Uterine fibroids in women of childbearing age: a cross-sectional study at the primary health care corporation in Qatar

Background and aimPrevious studies have shown an association between obesity and uterine fibroids (UF). Body roundness index (BRI) is an anthropometric measure associated with obesity. However, the association with UF has not been thoroughly elucidated, and further investigation is required to explore the possible link. Our study investigated the possible link between BRI and UF in women aged 20 to 44 years, with a view to providing effective scientific evidence for health management and disease prevention in this population.MethodsThis cross-sectional study analysis included data from 4043 women of childbearing age from the National Health and Nutrition Examination Survey (NHANES) database 1999–2006.We applied multiple regression analysis to study the association between BRI and UF, subgroup analysis was used to ensure broad applicability and representativeness of conclusions, and finally linear correlation between BRI and UF was explored by smooth curve fitting.ResultsThis study involved 4,043 female participants aged 20–44 years, of whom 331 (8.19%) had fibroids. After controlling for all potential confounders, each additional unit of BRI increased the prevalence of UF by 7% (OR = 1.07,95% CI: 1.01,1.12), Sensitivity analysis by dividing BRI into four groups found a 54% increase in the prevalence of UF within the fourth quartile (Q4) of BRI compared with the first quartile (Q1) of BRI (OR = 1.54, 95% CI: 1.08, 2.20).The link between BRI and UF maintained in subgroup analyses. Furthermore, the study showed a linear positive correlation between BRI and the probability of UF prevalence.ConclusionsHigher levels of BRI may be linked to a higher prevalence of UF, according to studies conducted on American women of childbearing age. The study’s conclusions highlight how important BRI is for managing and preventing UF.

Background and Objectives: Uterine fibroids develop in 25–40% of women of childbearing age; however, there are discrepancies resulting from population and socioeconomic differences. The pathogenesis of fibroids is not clear. The aim of the study was to assess the potential connection between the use of oral contraceptives and the occurrence of uterine fibroids in women of childbearing age. Materials and Methods: In this prospective, survey, case–control study, data were collected from Caucasian female patients (mean age = 30) using a questionnaire concerning the onset, duration and form of hormonal contraception, and medical and obstetrical history. The questionnaires were handed personally to hospitalized patients as well as distributed through Google forms on social media. Results: In a study group (n = 140) of patients using hormonal contraception, 37.8% of them were diagnosed with uterine fibroids, whereas among the patients not using hormonal contraception (n = 206), uterine fibroids were diagnosed in 59.6% of the patients. The most common hormonal contraception was two-component hormonal tablets used by 93.3% of the patients. Taking contraceptives was a uterine fibroids protective factor (OR = 0.4, p = 0.007). In the study group, 5.5% of the patients were pregnant and 60.42% were diagnosed with uterine fibroids (OR = 4.4, p < 0.000001). Conclusion: Contraception was found to be a protective factor for uterine fibroids among the women surveyed. The presented data confirm the theory about the hormonal dependence of uterine fibroids.

Rationale: One of the most complicated and unresolved problems in clinical medicine is the choice of an optimal method for organ-preservation treatment of uterine fibroids in women of childbearing age. Aim: To assess clinical efficacy of robot-assisted laparoscopic myomectomy. Materials and methods: The search was performed in PubMed, Embase, Trip, Cochrane, DocMe databases by keywords: “fibroids”, “robot”, “da Vinci”, “robotic myomectomy”, “robot-assisted myomectomy”. Results: We found 25 publications on robot-assisted laparoscopic myomectomy, including 6 papers on its reproductive outcomes (levels of evidence II–IV). Duration of robot-assisted surgery ranged from 132 to 261 minutes, intraoperative blood loss was in the range from 50 to 387 mL, postoperative hospital stay ranged from 1 to 3.9 days. There was a lower percentage of intra- and postoperative complications after the robot-assisted interventions, compared to abdominal or classic laparoscopic access, as well as a lower percentage of conversion laparotomies compared to laparoscopy. Pregnancy rates after robotic myomectomy ranged from 16.7 to 69%. Only one case of uterine rupture after robot-assisted laparoscopic myomectomy has been described in the literature. Conclusion: Due to high cost of the method, the number of conducted studies is insufficient to evaluate the role of robotic technologies in the organ-preservation approach to uterine fibroids. Nevertheless, they suggest that robot-assisted laparoscopic myomectomy is justified in women of childbearing age who are planning pregnancy, with big centripetally growing intramural nodes and deformation of the uterine cavity. This technique on its own is an independent method for fertility restoration and could be the first step before the use of assisted reproductive technology.

