COEIN. "PALM" refers to structural causes of AUB (Polyp, Adenomyosis, Leiomyoma, Malignancy), and "COEI" refers to nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, and Iatrogenic). The "N" is reserved for those entities that are currently not otherwise classified. Using FIGO System 1 as a gateway to FIGO System 2 streamlines the investigation of reproductive-aged women and girls with AUB. Understanding the pathogenesis of the FIGO System 2 "PALM-COEIN" causes helps interpret investigations and the onward management of AUB. Numerous evidence gaps exist concerning AUB; however, if researchers and trialists universally adopt FIGO Systems 1 and 2 for the assessment and diagnosis of AUB, clear translatable research findings can be applied globally.
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Affiliation(s)
- Varsha Jain
- Centre for Reproductive HealthUniversity of EdinburghEdinburgh, ScotlandUK
| | - Malcolm G. Munro
- Department of Obstetrics and GynecologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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Munro MG, Critchley HOD. Our path from abnormal uterine bleeding and iron deficiency to impaired fetal development: A long and winding road. Int J Gynaecol Obstet 2023; 162 Suppl 2:3-6. [PMID: 37538012 DOI: 10.1002/ijgo.14942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
SynopsisAbnormal uterine bleeding adversely impacts the lives of reproductive‐aged girls and women; furthermore, the resulting periconceptual iron deficiency risks enduring neurological sequelae in the child.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, The University of California, Los Angeles, Los Angeles, California, USA
- FIGO Committee on Menstrual Disorders and Related Health Impacts (MDRHI), London, UK
| | - Hilary O D Critchley
- FIGO Committee on Menstrual Disorders and Related Health Impacts (MDRHI), London, UK
- Centre for Reproductive Health, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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Song X, Na R, Peng N, Cao W, Ke Y, Liu P, Chen C. Case report: The intrauterine suture surgery-an original method in the treatment of old uterine false passage. Front Surg 2023; 10:1193961. [PMID: 37576922 PMCID: PMC10416626 DOI: 10.3389/fsurg.2023.1193961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To introduce an effective approach using the hysteroscopy system for patients with old uterine false passage after a failed conservative treatment. Materials and methods This study presents the case of a 34-year-old woman who was treated in the Department of Gynecology of Shenzhen Integrated Traditional Chinese and Western Medicine Hospital in 2018 with the complaint of "menstrual volumereduction for 2 years after abortion." A hysteroscopy was performed to make a clear diagnosis: (1) uterine cavity adhesion and (2) old uterine false passage. After the separation of adhesions, the patient was treated with estradiol and progesterone in sequence (estradiol valerate 3 mg, b.i.d., oral for 21 days; and dydrogesterone tablets 10 mg, b.i.d., oral for the second half of the cycle) for 3 months. After the review of the hysteroscopy results, it was found that there was no improvement in the old false passage; therefore, a suture and knotting surgery under hysteroscopy was performed to treat the old false passage in the uterus within 10 min, and the intraoperative blood loss was 2 ml. The patient was discharged 24 h postoperatively without any adverse perioperative complications. Results Two months after the operation, the review of the hysteroscopy results showed that the old false passage in the uterus disappeared. After the 6-month follow-up, the menstrual volume increased compared with the previous one, close to the normal menstrual volume, and the patient experienced no pain and menstrual discomfort. The patient was lost to follow-up and was contacted again in 2022. It was found out that in 2019, she was pregnant with a baby boy who is now 3 years old and healthy. Conclusion The intrauterine suture surgery presents a clear visual field to old uterine false passage after a failed conservative treatment. In patients with old uterine false passage suffering from reduced fertility, the intrauterine suture surgery can be a minimally invasive and effective alternative if the conservative treatment for old uterine false passage failed.
