Diagnosis Of Uterine Fibroids Research Articles

First Australian estimates of incidence and prevalence of uterine fibroids: a data linkage cohort study 2000-2022.

What is the estimated prevalence and incidence of uterine fibroids diagnosed in Australian women of reproductive age? An estimated 7.3% of Australian women had a diagnosis of uterine fibroids by the age of 45-49 years, with age-specific incidence highest in women aged 40-44 years (5.0 cases per 1000 person-years). Uterine fibroids are associated with a high symptom burden and may affect overall health and quality of life. Studies in different countries show a wide variation in both the prevalence (4.5-68%) and incidence (2.2-37.5 per 1000 person-years) of uterine fibroids, which may be partly explained by the type of investigation, method of case ascertainment, or the age range of the study population, necessitating the reporting of country-specific estimates. This observational prospective cohort study using self-report survey and linked administrative data (2000-2022) included 8066 women, born between 1973 and 1978, in the Australian Longitudinal Study on Women's Health. A combination of self-report survey and linked administrative health data (hospital, emergency department, the Medicare Benefits Schedule, and the Pharmaceutical Benefits Scheme) were used to identify women with a report of a diagnosis of uterine fibroids between 2000 and 2022. Of the 8066 Australian women followed for 22 years, an estimated 7.3% of women (95% CI 6.9, 7.6) had a diagnosis of uterine fibroids by the age of 45-49 years. The incidence increased with age and was highest in women aged 40-44 years (5.0 cases per 1000 person-years, 95% CI 4.3, 5.7 cases per 1000 person-years). Women with uterine fibroids were more likely to experience heavy or painful periods. They were also more likely to report low iron levels, endometriosis, and poor self-rated health and to have two or more annual visits to their general practitioner. Our estimates are based on self-report of doctor diagnosis or treatment for fibroids and/or data linked to treatment and procedure administrative records. This predominantly captures women with symptomatic fibroids, but has the potential for misclassification of asymptomatic women and an underestimate of overall prevalence and incidence. In addition, questions on fibroids were only asked in surveys when women were 37-42 years of age to 43-48 years of age, so cases at younger ages may have been underestimated (particularly in women with less severe symptoms) as these were only ascertained through data linkage. These are the first population-based estimates of the prevalence and incidence of uterine fibroids in women of reproductive age in Australia. Establishing these first estimates will help inform health policy and health care provision in the Australian context. The ALSWH is funded by the Australian Government Department of Health and Aged Care. L.FW. was supported by an Australian National Health and Medical Research Council (NHMRC) Centres for Research Excellence grant (APP1153420) and G.D.M. was supported by an NHMRC Leadership Fellowship (APP2009577). The funding bodies played no role in the design, the collection, analysis or interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication. There are no competing interests. N/A.

Metrics of uterine myomatosis symptomatology in clinical practice.

A review of diagnostic options and standardized methods for specifying clinical symptoms associated with uterine myomatosis. A literature search of databases aimed at finding validated metrics for assessing myomas symptomatology. Summary of obligatory and optional examination methods in the diagnosis of uterine fibroids and methods of examination of reproductive parameters of the couple in relation to myomatosis. Defining the metrics of bleeding manifestations of myomatosis with emphasis on the "Pictorial Bleeding Assessment Chart". Reviewing metrics of algic manifestations of myomatosis and quality of life with emphasis on the "Quality of Life Questionnaire - Myomatosis - Severity Symptom Scale". The purpose of the applicable metrics, which summarize objective findings and subjective complaints of patients, is to describe and evaluate possible correlations and dynamics of changes in the health status, depending on the chosen therapy.

