Fibroids In Women Research Articles

Миома матки и фертильность

Despite the fact that the study of uterine fibroids has been widely discussed, the problem still remains unsolved. Uterine fibroids are the most common benign neoplasm of female genital system. Increasingly diagnosed in recent decades, uterine fibroids in women planning a pregnancy, which is associated primarily with the social factor: modern women tend to postpone the time of childbirth until a stable material and social status, which often occurs close to the late reproductive age, when the prevalence of uterine fibroids naturally increases. The link between uterine fibroids and fertility disorders ambiguous, but, without a doubt, the presence of uterine fibroids should be taken into account in women with infertility and habitual miscarriage. The optimal solution, but today, in addition to surgical treatment task of restoring fertility in women with uterine fibroids do not exist, there is a possibility of conservative management of these patients. Advantages and disadvantages of surgical and conservative tactics restore fertility in patients with uterine myoma should undergo evaluation and further development.

Immunoexpression of Steroid Hormone Receptors and Proliferation Markers in Uterine Leiomyoma and Normal Myometrial Tissues from the Miniature Pig, Sus scrofa.

Uterine leiomyomas in miniature pet pigs occur similarly to those in women with regard to frequency, age, parity, and cycling. Clinical signs, gross, and histologic features of the porcine tumors closely resemble uterine leiomyomas (fibroids) in women. Although fibroids are hormonally responsive in women, the roles of estrogen and progesterone have not been fully elucidated. In this study, immunohistochemistry was used to assess the expression of the steroid hormone receptors, estrogen receptor alpha (ER-α), estrogen receptor beta (ER-β) and progesterone receptor (PR), and cell proliferation markers, proliferating cell nuclear antigen (PCNA) and Ki-67 in tumor and matched myometrial tissues sampled from miniature pigs. A "quickscore" method was used to determine receptor expression and labeling indices were calculated for the markers. ER-α/β and PR were localized to the nuclei of smooth muscle cells in both tissues. PR expression was intense and diffuse throughout all tissues, with correlation between tumors and matched myometria. Conversely, ER-α expression was variable between the myometrial and tumor tissues, as well as between animals. ER-β expression was low. PCNA and Ki-67 were localized to the nucleus and expression varied among tumors; however, normal tissues were overall negative. These findings support further investigation into the use of the miniature pig as a model of fibroids in women.

Radiofrequency Volumetric Thermal Ablation of Fibroids and Laparoscopic Myomectomy: Long-Term Follow-up From a Randomized Trial.

Aims: Laparoscopic myomectomy (LM) has been the gold standard treatment for uterine fibroids in women desiring uterine conservation. To evaluate a new fibroid treatment modality - radiofrequency volumetric thermal ablation (RFVTA) - we compare 12-month results in women who had symptomatic uterine fibroids and who were randomized to laparoscopic ultrasound-guided RFVTA or LM. Materials and Methods: Our study is a 1 : 1 parallel, randomized, prospective, single-center, longitudinal, comparative analysis of RFVTA to LM for fibroid treatment in women ≥ 18 years of age who desired uterine conservation. Fifty women were randomized intraoperatively to RFVTA (n = 25) or to LM (n = 25) after laparoscopic ultrasound mapping of the uterus. Results: Post surgery, ablation and myomectomy subjects took pain medications for 4 days (range: 1-46) and 7 days (range: 1-83 days) respectively (p = 0.60). Ablation and myomectomy subjects missed 10.0 workdays (range: 2-86 days) and 17.0 workdays (range: 7-30 days) (p = 0.28), resumed normal activities in 20.5 days (range: 5-103 days) versus 28.0 days (range: 10-42 days) (p = 0.86) respectively. Mean symptom severity scores decreased (improved) by - 7.8 for the ablation subjects and by - 17.9 for the myomectomy subjects (p = 0.16). Health-related quality of life improved (increased) by 7.5 and 13.1, respectively, for the two groups (p = 0.46). Two myomectomy subjects had pregnancies that ended in a Cesarean delivery and a vaginal delivery of healthy infants. Two pregnancies in the RFVTA group ended in full-term vaginal deliveries of healthy infants. Conclusions: Early postoperative recovery and twelve-month results attest to similar clinical benefits from RFVTA and LM.

The management of uterine fibroids in women with otherwise unexplained infertility.

Abstract Objective To provide recommendations regarding the best management of fibroids in couples who present with infertility. Usual and novel treatment options for fibroids will be reviewed with emphasis on their applicability in women who wish to conceive. Options Management of fibroids in women wishing to conceive first involves documentation of the presence of the fibroid and determination of likelihood of the fibroid impacting on the ability to conceive. Treatment of fibroids in this instance is primarily surgical, but must be weighed against the evidence of surgical management improving clinical outcomes, and risks specific to surgical management and approach. Outcomes The outcomes of primary concern are the improvement in pregnancy rates and outcomes with management of fibroids in women with infertility. Evidence Published literature was retrieved through searches of PubMed, MEDLINE, the Cochrane Library in November 2013 using appropriate controlled vocabulary (e.g., leiomyoma, infertility, uterine artery embolization, fertilization in vitro) and key words (e.g., fibroid, myomectomy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English and French. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to November 2013. Grey (unpublished literature) was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence in this document was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table). Benefits, harms, and costs These recommendations are expected to allow adequate management of women with fibroids and infertility, maximizing their chances of pregnancy by minimizing risks introduced by unnecessary myomectomies. Reducing complications and eliminating unnecessary interventions are also expected to decrease costs to the health care system.