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Affiliation(s)
- Xiaolei Song
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Re Na
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Nianghai Peng
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Wenming Cao
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Yan Ke
- Department of Gynecology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Ping Liu
- Department of Gynecology, Southern Hospital of Southern Medical University, Guangdong, China
| | - Chunlin Chen
- Department of Gynecology, Southern Hospital of Southern Medical University, Guangdong, China
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Moawad G, Fruscalzo A, Youssef Y, Kheil M, Tawil T, Nehme J, Pirtea P, Guani B, Afaneh H, Ayoubi JM, Feki A. Adenomyosis: An Updated Review on Diagnosis and Classification. J Clin Med 2023; 12:4828. [PMID: 37510943 PMCID: PMC10381628 DOI: 10.3390/jcm12144828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Adenomyosis is a commonly diagnosed benign condition characterized by the presence of ectopic endometrial glands within the underlying myometrium. The most common presenting signs and symptoms are abnormal uterine bleeding, chronic pelvic pain, and infertility. The clinical relevance of this condition is evident in both medical and surgical care. Histopathology and imaging studies are used for the diagnosis and classification of adenomyosis, which are hallmarks of the advancement of our ability to diagnose adenomyosis. Importantly, the diagnosis and classification of adenomyosis lacks standardization due to the nature of imaging techniques, features of adenomyosis, and the clinical spectrum of adenomyosis. We reviewed the literature to summarize the available classification systems for adenomyosis and highlight the different imaging approaches and histologic criteria used in diagnosis. Despite the high prevalence of the disease, there is no clear consensus on one classification system. We provide a review of some of the classification systems available and discuss their strengths and limitations.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynaecology, The George Washington University Hospital, Washington, DC 20037, USA
| | - Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR-Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Youssef Youssef
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology-Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Mira Kheil
- Department of Obstetrics & Gynecology, Henry Ford Health, Detroit, MI 48202, USA
| | - Tala Tawil
- Department of Pathology, Henry Ford Health, Detroit, MI 48202, USA
| | - Jimmy Nehme
- Department of Internal Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Paul Pirtea
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hopital Foch-Faculté de Médecine Paris, 92150 Suresnes, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, HFR-Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Huda Afaneh
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hopital Foch-Faculté de Médecine Paris, 92150 Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR-Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
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Rezende GP, Brito LGO, Gomes DAY, de Souza LM, Polo S, Benetti-Pinto CL. Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women. SAO PAULO MED J 2023; 142:e2022539. [PMID: 37436255 PMCID: PMC10328441 DOI: 10.1590/1516-3180.2022.0539.r2.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.
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Affiliation(s)
- Gabriela Pravatta Rezende
- MD, MSc. Attending Physician, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
| | - Luiz Gustavo Oliveira Brito
- MD, PhD. Associate Professor, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
| | - Daniela Angerame Yela Gomes
- MD, PhD. Associate Professor, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
| | - Leticia Mansano de Souza
- Medical Student, School of Medical Sciences, Universidade
Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Sergio Polo
- Medical Student, School of Medical Sciences, Universidade
Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Cristina Laguna Benetti-Pinto
- MD, PhD. Associate Professor, Department of Tocogynecology,
School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP),
Campinas (SP), Brazil
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Munro MG, Mast AE, Powers JM, Kouides PA, O'Brien SH, Richards T, Lavin M, Levy BS. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. Am J Obstet Gynecol 2023; 229:1-9. [PMID: 36706856 DOI: 10.1016/j.ajog.2023.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
For reproductive-aged women, the symptom of heavy menstrual bleeding is highly prevalent and a major contributor to iron deficiency and its most severe manifestation, iron deficiency anemia. It is recognized that these 2 clinical entities are not only highly prevalent, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both heavy menstrual bleeding and iron deficiency, with or without anemia, adversely impact quality of life-heavy menstrual bleeding during the episodes of bleeding and iron deficiency on a daily basis. These combined issues adversely affect the lives of reproductive-aged girls and women of all ages, from menarche to menopause, and their often-insidious nature frequently leads to normalization. The effects on cognitive function and the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence that suggests that iron deficiency, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders, critically important evidence that begs the normalization of iron stores in reproductive-aged women. The authors seek to raise individual, societal, and professional awareness of this underappreciated situation in a fashion that leads to meaningful and evidence-based changes in clinical guidance and healthcare policy directed at preventing, screening, diagnosing, and appropriately managing both disorders. This manuscript provides evidence supporting the need for action and describes the elements necessary to address this pervasive set of conditions that not only affect reproductive-aged girls and women but also the lives of children everywhere.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Alan E Mast
- Versiti Blood Research Institute, Milwaukee, WI
| | - Jacquelyn M Powers
- Department of Pediatrics, Baylor College of Medicine, Houston TX; Cancer and Hematology Center, Texas Children's Hospital, Houston, TX
| | - Peter A Kouides
- Mary M. Gooley Hemophilia Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sarah H O'Brien
- Center for Health Equity and Outcomes Research and the Hemostasis and Thrombosis Center, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division of Pediatric Hematology, Oncology & Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH
| | - Toby Richards
- Division of Surgery, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Michelle Lavin
- National Coagulation Centre, St James' Hospital, Dublin, Ireland; Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara S Levy
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, CA; Department of Obstetrics and Gynecology, The George Washington University, Washington, DC
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Porcaro G, Bilotta G, Capoccia E, Bezerra Espinola MS, Aragona C. D-Chiro-Inositol in Endometrial Hyperplasia: A Pilot Study. Int J Mol Sci 2023; 24:10080. [PMID: 37373229 DOI: 10.3390/ijms241210080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Endometrial hyperplasia is a threatening pathology driven by unopposed estrogen stimulus. Moreover, insulin may act on the endometrium, prompting further growth. We aimed at assessing whether D-chiro-Inositol, an insulin sensitizer with estrogen-lowering properties, might improve the condition of patients with simple endometrial hyperplasia without atypia. We enrolled women with simple endometrial hyperplasia without atypia and related symptoms, including abnormal uterine bleeding. We treated the patients with one tablet per day, containing 600 mg of D-chiro-inositol for six months. Patients underwent ultrasound to assess the thickness of the endometrium at baseline, after three months, and at the end of this study. Endometrial thickness went from 10.82 ± 1.15 mm to 8.00 ± 0.81 mm after three months (p < 0.001) and to 6.9 ± 1.06 mm after six months (p < 0.001 versus baseline; p < 0.001 versus three months). D-chiro-inositol treatment also improved heavy menstrual bleeding and the length of menstruation. Despite the fact that our data should be validated in larger studies with appropriate control groups, our promising results support the hypothesis that D-chiro-inositol may represent a useful treatment in the case of endometrial hyperplasia without atypia.