Clinical case of treatment of giant uterine fibroid

Uterine leiomyomas are the most common type of benign tumor that occurs in the female pelvis. Uterine leiomyoma is a tumor of smooth muscles. Its prevalence is higher in the reproductive age group and decreases after menopause. Giant uterine fibroids are a rare tumor of the uterus. Giant uterine fibroids, especially subcutaneous types, are complicated by malnutrition due to deterioration of their blood supply. The complaints of the patients are non-specific: an increase in the size of the abdomen, aching pains, sometimes difficulty urinating and defecating. A physical examination reveals a giant abdominal and pelvic formation. Ultrasound with Dopplerometry and contrast-enhanced MRI diagnoses a giant tumor next to the uterus with a heterogeneous structure and the presence of cystic cavities, which is difficult to distinguish from a true large ovarian tumor. The article illustrates the complexity of differential diagnosis of giant tumor of the uterus and ovaries. There are no significant differences between these tumors during ultrasound and MRI examinations. The final diagnosis can be made intraoperativery. The article presents a clinical observation of the giant uterine fibroids of a 48-year-old female patient. Ultrasound and contrast-enhanced MRI revealed a giant tumor of the right ovary, which occupied the entire abdominal cavity, of a heterogeneous structure. Intraoperatively, two tumors, intimately adjacent to each other, 31 cm and 28 cm in diameter, emanating from the isthmus of the uterus, were found. The final diagnosis of uterine fibroids was established histologically. Difficulties in differential diagnosis between uterine fibroids and ovarian tumors before surgery are associated with the large size of the tumor and the heterogeneity of the structure due to its malnutrition.

Hypertension, Cardiovascular Risk Factors, and Uterine Fibroid Diagnosis in Midlife

Fibroids are benign neoplasms associated with severe gynecologic morbidity. There are no strategies to prevent fibroid development. To examine associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with incidence of reported fibroid diagnosis in midlife. The Study of Women's Health Across the Nation is a prospective, multisite cohort study in the US. Participants were followed-up from enrollment (1996-1997) through 13 semiannual visits (1998-2013). Participants had a menstrual period in the last 3 months, were not pregnant or lactating, were aged 42 to 52 years, were not using hormones, and had a uterus and at least 1 ovary. Participants with prior fibroid diagnoses were excluded. Data analysis was performed from November 2022 to February 2024. Blood pressure, anthropometry, biomarkers (cholesterol, triglycerides, and C-reactive protein), and self-reported antihypertensive treatment at baseline and follow-up visits were measured. Hypertension status (new-onset, preexisting, or never [reference]) and hypertension treatment (untreated, treated, or no hypertension [reference]) were categorized. Participants reported fibroid diagnosis at each visit. Discrete-time survival models estimated hazard ratios (HRs) and 95% CIs for associations of time-varying hypertension status, antihypertensive treatment, anthropometry, and biomarkers with incident reported fibroid diagnoses. Among 2570 participants without a history of diagnosed fibroids (median [IQR] age at screening, 45 [43-48] years; 1079 [42.1%] college educated), 526 (20%) reported a new fibroid diagnosis during follow-up. Risk varied by category of hypertension treatment: compared with those with no hypertension, participants with untreated hypertension had a 19% greater risk of newly diagnosed fibroids (HR, 1.19; 95% CI, 0.91-1.57), whereas those with treated hypertension had a 20% lower risk (HR, 0.80; 95% CI, 0.56-1.15). Among eligible participants with hypertension, those taking antihypertensive treatment had a 37% lower risk of newly diagnosed fibroids (HR, 0.63; 95% CI, 0.38-1.05). Risk also varied by hypertension status: compared with never-hypertensive participants, participants with new-onset hypertension had 45% greater risk of newly diagnosed fibroids (HR, 1.45; 95% CI, 0.96-2.20). Anthropometric factors and blood biomarkers were not associated with fibroid risk. Participants with untreated and new-onset hypertension had increased risk of newly diagnosed fibroids, whereas those taking antihypertensive treatment had lower risk, suggesting that blood pressure control may provide new strategies for fibroid prevention.

“In our community, we normalize pain”: discussions around menstruation and uterine fibroids with Black women and Latinas

BackgroundUterine fibroids are non-cancerous neoplasms that arise from the uterus affecting over 75% of women. However, there is a disparity with Black women having an increased prevalence of nearly 80%. Black women also experience increased symptom burden, including younger age at the time of diagnosis and increased number and volume of fibroids. Less is known about other ethnoracially diverse women such as Latinas and the potential cultural impacts on fibroid burden and treatment.MethodsCommunity engagement studios were conducted to facilitate discussions with stakeholders on their uterine fibroid and menstruation experience. We recruited Black women (n = 6) diagnosed with uterine fibroids and Latinas (n = 7) without uterine fibroids. We held two virtual community engagement studios split by uterine fibroid diagnosis. The studios were not audio recorded and notes were taken by four notetakers. The notes were thematically analyzed in Atlas.ti using content analysis.ResultsParticipants felt there was a lack of discussion around menstruation overall, whether in the home or school settings. This lack of menstruation education was pronounced when participants had their first menstruation experience, with many unaware of what to expect. This silence around menstruation led to a normalization of painful menstruation symptoms. When it came to different treatment options for uterine fibroids, some women wanted to explore alternative treatments but were dismissed by their healthcare providers. Many participants advocated for having discussions with their healthcare provider about life goals to discuss different treatment options for their uterine fibroids.ConclusionDespite uterine fibroid diagnosis, there is silence around menstruation. Menstruation is a normal biological occurrence and needs to be discussed to help prevent delayed diagnosis of uterine fibroids and possibly other gynecological disorders. Along with increased discussions around menstruation, further discussion is needed between healthcare providers and uterine fibroid patients to explore appropriate treatment options.