Objective: Ulipristal acetate has been found to be non-inferior to other pre-operative treatments of uterine fibroids, particularly leuprolide. The objective of this study was to assess the pharmacoeconomic profile of ulipristal acetate compared to leuprolide for the pre-operative treatment of moderate-to-severe uterine fibroids in women of reproductive age in The Netherlands. The analysis was performed and applied within the framework of the ulipristal acetate submission for reimbursement in 2012.Methods: A decision model was developed to compare the total costs of ulipristal acetate compared to leuprolide, the standard care in The Netherlands. The target population of this study corresponded to the type of patients included in the PEARL II clinical trial; i.e. women of reproductive age requiring pre-operative treatment for uterine fibroids. Sensitivity analysis was implemented to assess uncertainties. Data regarding costs, effects, and other input parameters were obtained from relevant published literatures, the Dutch Healthcare Insurance Board, and expert opinion obtained by means of a panel of experts from several medical centers in The Netherlands.Results: In The Netherlands, the total costs of ulipristal acetate and leuprolide were estimated at €4,216,027 and €4,218,095, respectively. The annual savings of ulipristal acetate were, therefore, estimated at €2,068. The major driver of this cost difference was the cost of administration for leuprolide. Sensitivity analyses showed that ulipristal acetate mostly remained cost-saving over a range of assumptions. The budget impact analysis indicated that the introduction of ulipristal acetate was estimated to result in cost savings in the first 3 years following the introduction. The results of this study were used in the decision on reimbursement of ulipristal acetate according to the Dutch Reference Pricing system in 2012.Conclusion: Ulipristal acetate was cost saving compared to leuprolide and has the potential to provide substantial savings on the healthcare budget in The Netherlands.

Background. Uterine fibroids is a benign monoclonal tumor originating from the smooth muscle layer of the uterus. Non-modifiable risk factors for the development of uterine fibroids, such as age, ethnicity, age at menarche, etc, have been studied quite extensively, while the role of many controllable factors remains debatable.The aim of the study. To identify the main modifiable factors associated with uterine fibroids in women of reproductive age living in the Baikal region, including certain ethnic groups.Materials and methods. We carried out a multicenter cross-sectional study in 2016–2019 in institutions of Irkutsk and Bokhan (Irkutsk region) and Ulan-Ude (Republic of Buryatia). The subjects of the study were women to have annual workplace medical examination. The study included 1,347 participants of reproductive age (34.33 ± 6.37 years) who met the inclusion criteria. Among all women included in the study, there were 867 (64.37 %) Caucasians, 361 (26.80 %) Asians, and 119 (8.83%) women of mixed (Caucasian-Asian), ethnicity. The research methods included a questionnaire, general clinical and gynecological examination, and pelvic ultrasound examination.Results. According to our study, the main non-modifiable factors associated with the presence of uterine fibroids were: Asian ethnicity; age at menarche 12–13 years; age of the study participant 40–44 years; menopausal symptoms; adenomyosis. The “controllable” factors included: city residency; body mass index over 40 kg/m2; history of abortions and miscarriages; metabolic syndrome; using combined oral contraceptives; lack of sexual activity; smoking; presence of anumber of occupational hazards.Conclusion. Our study identified the main controllable factors associated with the presence of uterine fibroids in a multiethnic population of women of reproductive age.