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Affiliation(s)
- Giuseppina Porcaro
- Women's Health Centre, USL Umbria 2, 05100 Terni, Italy
- The Experts Group on Inositol in Basic and Clinical Research (EGOI), 00156 Rome, Italy
| | | | | | - Maria Salomé Bezerra Espinola
- The Experts Group on Inositol in Basic and Clinical Research (EGOI), 00156 Rome, Italy
- Systems Biology Group Lab, 00161 Rome, Italy
| | - Cesare Aragona
- The Experts Group on Inositol in Basic and Clinical Research (EGOI), 00156 Rome, Italy
- Systems Biology Group Lab, 00161 Rome, Italy
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Lambrecht I, Van den Bosch T. The use of a short course of Ulipristal Acetate for acute abnormal uterine bleeding in women without uterine fibroids. Facts Views Vis Obgyn 2023; 15:99-105. [PMID: 37436045 PMCID: PMC10410647 DOI: 10.52054/fvvo.15.2.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Ulipristal Acetate (UPA) is a synthetic selective progesterone receptor modulator. It is used as emergency contraception and to reduce pain and blood loss in women of reproductive age with uterine fibroids. The first mechanism of action is myometrial apoptosis, the second is on the hypo-thalamic-pituitary-ovarian axis and the third action, is an anti-proliferative effect on the endometrium. Mainly based on the latter two, UPA is increasingly used off-label in women with abnormal uterine bleeding (AUB) without fibroids. OBJECTIVES The aim of this paper is to find evidence for a short course of UPA to treat acute AUB without fibroids, performing a systematic review as well as scrutinising literature data on the pharmacokinetics and on short term bleeding control in women with fibroids. MATERIALS AND METHODS A systematic electronic literature review was performed in February 2022. Inclusion criteria were UPA administered to women without myomas in a setting of acute uterine bleeding. Further criteria included papers describing early bleeding control using UPA, deemed independent of the presence of fibroids, with specific attention to the median time to amenorrhoea. MAIN OUTCOME MEASURES The main outcome measured was the bleeding control within 10 days. RESULTS One case report was identified. The data on symptomatic women with fibroids using 5 mg or 10 mg daily revealed bleeding control was reported within 10 days in 81% and 89% respectively, with amenorrhoea in 57% and in 78% respectively. CONCLUSION A short-term administration may prove effective in abnormal uterine bleeding irrespective of the presence of uterine fibroids. However, more randomised controlled trials are needed and should be performed before implementation in general clinical practice. WHAT IS NEW? A short course of Ulipristal acetate as promising treatment for acute uterine bleeding without fibroids.
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Roux F, Chih H, Hendriks J, Burns S. Mixed Method Evaluation of My Vital Cycles ®: A Holistic School-Based Ovulatory Menstrual Health Literacy Program. Int J Environ Res Public Health 2023; 20:5964. [PMID: 37297568 PMCID: PMC10252248 DOI: 10.3390/ijerph20115964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
There is a high prevalence of ovulatory menstrual (OM) dysfunctions among adolescents, and their menstrual health literacy is poor. The OM cycle can be used as a personal health monitor provided that the skills to understand it are correctly taught. My Vital Cycles®, a holistic school-based OM health literacy program, was trialed with a Grade 9 cohort in one single-sex school in Western Australia using the Health Promoting School framework. A validated OM health literacy questionnaire was administered pre- and post-program with 94 participants. Functional OM health literacy improved overall, with 15 out of 20 items showing improvement post-program (p < 0.05). In addition, 19 out of 53 items for interactive OM health literacy, and 18 out of 25 items for critical OM health literacy improved (p < 0.05). The improvement in mood concerns (p = 0.002) was unexpected. Thematic analysis of three focus groups of 18 girls revealed four themes of increasing comfort levels; finding the program informative; inclusion of non-teaching support such as healthcare professionals; and suggestions for future refinements. Overall, this Western Australian PhD project which developed and trialed My Vital Cycles® improved OM health literacy and was positively received. Future research possibilities include understanding the program's impact on mental health and further trials in co-educational settings; amongst different populations; and with extended post-program testing.