The impact of health literacy on uterine fibroid awareness, diagnosis, and treatment in the United States: a mini literature review.

Limited health literacy is a social health determinant leading to poor health outcomes. General and health literacy correlate and can impact diagnosis and treatment understanding. Limited literacy can lead to women receiving more significant rates of invasive surgical treatment, including hysterectomies. This review explores the impact of health literacy levels on uterine fibroid awareness, diagnosis, and treatment. PubMed, CINAHL, and Academic Search Premier searched articles published between January 1, 2012, and December 31, 2022. The keywords uterine fibroids, fibroids, myomas, leiomyomas, and health literacy were used. A total of four articles were returned. Increased rates of hysterectomies were found among participants with low income and education, as well as those with limited health literacy. Hysterectomies are the removal of the uterus and thus removes a woman's right to have children. While increased efforts are needed to understand the impact of health literacy levels on disparities and inequities in uterine fibroid diagnosis and treatment, there is still a need for targeted patient education and community-based education that ensures patient understanding of the diagnosis and treatment options for uterine fibroids.

Association between leisure sedentary behaviour and uterine fibroids in non-menopausal women: a population-based study

ObjectiveSedentary behaviour is associated with a variety of adverse health outcomes, including obesity, oestrogen metabolism and chronic inflammation, all of which are related to the pathogenesis of uterine fibroids (UFs)....

Homoeopathic Treatment of Uterine Fibroid: A Case Report

AbstractUterine fibroids are common findings in women and represent benign smooth muscle tumours of the uterus. These tumors are very frequently encountered in clinical practice. Homeopathy offers a more favourable response to such conditions in addition to surgical interventions. A 30-year-old female patient visited our outpatient department with complaints of dyspareunia, which is characterized by painful sexual intercourse and abdominal distension. Ultrasonography confirmed her diagnosis of uterine fibroids. Following comprehensive case assessment and repertorization, the patient was initially prescribed individualized homeopathic medicine Natrum muriaticum 200c, followed by other medications as needed. Within approximately a year of homeopathic treatment, the patient's condition began to improve. The Modified Naranjo Criteria for Homeopathy (MONARCH) tool was employed to evaluate the causal relationship between homeopathic intervention and clinical outcome. A MONARCH score of +7 indicated that the clinical improvement was likely attributed to the homeopathic treatment, which aligns with ultrasonographic findings obtained before and after treatment. This case study underscores the effectiveness of tailored homeopathic treatment for uterine fibroids. However, more studies and evidence-based clinical verification are necessary to establish the efficacy of homeopathy in such cases.

Describing the Patient Journey of Women with Claims for Uterine Fibroids and Heavy Menstrual Bleeding Using a Commercial Database (2011-2020).

This retrospective database claims analysis describes the clinical characteristics and treatment patterns of commercially insured United States women with uterine fibroids (UF) and heavy menstrual bleeding (HMB). Women age 18-55 years with an incident UF diagnosis (index date) between 1/1/2012 and 12/31/2019 and ≥1 claim for HMB (UF-HMB), were identified from the Optum® Clinformatics® database. Outcomes included clinical characteristics, pharmacologic therapy use, and surgeries/procedures. Regression models were used to identify factors associated with time to post-diagnosis hormonal therapy and hysterectomy. A total of 85,428 women had UF-HMB (mean [SD] age, 43.7 [6.4] years). The median follow-up was 3.2 years. After HMB, the most common symptoms were pelvic pressure/pain (27.6%) and backache (17.5%). Within 6 months of UF diagnosis, 40.2% of patients had received only pharmacologic therapy; 25.5% had received no treatment; 24.3% had a hysterectomy, and 10.0% had other procedures. By the end of follow-up, 50.0% had received a hysterectomy. Multiple factors were predictive of a higher likelihood of receiving hormonal therapy (geographic region, infertility, pre-index pregnancy) or hysterectomy (older age, prior hormonal treatment, specific bulk symptoms, White race). Within 6 months of UF diagnosis, fewer than one-half of women with UF-HMB had received hormonal therapy, one-quarter received no treatment, and one-quarter had received a hysterectomy or another gynecologic procedure. Patients who received a hysterectomy were more likely to be older, White, and to have bulk symptoms.