Relevance. Due to the high prevalence of uterine fibroids in women of reproductive age and the negative impact on reproductive health, one of the priority tasks of specialists is to search not only for new therapeutic methods, but also for ways to prevent this disease. Aim. To determine the role of vitamin D deficiency in the risk of uterine fibroids recurrence after surgical treatment in women of reproductive age. Materials and methods. A comparative analysis of the recurrence rate of uterine fibroids in patients of reproductive age after surgical treatment. The study involved 49 women of reproductive age 20-39 years (average age 31.5±4.3 years) with unrealized reproductive plans. All underwent surgical treatment in the scope of laparoscopic conservative myomectomy for uterine fibroids with different symptoms. All patients were given vitamin D levels. Results. In 93.5% of cases, the risk of recurrence of uterine fibroids increases at vitamin D levels below 34.5 ng/ml, when reaching 38.6 ng/ml and above, the risk of reformation of nodes is minimal. Conclusions. When the vitamin D level exceeds 38.6 ng/ml, it is possible to minimize the risk of recurrence of uterine fibroids in women of reproductive age, thereby avoiding repeated surgical interventions and associated complications.

Uterine fibroids are benign gynecologic tumors, and women aged between 30 to 50 years are known to have a high incidence of uterine fibroids. A growing number of pharmacotherapies and minimally invasive organ-preserving treatments have been designed and conducted over the past few years. However, there has not been any therapeutic drugs exhibiting an ideal therapeutic effect and low recurrence rate, such that the surgical treatment continues to be primarily employed in the actual clinical treatment. In general, surgical treatment has been performed as the organ- and fertility-preserving hysteroscopic or laparoscopic resections of the fibroids. Minimally invasive surgical equipment (e.g., hysteroscopy, traditional porous laparoscopy, trans-umbilical laparoscopy, transvaginal laparoscopy, as well as robot-assisted laparoscopy) has been extensively applied to clinical treatment. Compared with traditional laparotomy, minimally invasive surgical equipment is characterized by minimally invasive surgery, high efficiency and safety. As medical technology has been leaping forward, interventional therapy and radiofrequency ablation can also be employed for treating uterine fibroids. In accordance with the research progress worldwide, the current situation, limitations, and advantages of the treatment of uterine fibroids in patients with fertility requirements are reviewed in this study.

The article presents an analytical assessment of long-term postoperative consequences in women of reproductive age after hysterectomy for uterine fibroids. The aim of the study to determine the structure of long-term results of hysterectomy for uterine fibroids in women of reproductive age using different approaches to the possibility of optimizing the diagnostic algorithm in the preoperative period in the future. Materials and methods – 160 women aged 40 to 50 years with symptomatic uterine fibroids, who underwent hysterectomy performed by vaginal, laparoscopically assisted vaginal, abdominal, were examined. Research methods are the following: physical examination of patients, assessment of pelvic floor (cough test, Valsalva maneuver, “Stop Test” with Kegel cones), diagnosis of urogenital dysfunction using a standardized POP-Q system; instrumental examination:, complete urodynamic testing, cystometry, (for assessment of the severity of urinary incontinence the classification of the International Continence Society (ICS) was used); assessment of the patient’s quality of life on the 10th day after surgery, 3, 6, 12 months and three years after surgery using the international standard questionnaire MOS SF-36; study of the local infectious status of the female body (bacteriological and bacterioscopic examination of discharge from vagina and urethra, determination of vaginal pH Results and their discussion. The structure of distant postoperative manifestations was determined (after 36 months of postoperative monitoring): clinical manifestations of intestinal function discomfort in the same degree in patients of three subgroups, 2.4 and 2.9 times less often in group I patients indicated chronic pelvic pain, in 1.7 times less often - for genitourinary disorders, vaginal prolapse in a third of cases, especially in women with abdominal HE and classic vaginal HE (30.0±5.0 % and 37.8±5.0 %, respectively, against 17.8±4.0 % – in the group with laparotomically assisted HE). Conclusions. Given the data on genitourinary disorders and vaginal prolapse in almost a third of observations after hysterectomy for uterine fibroids, it is advisable to consider additional examination of latent signs of genitourinary syndrome at the preoperative stage to optimize the choice of access, the volume of surgical treatment.