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Affiliation(s)
- Felicity Roux
- Curtin Medical School, Curtin University, Bentley, WA 6102, Australia
| | - HuiJun Chih
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
| | | | - Sharyn Burns
- School of Population Health, Curtin University, Bentley, WA 6102, Australia
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Li Q, Ren J, Yang L, Sun H, Zhang X, Yan G, Han Y, Wang X. Parsing the Q-Markers of Baoyin Jian to Treat Abnormal Uterine Bleeding by High-Throughput Chinmedomics Strategy. Pharmaceuticals (Basel) 2023; 16:ph16050719. [PMID: 37242503 DOI: 10.3390/ph16050719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Abnormal uterine bleeding (AUB) is a common and frequently occurring disease in gynecology, seriously threatening women's health. Baoyin Jian (BYJ) is a classical prescription for treating AUB. However, the lack of quality control standards of BYJ for AUB have limited the development and applications of BYJ. This experiment aims to explore the mechanism of action and screen the quality markers (Q-markers) of BYJ against AUB through the Chinmedomics strategy to improve the quality standards of Chinese medicine and provide scientific basis for its further development. BYJ has hemostatic effects in rats, as well as the ability to regulate the coagulation system following incomplete medical abortion. According to the results of histopathology, biochemical indexes and urine metabolomics, a total of 32 biomarkers of ABU in rats were identified, 16 of which can be significantly regulated by BYJ. Using traditional Chinese medicine (TCM) serum pharmacochemistry technology, 59 effective components were detected in vivo, of which 13 were highly correlated with efficacy, and 9 components, namely catalpol, rehmannioside D, paeoniflorin, berberine, phellodendrine, baicalin, asperosaponinVI, liquiritin, and glycyrrhizic acid, were screened out as the Q-markers of BYJ based on the "Five Principles" of Q-markers. In sum, BYJ can effectively alleviate abnormal bleeding symptoms and metabolic abnormalities in AUB rats. The study shows that Chinmedomics is an effective tool for screening Q-markers and provides scientific support for the further development and clinical use of BYJ.
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Affiliation(s)
- Qiuhan Li
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Junling Ren
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa 999078, Macau
| | - Le Yang
- State Key Laboratory of Dampness Syndrome, The Second Affiliated Hospital Guangzhou University of Chinese Medicine, Dade Road 111, Guangzhou 510120, China
| | - Hui Sun
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Xiwu Zhang
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Guangli Yan
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Ying Han
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
| | - Xijun Wang
- National Chinmedomics Research Center, National TCM Key Laboratory of Serum Pharmacochemistry, Metabolomics Laboratory, Department of Pharmaceutical Analysis, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin 150040, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa 999078, Macau
- State Key Laboratory of Dampness Syndrome, The Second Affiliated Hospital Guangzhou University of Chinese Medicine, Dade Road 111, Guangzhou 510120, China
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Don EE, Middelkoop MA, Hehenkamp WJK, Mijatovic V, Griffioen AW, Huirne JAF. Endometrial Angiogenesis of Abnormal Uterine Bleeding and Infertility in Patients with Uterine Fibroids-A Systematic Review. Int J Mol Sci 2023; 24:ijms24087011. [PMID: 37108180 PMCID: PMC10138959 DOI: 10.3390/ijms24087011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Uterine fibroids are the most common benign tumors in women, with abnormal uterine bleeding (AUB) as the main reported symptom. Additionally, an association between fibroids and infertility has been established, especially if the fibroid protrudes in the uterine cavity. Hormonal therapy is associated with side-effects and as well as hysterectomy, which is incompatible with a desire to conceive. To improve treatment, it is essential to unravel the etiology of fibroid-related symptoms. We aim to evaluate endometrial angiogenesis in women with fibroids, with and without AUB, and the influence of pharmaceutical therapies in these patients. Furthermore, we explore the possible role of altered angiogenesis in patients with fibroids and infertility. We performed a systematic review according to PRISMA-guidelines (PROSPERO: CRD42020169061), and included 15 eligible studies. Endometrial expression of vascular endothelial growth factor (VEGF) and adrenomedullin was increased in patients with fibroids. This suggests aberrant angiogenesis, potentially involving disturbed vessel maturation, resulting in immature and fragile vessels. Treatment with gonadotropin-releasing hormone agonist, ulipristal acetate, and continuous oral contraception pills reduced several angiogenic parameters, including VEGF. If infertile and fertile patients with fibroids were compared, a significant decreased expression of the bone morphogenetic protein/Smad-protein pathway was found, possibly caused by the increased expression of transforming growth factor-beta. For future therapeutic development, these different angiogenic pathways could be of interest as possible targets to treat fibroid-related symptoms.