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids in Southwest Nigeria: a Cross-sectional Study.

Studies have suggested the potential roles of serum macronutrients such as calcium and magnesium in the development of uterine fibroids. The primary objective was to assess the association between serum magnesium and calcium levels and the prevalence of uterine fibroids in women of reproductive age. A cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio = 0.06), uterine size, and the number of fibroid nodules. However, no significant association was observed between serum magnesium levels and uterine fibroids. This study found significant inverse associations between low serum calcium levels and uterine fibroids, uterine size, and the number of fibroid nodules.

Efficacy of different doses of mifepristone in the management of uterine leiomyoma in a tertiary care centre

Leiomyoma or uterine fibroid are benign tumours that arise from the smooth muscles of the uterus. The leiomyomas are common gynaecological problem encountered among reproductive age group women. Mifepristone is the commonly used drug in the management of uterine leiomyoma. The objective of the study were to study the efficacy and safety of 10mg and 25mg of Mifepristone in the management of uterine fibroid. This is a randomized controlled Trial conducted in tertiary care centre. Hundred women with the diagnosis of uterine fibroid were taken up for the study. Group-A (n=50) were given Mifepristone 10mg and Group-B (n=50) were given Mifepristone 25mg daily for a period of 3 months. Reduction in the size of fibroid were assessed at the end of 3 months. At the end of 3months there was a significant reduction in both menstrual blood loss and fibroid volume in both the groups (p<0.001). There was a also significant improvement in haemoglobin levels in both the groups. When compared to Group –A (10mg Mifepristone) more side effects were noted in Group-B (25mg Mifepristone). Nausea and vomiting developed in 90% and 60% of patients in group A and B.Gastrointestinal discomfort developed in 80% and 50% of patients in group A and B. Both Mifepristone 10mg and 25mg had similar clinical outcomes but 10mg had better compliance and lower side effects. Hence, 10mg can be preferred over 25mg in order to bring about effective management of uterine fibroid.

Validation of self-report of uterine fibroid diagnosis using a transvaginal ultrasound scan

Self-report of uterine fibroids (UF) has been used for epidemiologic research in different environments. Given the dearth of studies on the epidemiology of UF in Sub-Saharan Africa (SSA), it is valuable to evaluate its performance as a potential tool for much needed research on this common neoplasm in SSA women. We conducted a cross-sectional study of self-report of UF compared with transvaginal ultrasound diagnosis (TVUS) among 486 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria. We used log-binomial regression models to compute the classification, sensitivity, specificity, and predictive values of self-report compared to TVUS, adjusted for significant covariates. The prevalence of UF on TVUS was 45.1% (219/486) compared to 5.4% (26/486) based on self-report of abdominal ultrasound scan and 7.2% (35/486) based on report of healthcare practitioner’s diagnosis. Self-report correctly classified 39.5% of the women compared to TVUS in multivariable adjusted models. The multivariable adjusted sensitivity of self-report of healthcare worker diagnosis was 38.8%, specificity was 74.5%, positive predictive value (PPV) was 55.6%, and negative predictive value (NPV) was 59.8%. For self-reported abdominal ultrasound diagnosis, the multivariable adjusted sensitivity was 40.6%, specificity was 75.3%, PPV was 57.4%, and NPV was 60.6%. Self-report significantly underestimates the prevalence of UF and is not accurate enough for epidemiological research on UF. Future studies of UF should use population-based designs and more accurate diagnostic tools such as TVUS.

Automated Uterine Fibroids Detection in Ultrasound Images Using Deep Convolutional Neural Networks.