The urgency of the problem of uterine fibroids is associated with a high frequency and a constant tendency to increase, rejuvenation of the pathology and adverse effects on the possibility of implementing reproductive function. The study was made of the efficacy of Epigalin in the treatment of uterine fibroids in women of reproductive age for influencing the clinical manifestations of the disease, the size of the nodes and the uterus, taking into account the immunohistochemical markers of the pathological process.In the clinical study, 80 patients of reproductive age with uterine leiomyoma aged from 26 to 43 years were under observation. 43 women who formed the main group received a complex preparation of plant origin Epigalin containing 200 mg of indole-3-carbinol and 45 mg of epigallocatechin-3-gallate, 1 capsule twice a day for 3 months. The results were compared with the data of 37 patients with uterine leiomyoma receiving a single-component preparation containing indole-3-carbinol at a daily dose of 400 mg divided into two doses for 3 months(comparison group). The effectiveness of treatment was assessed after three months for clinical manifestations, complaints and ultrasound data.Immunohistochemical studies have shown that the lower the expression of TNF-α as a key mediator of the inflammatory response and immune response, which provides antitumor protection by regulating apoptosis, the greater the proliferative potential in uterine myoma cells. Therefore, the administration of drugs that regulate apoptosis, in particular epigallocatechin-3-gallate, is pathogenetically justified.Depending on the clinical and morphological picture of the disease, Epigalin can be used as an independent therapy, or in combination with other drugs, as well as adjuvant therapy after surgical treatment, since myomectomy does not eliminate the underlying cause of the disease. Using Epigalin for 2 capsules for 3 months in women with uterine leiomyoma allows to achieve subjective and objective improvement in 65.1% and 60.5% of patients. A good tolerance and safety of the drug allows you to assign it a long course.

Update on medical treatment of uterine fibroids

Introduction. Breech presentation and uterine fibroids in women are clinical cases which occur more and more frequently in modern obstetric practice. Regarding this issue, scientists’ attention is drawn to the aspect of surgical delivery for such patients, which unavoidably requires taking into account both unplanned necessity of expanding the volume of caesarian section (myomectomy, uterine removal) and increased intraoperative blood loss. Aim. Decreasing the indexes of maternal morbidity in women with uterine fibroid and breech presentation by developing the optimal approach to their delivery.Materials and methods. An analysis of primiparae and secundiparae with uterine fibroid and with single full-term pregnancy with breech presentation has taken place and constituted the main group (MG) (n=40). The control group (CG) (n=40) consisted of primiparae and secundiparae with single full-term pregnancy with breech presentation without uterine fibroid. All the women had their deliveries at Odesa Regional Perinatal Centre. The data has been processed with Microsoft Office Excel 2017. Research results. The analysis of the data received has shown that gynecological anamnesis of women from the CG was reliably more frequently complicated by: late menarche 12 (30%), abnormal uterine bleeding 9 (22.5%) and dysmenorrhea 18 (45%) (p<0,05). It has been determined that the women from the CG had deliveries through natural birth canal almost twice as frequently 32 (80 %). In the MG 17 (42,5 %) conservative deliveries occurred under the condition of patients having subserous or intramural myoma nodules with the size not larger than 5 cm localized in the uterus body (p<0,05). It has been determined that pregnancies of the CG women ended with surgical delivery three times as frequently 23 (57,5 %) as in the MG 8 (20 %) (p<0,05). All cases of the cesarean section in the MG were planned in advance with regard to such variations of fibrosis as: multiple nodules, single nodules with centripetal growth, localization in the lower uterine segment or large size (5 - 16 см). It has been shown that advanced planning of the surgical deliveries with uterine fibroid and breech presentation in the MG 23 (57,5 %) does not prevent from urgent situations н 7 (30,4 %), which is complicated by the necessity of extending the volume of the surgery 3 (13 %). Issues of elective cesarean section among women from the MG did not require volume extension in any case. В свою чергу, advanced planning of conservative delivery with breech presentation in the CG 40 (100%) also does not prevent from cases of urgent surgical deliveries 8 (20 %), where the leading indication for it was deviation of labour activity 4 (50 %). Conclusions. Balanced obstetrical approach to the issue of uterine fibroid with breech presentation considering the variation of fibroids in each particular case favours preliminary determination of the optimal method of delivery for each woman, which might be effective in the cases of decreasing the indexes of maternal morbidity among such patients due to decreasing both the number of surgical deliveries and the cases of volume extension for cesarian sections.