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Affiliation(s)
- Emma E Don
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Mei-An Middelkoop
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Velja Mijatovic
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Arjan W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Sahu HD, Varma AV, Karmarkar S, Malukani K, Khanuja A, Kesharwani P. Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness. Cureus 2023; 15:e37931. [PMID: 37220431 PMCID: PMC10200126 DOI: 10.7759/cureus.37931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Abnormal uterine bleeding (AUB) is a common complaint in postmenopausal and perimenopausal women, caused by a range of disorders, including structural and systemic diseases. The evaluation of endometrial thickness (ET) via radiological methods, followed by a histopathological examination of the endometrium, is useful for proper diagnosis. Among systemic diseases, thyroid dysfunction, specifically hypothyroidism and hyperthyroidism, contribute significantly to AUB cases. MATERIALS AND METHODS This descriptive cross-sectional study was conducted at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India, over a period of 16 months, from May 2021 to September 2022. Patients presenting with abnormal uterine bleeding and undergoing thyroid function tests (TFTs), ultrasonography, and endometrial biopsy/hysterectomy at the gynecological outpatient department were included. Hospital records were used to obtain clinical details and investigation results. Endometrial thickness and thyroid status were recorded, and descriptive statistics were used to analyze the collected data. RESULTS This study included 150 patients with abnormal uterine bleeding, with a mean age of 44 years and 80.6% of patients in the premenopausal age group. A total of 48% of patients had a deranged thyroid profile, with hypothyroidism being more common (91.6%). Structural causes of AUB were identified in 81.3% of cases, with adenomyosis (33.65%), concomitant adenomyosis and leiomyoma (31.5%), and leiomyoma (14.8%) being the most common. Endometrial polyps (4.6%) and endometrial carcinoma (0.6%) were also observed and were consistent with the final histopathology. The remaining 18 patients had no structural causes and were categorized as cases of dysfunctional uterine bleeding (DUB). Increased ET was more commonly observed in postmenopausal patients (4.3%) compared to premenopausal patients (0.7%) among those with AUB, while the reverse was true for patients with DUB. Increased ET was commonly associated with hypothyroidism in both groups. Histopathological examination of endometrial biopsies/hysterectomy specimens revealed additional findings in some patients, including hyperplasia of the endometrium with (0.7%) and without atypia (4%), leading to a more accurate diagnosis. CONCLUSION AUB is a prevalent condition affecting women in both pre-menopausal and postmenopausal stages, frequently caused by structural anomalies. However, thyroid dysfunction, especially hypothyroidism, is also a significant contributing factor. As such, thyroid function tests (TFTs) are an effective and economical means of identifying potential underlying causes of AUB. Hypothyroidism is frequently associated with increased endometrial thickness, and histopathological examination remains the gold standard for determining the precise cause of AUB.
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Affiliation(s)
- Harshita Deep Sahu
- Pathology, Sri Aurobindo Medical College and Post-graduate Institute, Indore, IND
| | - Amit V Varma
- Pathology, Sri Aurobindo Medical College and Post-graduate Institute, Indore, IND
| | - Srushti Karmarkar
- Pathology, Sri Aurobindo Medical College and Post-graduate Institute, Indore, IND
| | - Kamal Malukani
- Pathology, Sri Aurobindo Medical College and Post-graduate Institute, Indore, IND
| | - Anushka Khanuja
- Pathology, Sri Aurobindo Medical College and Post-graduate Institute, Indore, IND
| | - Pooja Kesharwani
- Pathology, Sri Aurobindo Medical College and Post-graduate Institute, Indore, IND
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Shim S, Streich-Tilles T, Gutmark-Little I, Yao M, Shafer J, Breech L, Casnellie L, Backeljauw P. Abnormal Uterine Bleeding during Pubertal Induction with Transdermal Estrogen in Turner Syndrome Individuals. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00314-5. [PMID: 36934801 DOI: 10.1016/j.jpag.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/13/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
STUDY OBJECTIVES Incidence of abnormal uterine bleeding (AUB) during pubertal induction among individuals with Turner syndrome (TS) has not been described previously. We estimated the incidence and characterize factors associated with AUB among TS individuals. A secondary objective was to evaluate the management of AUB among this patient population. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION We conducted a retrospective chart review to evaluate TS individuals undergoing hormone replacement therapy (HRT) for pubertal induction with transdermal estrogen (TDE). A total of 45 participants were identified between January 2007 and June 2019. RESULTS Of the 45 TS individuals included, 16 (35%) experienced AUB. Individuals with AUB most commonly experienced prolonged (44%), prolonged and heavy (25%), and intermenstrual (19%) bleeding. Individuals who experienced AUB were more likely to experience spontaneous bleeding (69% vs. 28%) and a duration of unopposed estrogen greater than 18 months (63% vs. 41%), undergo progestin cycling less often than monthly (69% vs. 0%), use a micronized progestin dose of less than 200 mg (25% vs. 14%), and be noncompliant with HRT (19% vs. 0%) compared to those who did not experience AUB. CONCLUSIONS There is a relatively high incidence of AUB among TS individuals undergoing pubertal induction with TDE. Care providers should consider the clinical factors examined to guide monitoring and management of TS individuals on HRT.