Fibroids of the uterus are a common benign tumor affecting women of childbearing age. Uterine fibroids (UF) can be effectively treated with earlier identification and diagnosis. Its automated diagnosis from medical images is an area where deep learning (DL)-based algorithms have demonstrated promising results. In this research, we evaluated state-of-the-art DL architectures VGG16, ResNet50, InceptionV3, and our proposed innovative dual-path deep convolutional neural network (DPCNN) architecture for UF detection tasks. Using preprocessing methods including scaling, normalization, and data augmentation, an ultrasound image dataset from Kaggle is prepared for use. After the images are used to train and validate the DL models, the model performance is evaluated using different measures. When compared to existing DL models, our suggested DPCNN architecture achieved the highest accuracy of 99.8 percent. Findings show that pre-trained deep-learning model performance for UF diagnosis from medical images may significantly improve with the application of fine-tuning strategies. In particular, the InceptionV3 model achieved 90% accuracy, with the ResNet50 model achieving 89% accuracy. It should be noted that the VGG16 model was found to have a lower accuracy level of 85%. Our findings show that DL-based methods can be effectively utilized to facilitate automated UF detection from medical images. Further research in this area holds great potential and could lead to the creation of cutting-edge computer-aided diagnosis systems. To further advance the state-of-the-art in medical imaging analysis, the DL community is invited to investigate these lines of research. Although our proposed innovative DPCNN architecture performed best, fine-tuned versions of pre-trained models like InceptionV3 and ResNet50 also delivered strong results. This work lays the foundation for future studies and has the potential to enhance the precision and suitability with which UF is detected.

173 Delving into Sociocultural Influences in Access to Care in Black Women and Latinas with Uterine Fibroids

OBJECTIVES/GOALS: Uterine fibroids (UF) are a significant public health concern with a lifetime prevalence of over 70% in all women, however Black/African American women (BW) are disproportionately affected by UF, and Hispanic/Latinas (HL) mostly understudied. Our goal is to investigate sociocultural influences on menstrual and UF experiences of BW and HL with UF. METHODS/STUDY POPULATION: We have taken a community engaged research approach and partnered with the Fibroid Foundation, a patient UF advocacy group. Following IRB approval, the study was advertised on the Fibroid Foundation’s various social media platforms, such as Instagram. Screening began on October 25, 2022, the screening survey included participants’ contact information, preferred time of contact, time zone, and confirming identifying as a BW and/or HL diagnosed with UF. Ensuring eligibility, we plan to conduct semi-structured interviews for participants. The interviews will be conducted via phone or video call based on participant preference. The interviews will be sent for transcription to an external HIPAA compliant vendor then analyze the interviews for a priori and new themes using traditional content analysis. RESULTS/ANTICIPATED RESULTS: As of November 13, 2022, over 200 participants have completed the screening survey with a total of 133 (66.5%) being eligible to participate. The demographics are the following: 109 (82%) Black women, 14 (10.5%) Latinas, 4 (3%) Afro-Latinas, and 6 (4.5%) did not disclose ethnoracial identity. The participants were sent a consent form and will be interviewed. We anticipate achieving our goal of interviewing a minimum of 60 women for this study. Based on our previous research, we expect to find sociocultural influences leading to negative experiences of menstruation that affect access to care for UF. We also expect women will lack sufficient and accurate information regarding menstrual symptoms and UF. We additionally anticipate seeing delays in UF diagnosis. DISCUSSION/SIGNIFICANCE: There is a need to discuss sociocultural influences around menstruation as negative perceptions lead to delayed diagnosis of UF and can be translated to other gynecological diseases, such as endometriosis and endometrial and ovarian cancer. This suite of female-specific conditions all share increased disparity in historically minoritized women.

Age of first diagnosis and incidence rate of uterine fibroids in Ghana. A retrospective cohort study.