Uterine fibroids are non-cancerous neoplasms of the uterus. Women of color, including non-Hispanic Black/African American women and Hispanic/Latinas, have a higher uterine fibroid prevalence, incidence, and disease burden compared to non-Hispanic White women. Therefore, understanding ethnoracial factors in the diagnosis and treatment of uterine fibroids in women of color is critical. This study provides insight on the ethnoracial factors and cultural barriers experienced by women of color in the management and treatment of uterine fibroids. Women were recruited via The Fibroid Foundation, a nonprofit that provides uterine fibroid support and education. Women who were interested completed an online screening survey. Eligible participants were interviewed via phone. Transcribed audio recordings were qualitatively analyzed using the principles of grounded theory. Forty-seven women of reproductive age who were diagnosed with uterine fibroids and received U.S.-based care participated in a semi-structured interview exploring experiences with uterine fibroid diagnosis and management. Twenty-eight women self-identified as Black, Latina, or other ethnicity. Women of color reported fibroid symptoms that significantly disrupted their work and home life. Women of color also reported perceptions that their race/ethnicity impacted their uterine fibroid treatment, including negative interpersonal provider-patient interactions. These perceptions engendered feelings of skepticism towards the medical system based on historical injustices and/or their own negative experiences and led some to go without longitudinal care. Cultural and familial factors have significant impact on uterine fibroid diagnosis and management. Greater attention to culturally sensitive care and potential bias reduction in the treatment of uterine fibroids should be a priority.

This research was conducted in the Obstetric and Gynaecological ward of maternity section in General Hospital Kafanchan, Kaduna state on the incidence of uterine fibroid among women of childbearing age (15 – 45years). A non – experimental historical survey study was adopted and a convenient non probability technique was used to select the sample for the study. Past records were the instrument used for data collection. Distributive techniques using frequency tables and inferential statistics were used for data analysis. Uterine fibroid has been a very serious health problem to women of childbearing age for several years, and a major cause of barrenness which could be either via hysterectomy or myomectomy. The study showed a total of 120 patients recorded to have had uterine fibroid within the period of study. Affected age groups were from 30 to 50years in the study, however age 30 to 39years were the age group mostly affected. The average age of those affected was 45years, but statistical analysis showed that age does not really affect prevalence of uterine fibroid; that means uterine fibroid can develop at any age in the life of childbearing women. The main cause is idiopathic but factors such as nulliparous, female hormone, and advancing age from 30 to 40years predisposes women to fibroid. Nevertheless, once women of childbearing age from (15 -45years) are diagnosed with this disease, it should be treated adequately, health education should be given on the disease (uterine fibroid) and it’s possible outcomes; this will help to erase public negative perception on the disease and affected women. The disease can be treated via the use of medication such as ibuprofen and acetaminophen, hormone therapy and surgical intervention. Government should establish hospitals and health centres in all communities in the country for patients with this disease for proper screening and treatment.

Guideline No. 461: The Management of Uterine Fibroids.

Oral ulipristal acetate (Esmya®; Fibristal®), a synthetic selective progesterone receptor modulator, is the first selective progesterone modulator to be approved for the treatment of uterine fibroids. It was initially approved for the preoperative treatment of moderate to severe uterine fibroid symptoms in women of reproductive age. Recently, the indication was extended in the EU to include the intermittent treatment of moderate to severe uterine fibroid symptoms. This narrative review summarizes pharmacological, efficacy and tolerability data relevant to the preoperative and intermittent use of ulipristal acetate in patients with symptomatic uterine fibroids. Ulipristal acetate is an effective and generally well tolerated treatment for patients with symptomatic uterine fibroids, both as preoperative, single-course treatment and as intermittent, longer-term treatment. It is noninferior in efficacy to intramuscular leuprolide acetate, as a preoperative treatment, and is associated with a lower rate of hot flashes, a common adverse event with gonadotropin-releasing hormone analogues. Thus, ulipristal acetate is an effective option for both preoperative and intermittent treatment of moderate to severe, symptomatic uterine fibroids in women of reproductive age.