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Affiliation(s)
- Sarah Shim
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229.
| | - Tara Streich-Tilles
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Michael Yao
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Jessica Shafer
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Lesley Breech
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Lori Casnellie
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
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Middelkoop MA, Don EE, Hehenkamp WJK, Polman NJ, Griffioen AW, Huirne JAF. Angiogenesis in abnormal uterine bleeding: a narrative review. Hum Reprod Update 2023:7060342. [PMID: 36857162 DOI: 10.1093/humupd/dmad004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/12/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) has a significant socioeconomic impact since it considerably impacts quality of life. Therapeutic options are frequently based on trial and error and do not target disease aetiology. Pathophysiological insight in this disease is required for the development of novel treatment options. If no underlying cause is found for the AUB (e.g. fibroids, adenomyosis, polyps), endometrial-AUB (AUB-E) is usually caused by a primary endometrium disorder. When AUB is induced by prescribed (exogenous) hormones, it is classified as iatrogenic-AUB (AUB-I). Considering vascular modulation and function, AUB-E and AUB-I both could potentially result from abnormal vascularization in the endometrium due to alterations in the process of angiogenesis and vascular maturation. OBJECTIVE AND RATIONALE We aim to investigate the fundamental role of angiogenesis and vascular maturation in patients with AUB and hypothesize that aberrant endometrial angiogenesis has an important role in the aetiology of both AUB-E and AUB-I, possibly through different mechanisms. SEARCH METHODS A systematic literature search was performed until September 2021 in the Cochrane Library Databases, Embase, PubMed, and Web of Science, with search terms such as angiogenesis and abnormal uterine bleeding. Included studies reported on angiogenesis in the endometrium of premenopausal women with AUB-E or AUB-I. Case reports, letters, reviews, editorial articles, and studies on AUB with causes classified by the International Federation of Gynecology and Obstetrics as myometrial, oncological, or infectious, were excluded. Study quality was assessed by risk of bias, using the Cochrane tool and the Newcastle-Ottawa Scale. OUTCOMES Thirty-five out of 2158 articles were included. In patients with AUB-E, vascular endothelial growth factor A and its receptors (1 and 2), as well as the angiopoietin-1:angiopoietin-2 ratio and Tie-1, were significantly increased. Several studies reported on the differential expression of other pro- and antiangiogenic factors in patients with AUB-E, suggesting aberrant vascular maturation and impaired vessel integrity. Overall, endometrial microvessel density (MVD) was comparable in patients with AUB-E and controls. Interestingly, patients with AUB-I showed a higher MVD and higher expression of proangiogenic factors when compared to controls, in particular after short-term hormone exposure. This effect was gradually lost after longer-term exposure, while alterations in vessel maturation were observed after both short- and long-term exposures. WIDER IMPLICATIONS AUB-E and AUB-I are most likely associated with aberrant endometrial angiogenesis and impaired vessel maturation. This review supports existing evidence that increased proangiogenic and decreased antiangiogenic factors cause impaired vessel maturation, resulting in more fragile and permeable vessels. This matches our hypothesis and these mechanisms appear to play an important role in the pathophysiology of AUB-E and AUB-I. Exploring the alterations in angiogenesis in these patients could provide treatment targets for AUB.
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Affiliation(s)
- Mei-An Middelkoop
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Emma E Don
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
| | - Nicole J Polman
- Department of Obstetrics and Gynaecology, Flevoziekenhuis, Almere, the Netherlands
| | - Arjan W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands
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Kalra K, Jain S, Rajaram S, Gupta B, Singla A. A novel technique of vagino-hysteroscopy using alginate gel interface: A proof of concept study. Int J Gynaecol Obstet 2023. [PMID: 36728581 DOI: 10.1002/ijgo.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/27/2022] [Accepted: 02/01/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the feasibility of vagino-hysteroscopy using alginate gel Interface (VAGI) with conventional vaginoscopic hysteroscopy (CVH). METHODS Thirty women undergoing diagnostic vagino-hysteroscopy were randomly allocated into Group I (VAGI): Alginate occluder was used at introitus to facilitate hydrodistension during hysteroscopy; or Group II: Underwent no-touch hysteroscopy. Primary outcome was feasibility, defined as successful visualization of uterine cavity. Secondary outcomes included operative time, hydrostatic pressures for optimum visualization, pain experienced by patient on visual analog scale, maneuverability and surgeon satisfaction. Data analysis was performed using χ2 and Fisher exact tests for qualitative variables and Student t test for quantitative variables. RESULTS VAGI was significantly better than CVH (80% vs. 33.3%; relative risk 8, P = 0.025). With VAGI, optimum visualization was achieved at significantly lower pressures at all levels (vagina, P = 0.034; cervix, P = 0.01; uterus, P < 0.001), in less time (P = 0.007), and using less irrigation fluid (P < 0.001). Surgeon satisfaction was significantly higher for VAGI (P = 0.009). Subgroup analysis showed higher likelihood of success of VAGI in women who were premenopausal (P = 0.015), younger than 45 years (P = 0.024), and had a history of vaginal birth (P = 0.03). CONCLUSIONS VAGI is quicker to perform and provides optimum visualization at much lower pressures than CVH. Use of alginate is patient friendly and yields higher surgeon satisfaction rate.