Uterine fibroids are benign tumors that grow in or on the uterus of women. Globally, they occur in more than 80% of women of African ancestry and 70% in white women. Uterine fibroid requires much attention because of its high incidence rate among women of all races and ages. This study sought to document the age of first diagnosis and incidence rates of uterine fibroids in our urban setting. This study reviewed and analyzed the ages and year of diagnosis of all 2,469 patients with the first diagnosis of uterine fibroids from 1st January 2018 to 31st December 2021 in South-Central Ghana. The obtained data were analyzed using GNU PSPP, Python on Jupyter Notebook and Libre Office Calc with statistical significance level set at p≤0.05. The overall average age was 36.29±8.08 years, with age range 17-61 years and the age groups with the highest frequencies were 35-39 years (n = 642, 26.00%), 30-34 years (n = 563, 22.80%) and 40-44 years (n = 381, 15.43%). The mean ages of the patients in 2018, 2019, 2020 and 2021 were 36.70±8.00 years (95%CI = 35.97-37.43), 37.07±7.66 years (95%CI = 36.45-37.70), 35.92±7.87 years (95%CI = 35.30-36.53) and 35.78±8.54 years (95%CI = 35.19-36.38) respectively. The incidence rate (per 100,000) of uterine fibroids in 2018, 2019, 2020 and 2021 were 66.77 (95% CI = 60.63-72.90), 81.86 (95%CI = 75.19-88.58), 85.60 (95%CI = 78.85-92.35) and 92.40 (95%CI = 85.88-98.92) respectively, with 35-39 age group recording the highest in all years. The incidence rate of uterine fibroids increased as the years progressed and it is mostly high in 35-39 years age category, with a decreasing annual mean age trend indicative of early diagnosis.

Artificial intelligence-aided method to detect uterine fibroids in ultrasound images: a retrospective study

We explored a new artificial intelligence-assisted method to assist junior ultrasonographers in improving the diagnostic performance of uterine fibroids and further compared it with senior ultrasonographers to confirm the effectiveness and feasibility of the artificial intelligence method. In this retrospective study, we collected a total of 3870 ultrasound images from 667 patients with a mean age of 42.45 years ± 6.23 [SD] for those who received a pathologically confirmed diagnosis of uterine fibroids and 570 women with a mean age of 39.24 years ± 5.32 [SD] without uterine lesions from Shunde Hospital of Southern Medical University between 2015 and 2020. The DCNN model was trained and developed on the training dataset (2706 images) and internal validation dataset (676 images). To evaluate the performance of the model on the external validation dataset (488 images), we assessed the diagnostic performance of the DCNN with ultrasonographers possessing different levels of seniority. The DCNN model aided the junior ultrasonographers (Averaged) in diagnosing uterine fibroids with higher accuracy (94.72% vs. 86.63%, P < 0.001), sensitivity (92.82% vs. 83.21%, P = 0.001), specificity (97.05% vs. 90.80%, P = 0.009), positive predictive value (97.45% vs. 91.68%, P = 0.007), and negative predictive value (91.73% vs. 81.61%, P = 0.001) than they achieved alone. Their ability was comparable to that of senior ultrasonographers (Averaged) in terms of accuracy (94.72% vs. 95.24%, P = 0.66), sensitivity (92.82% vs. 93.66%, P = 0.73), specificity (97.05% vs. 97.16%, P = 0.79), positive predictive value (97.45% vs. 97.57%, P = 0.77), and negative predictive value (91.73% vs. 92.63%, P = 0.75). The DCNN-assisted strategy can considerably improve the uterine fibroid diagnosis performance of junior ultrasonographers to make them more comparable to senior ultrasonographers.

New possibilities of differential diagnosis of uterine fibroids and adenomyosis nodes based on a complex ultrasound assessment

BACKGROUND: Ultrasound is widely used in routine practice to diagnose various forms of adenomyosis and uterine fibroids. However, due to the lack of unified criteria, hypo- or overdiagnosis of internal endometriosis is possible. Moreover, there are a number of difficulties in the differential diagnosis of nodular adenomyosis and uterine fibroids.&#x0D; AIM: The aim of this study was to develop a complex technique for the differential diagnosis of uterine fibroids and adenomyosis nodes.&#x0D; MATERIALS AND METHODS: We applied a complex ultrasound technique with a detailed and consistent application of the following tools 3D reconstruction, elastography, color Doppler, 3D power Doppler (glass body mode). The study was conducted in 124 patients of reproductive age with subsequent intraoperative and histological confirmation of the diagnosis.&#x0D; RESULTS: After the proposed ultrasound technique, uterine fibroids were diagnosed in 112 (90.3%) patients, of whom 85 (75.9%) patients had uterine fibroids combined with a diffuse form of internal endometriosis. Nodular adenomyosis was diagnosed in 12 (9.7%) patients. The additional examination and surgical treatment showed that the preliminary diagnosis of uterine fibroids was confirmed in 110 out of 112 women, and in two other cases, nodular adenomyosis was diagnosed. Eleven (91.7%) out of 12 patients were diagnosed correctly with nodular adenomyosis by the complex ultrasound examination, while in one case the preliminary diagnosis proved to be incorrect, with a conglomerate of three myomatous nodes detected as a result of surgical treatment. Thus, based on the technique we developed, the correct diagnosis was made in 121 (97.6%) patients. Misdiagnosis in three cases was associated with a history of a long-term medical treatment of adenomyosis and therefore Doppler and elastography results had lower sensitivity.&#x0D; CONCLUSIONS: The development of the described complex ultrasound technique allows for accurately diagnosing the form of adenomyosis, identifying early forms of the disease and differentiating adenomyosis nodes from myomatous nodes, which is necessary for the correct diagnosis, the right choice of the management tactics and the necessary treatment.