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Affiliation(s)
- Kanika Kalra
- Department of Obstetrics and Gynecology, UCMS >BH, Delhi, India
| | - Sandhya Jain
- Department of Obstetrics and Gynecology, UCMS >BH, Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynecology, UCMS >BH, Delhi, India
| | - Bindiya Gupta
- Department of Obstetrics and Gynecology, UCMS >BH, Delhi, India
| | - Anshuja Singla
- Department of Obstetrics and Gynecology, UCMS >BH, Delhi, India
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Vitale SG, Della Corte L, Ciebiera M, Carugno J, Riemma G, Lasmar RB, Lasmar BP, Kahramanoglu I, Urman B, Mikuš M, De Angelis C, Török P, Angioni S. Hysteroscopic Endometrial Ablation: From Indications to Instrumentation and Techniques-A Call to Action. Diagnostics (Basel) 2023; 13:diagnostics13030339. [PMID: 36766443 PMCID: PMC9914843 DOI: 10.3390/diagnostics13030339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
The development of minimally invasive techniques has led to the creation of innovative alternatives in cases where traditional methods are not applicable. In modern gynecology, hysteroscopy has become the gold standard for the evaluation and treatment of intrauterine pathology. Endometrial ablation (EA) is a procedure that uses different types of energy to destroy the endometrium and is currently used as an alternative technique in cases of heavy menstrual bleeding when medical treatment has failed and uterine preservation is desired. The aim of this review was to evaluate the feasibility, safety, and clinical outcomes of hysteroscopic EA as an alternative in patients with abnormal uterine bleeding. A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane Library), from 1994 to June 2022, to evaluate the outcomes in patients with abnormal uterine bleeding (AUB) undergoing EA using hysteroscopic and non-hysteroscopic techniques. Only scientific publications in English were included. Twelve articles on the current use of endometrial ablation were included. Data on patient symptoms, tools used for EA, primary outcomes, and adverse events were recorded. EA should be considered an effective and safe approach in the management of patients with abnormal uterine bleeding caused by benign pathology, in whom medical treatment has failed or is contraindicated. Due to the lack of evidence, it would be interesting to determine whether EA would also have a role in the treatment of women with premalignant lesions, avoiding invasive surgical procedures or medical treatment in those patients for whom hysterectomy or the use of hormonal treatment is contraindicated.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-3479354575
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00189 Warsaw, Poland
| | - Josè Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Ricardo Bassil Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
| | - Bernardo Portugal Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, 34010 Istanbul, Turkey
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000 Zagreb, Croatia
| | - Carlo De Angelis
- Department of Maternal and Child Health and Urological Sciences, “Sapienza“ University of Rome, 00185 Rome, Italy
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Kanagasabai PS, Filoche S, Grainger R, Henry C, Hay-Smith J. Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review. Int J Gynaecol Obstet 2023; 160:38-48. [PMID: 35429335 PMCID: PMC10084285 DOI: 10.1002/ijgo.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/04/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Women with abnormal uterine bleeding (AUB) experience barriers to accessing healthcare services. OBJECTIVES To identify and describe the evidence on interventions to improve healthcare access of women with AUB. SEARCH STRATEGY A systematic search of databases including Medline, CINAHL, EMBASE, Scopus, and Cochrane register for clinical trials on February 26, 2021. SELECTION CRITERIA Studies including women with AUB and investigating an intervention to improve access at the levels of individual patient, community, organization, health system, or medical education. DATA COLLECTION AND ANALYSIS Data extraction and descriptive analysis of the country, study design, settings, participant characteristics, intervention, outcome measures, and key findings. MAIN RESULTS We identified 20 studies and most interventions (13 studies) targeted organizational changes. Creating a multidisciplinary team, bringing services together and developing a care pathway improved the availability of services. Management of AUB in an outpatient setting improved the affordability. The use of decision aids improved patient engagement in consultations. There is a lack of interventions at an individual or community level targeting health literacy, health beliefs, social acceptability, and opportunity to reach and pay for services. CONCLUSIONS Community-based culturally-adapted interventions focusing on access to women with different socio-economic and cultural backgrounds should be investigated.