ЛЕЙОМИОМА МАТКИ, ИМИТИРУЮЩАЯ ЛЕЙОМИОСАРКОМУ. КЛИНИЧЕСКИЙ СЛУЧАЙ

Radiation diagnosis of giant uterine fibroids is an urgent problem of modern radiology. Specialists in the field of radiation diagnostics, as a rule, have considerable difficulties in making an accurate diagnosis of a benign tumor of the uterus, taking it for malignant due to its large size. Uterine fibroids are benign tumors of the uterus, which occupies one of the leading places in the structure of diseases of the female reproductive system. A clinical observation of a patient with such a rare pathology as a giant uterine leiomyoma imitating leiomyosarcoma is given, which caused difficulties for radiation diagnosticians in making an accurate diagnosis of uterine fibroids. The use of a complex of histological and immunohistochemical diagnostic methods in combination with radiation imaging methods in difficult cases makes it possible to make the correct diagnosis.

Treatment Patterns in Patients with Uterine Fibroids With and Without a Diagnosis of Heavy Menstrual Bleeding: Results from a Large U.S. Claims Database.

Background: This retrospective database analysis describes clinical characteristics and treatment patterns of U.S. women with a diagnosis for uterine fibroids (UF), both with and without heavy menstrual bleeding (HMB). Materials and Methods: Two cohorts aged 18-50 years with an incident UF diagnosis, comprising women with and without claims for HMB (UF-HMB and UF-only), were identified from the IQVIA PharMetrics® Plus database (January 1, 2010-December 31, 2019). The index date was the first UF claim following diagnosis; treatment patterns were documented for postindex years 1 and 2 and the full duration of postindex follow-up. Also identified were claims for symptoms or signs potentially associated with UF. Outcomes were the proportion of patients treated with pharmacologic therapies of interest and gynecologic procedures. Logistic regression was used to identify factors associated with postdiagnosis hysterectomy and hormonal therapy. Results: A total of 66,313 (71.8%) women were included in the UF-HMB cohort (mean age [standard deviation]) 42.6 [5.4] years), and 26,068 (28.2%) in the UF-only cohort (41.8 [6.3]). Median follow-up was ∼4 years. Pain was the most common symptom (42.7% in patients with UF-HMB and 36.6% with UF-only); also common were abnormal bleeding (15.6%, 11.5%) and fatigue (22.2%, 15.5%). Within 1 year of UF diagnosis, 28.8% and 49.2% of women with UF-HMB and UF-only, respectively, had no claims for relevant pharmacologic or surgical treatment. In logistic regression, multiple factors were associated with a higher likelihood of receiving hysterectomy or hormonal therapy. Conclusions: Patients with UF-HMB were more likely to receive UF treatment, either surgical or pharmacologic, than women with UF-only. Apart from HMB, pain was the most commonly documented symptom of UF.

Bloodwork: Circulatory Disorders, Immunity, and the Scarring of Systems

AbstractIn June 2021, laboratory analysis of my blood indicated dangerously low levels of iron. This article chronicles my subsequent diagnosis of uterine fibroids, the hysterectomy that followed, and the scarring that came afterward. In doing so, the article tells the story of how blood circulates—or not—through biosocial systems. It shows how the properties of blood are frequently connected to conditions of exploitation to advance the argument that paying attention to how blood works, or “bloodwork,” can illuminate systemic inequality and alternative systems. In conversation with social reproduction theory, I consider capitalism’s powerful extractivist orderings of immunity in which my iron comes at another’s expense, alongside logics of immunity based on different circulatory visions. I hold on to the possibility of growing stronger without weakening others—so long as we can attend to history and its scars.