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Affiliation(s)
| | - Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Claire Henry
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago Wellington, Wellington, New Zealand
| | - Jean Hay-Smith
- Rehabilitation Teaching and Research Institute, University of Otago Wellington, Wellington, New Zealand
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Vitale SG, Riemma G, Mikuš M, Carugno J, Torella M, Reyes-Muñoz E, Cela V, Perez Medina T, Della Corte L, Pacheco LA, Haimovich S, De Franciscis P, Angioni S. Quality of Life, Anxiety and Depression in Women Treated with Hysteroscopic Endometrial Resection or Ablation for Heavy Menstrual Bleeding: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas) 2022; 58:1664. [PMID: 36422203 PMCID: PMC9695759 DOI: 10.3390/medicina58111664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 10/10/2023]
Abstract
Background and Objectives: Hysteroscopic endometrial resection (ER) or global endometrial ablation (GEA) are feasible methods to treat heavy menstrual bleeding (HMB). The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess patient's quality of life (QoL) in women treated with ER/GEA compared to hysterectomy. Materials and Methods: Electronic searches in MEDLINE Scopus, ClinicalTrials.gov, EMBASE, PROSPERO and Cochrane CENTRAL were conducted from their inception to July 2022. Inclusion criteria were RCTs of premenopausal women with HMB randomized to conservative surgical treatment (ER/GEA) or hysterectomy. The primary outcome was the evaluation of QoL using the SF-36 score. Results: Twelve RCTs (2773 women) were included in the analysis. Women treated with hysteroscopic ER/GEA showed significantly lower scores for the SF-36 general health perception (mean difference (MD) -8.56 [95% CI -11.75 to -5.36]; I2 = 0%), social function (MD -12.90 [95% CI -23.90 to -1.68]; I2 = 91%), emotional role limitation (MD -4.64 [95% CI -8.43 to -0.85]; I2 = 0%) and vitality (MD -8.01 [95% CI -14.73 to -1.30]; I2 = 74%) domains relative to hysterectomy. Anxiety, depression scores and complication rates were similar between treatments. Relative to uterine balloon therapy, amenorrhea was more common with EA/GER (relative risk 1.51 [95% CI 1.03 to 1.20] I2 = 28%), but posttreatment satisfaction was similar. Conclusions: Women's perception of QoL might be seen to be less improved after hysteroscopic ER/GEA rather than hysterectomy. However, such findings need to be confirmed by additional trials due to the high number of outdated studies and recent improvements in hysteroscopic instrumentation and techniques.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, FL 33124, USA
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico
| | - Vito Cela
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Tirso Perez Medina
- Department of Obstetrics and Gynecology, University Hospital Puerta de Hierro Majadahonda, Autonoma University of Madrid, 28001 Madrid, Spain
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | | | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Laniado University Hospital, Netanya, Israel and Adelson School of Medicine, Ariel University, Ariel 98603, Israel
| | - Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Shen Y, Liu X, Xu L, Zhu W, Zhang Z, Liu J, Jiang L, Mao Y, Xu J, Yan X, Sun J, Liu F, Xiong X, Chen X, Che Y, Du J. Whole-exome sequencing reveals novel variants associated with abnormal uterine bleeding caused by copper intrauterine device. Per Med 2022; 19:523-534. [PMID: 36250535 DOI: 10.2217/pme-2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aim: This study aimed to explore the genetic risk factors and validate variants of abnormal uterine bleeding after copper intrauterine device insertion. Methods: Whole-exome sequencing was performed and several variants were validated by Sequenom MassARRAY. Results: Eight variants showed potential clinical damage according to American College of Medical Genetics and Genomics criteria. By combined analysis of screening and validation, NFASC RS2802808 C>G p.Ile971Met (Pallele = 0.009 and Pgenotype = 0.027) and PIGR RS2275531 C>T p.Gly365Ser (Pallele = 0.009 and Pgenotype = 0.013) variants were identified as significantly associated with abnormal uterine bleeding with a false discovery rate <0.05. NFASC and PIGR may play a role in abnormal uterine bleeding by regulating coagulation fibrinolysis and endometrial epithelium inflammation functions. Conclusion: These findings provide a genetic basis for clinical individualization and precision of intrauterine device implantation.
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Affiliation(s)
- Yupei Shen
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Xiaoli Liu
- Chongqing Health Center for Women & Children, Chongqing, China
| | - Linfen Xu
- Fujian Maternity & Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Weiqiang Zhu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Zhaofeng Zhang
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Junwei Liu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Lifang Jiang
- NHC Key Laboratory of Birth Defects Prevention, Henan Institute of Reproduction Health Science & Technology, Zhengzhou, Henan, China
| | - Yanyan Mao
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Jianhua Xu
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Xiaoqin Yan
- Maternal & Child Health & Family Planning Service Center of Huixian City, Henan, China
| | - Junjie Sun
- Chongqing Health Center for Women & Children, Chongqing, China
| | - Fang Liu
- Chongqing Health Center for Women & Children, Chongqing, China
| | - Xiumei Xiong
- Fujian Maternity & Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Xiujuan Chen
- Fujian Maternity & Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yan Che
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Jing Du
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical & Pharmaceutical Technologies), Fudan University, Shanghai, China
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