Алгоритм лечебно-профилактической тактики ведения пациенток с миомой матки

Presented their own data on the prevalence of uterine fibroids in women in different age groups, as well as infertility, miscarriage, and with other diseases of internal genital organs. Shows the main clinical manifestations of uterine fibroids. Proposed algorithm for the management of patients with uterine fibroids, which takes into account the size and localization of nodes, concomitant somatic disorders and gynecological and reproductive plans woman. Pathogenesis noted the desirability and efficacy of clinical mefipristone in conservative therapy of uterine fibroids. Shown the importance of modern organ treatments.

Дифференцированный подход к органосохраняющему лечению миомы матки у женщин репродуктивного возраста

Дифференцированный подход к органосохраняющему лечению миомы матки у женщин репродуктивного возраста

Uterine artery embolization for symptomatic uterine fibroids.

Uterine artery embolization for symptomatic uterine fibroids.

New era in treatment of uterine fibroids in women of different age groups

Despite the high level of development of modern surgery and pharmacology, none of surgical procedures (hysterectomy/myomectomy or uterine artery embolization) or the drug does not guarantee the absence of recurrence of uterine fibroids in the future. However, there are quite effective methods of pharmacotherapy its manifestations. In particular, selective progesterone receptor modulators show high effectiveness against the symptoms of fibroids and sizes nodes, which allows us to consider them as a full fledged alternative to surgical treatment of uterine fibroids. The results of PEARL-I, -II, -III studies show that the use of such a selective progesterone receptor modulator as ulipristal acetate in treating symptomatic uterine fibroids is safe and well tolerated, leading to rapid cupping uterine bleeding nodes, greatly reduces the size and the therapeutic effect is maintained even after therapy discontinuation.

Novel MED12 gene somatic mutations in women from the Southern United States with symptomatic uterine fibroids.

Although somatic mutations in exon 2 of the mediator complex subunit 12 (MED12) gene have been reported previously in uterine fibroids in women from Finland, South Africa, and North America, the status of these mutations was not reported in the Southern United States women. The aim of this study is to determine the MED12 somatic mutations in uterine fibroids of women from Southern Unites States, which will help to better understand the contribution of MED12 mutations in fibroid tumor biology. Herein, we determined the frequency of MED12 gene exon 2 somatic mutations in 143 fibroid tumors from a total of 135 women from the Southern United States and in 50 samples of the adjacent myometrium using PCR amplification and Sanger sequencing. We observed that the MED12 gene is mutated in 64.33 % (92/143) of uterine fibroid cases in the exon 2 (including deletion mutations). These mutations include 107T > G (4.3 %), 130G > C (2.8 %), 130G > A (7.0 %), 130G > T (2.8 %), 131G > C (2.1 %), 131G > A (20.2 %), and 131G > T (2.1 %). Interestingly, we identified four novel mutations in these patients: 107 T > C (12.8 %), 105A > T (2.1 %), 122T > A (2.1 %), and 92T > A (2.1 %). As expected, we did not observe any mutations in the normal myometrium. Moreover, we found a higher rate of deletion mutations (17.5 %, 25/143) in the above fibroid tumors. Our results clearly demonstrate that the MED12 gene exon 2 is frequently mutated in human uterine fibroids in Southern United States women. These results highlight the molecular pathogenesis of human uterine fibroids with the central role of MED12 somatic mutations.

P30.16: Usefulness of elastography in the differential diagnosis of endometrial polyps and submucous fibroids in women with abnormal uterine bleeding

<scp>P</scp>30.16: Usefulness of elastography in the differential diagnosis of endometrial polyps and submucous fibroids in women with abnormal uterine bleeding

Association of Body Size and Body Fat Distribution with Uterine Fibroids Among Chinese Women

Uterine fibroids are the most common tumors in reproductive women. The present study aims to identify the relationship between uterine fibroids and body size and body fat distribution among Chinese women. Data on the records of 826 participants who attended health examinations, including 316 cases and 510 controls were collected from 2009 to 2012 at a health examination center in Beijing. A multivariate logistic regression analysis was used to estimate the odds ratios of body size, body fat distribution, and body composition after adjusting for age, age at menarche, gravity, parity, and age at last birth. Current body mass index, waist circumference, hip circumference, waist-to-height ratio, body fat mass, body fat percentage, and intracellular water were each positively associated with uterine fibroid. Although the effects in hysterectomy-confirmed cases were frequently greater, we observed no associations with waist circumference, hip circumference, or body fat percentage in this subgroup. Combined with different indicators of fat distribution, women with higher body mass indices and waist-to-hip ratios were at the highest risk, which was significant within the total and separate groups. Women with a body fat percentage greater than 30% were also at a higher risk. Our study suggested that uterine fibroids in women might be related to excess weight and central obesity.

Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy

ObjectiveTo compare the mean hospital discharge times and perioperative outcomes for radiofrequency volumetric thermal ablation (RFVTA) of fibroids and laparoscopic myomectomy (LM). MethodsThe present postmarket, randomized, prospective, single-center, longitudinal, comparative study, conducted in Tübingen, Germany, evaluated the outcomes of RFVTA and the current standard of care (LM) for symptomatic uterine fibroids in women who desired uterine conservation. The surgeons were blinded to the treatment until all fibroids had been mapped by laparoscopic ultrasound. ResultsThe mean hospitalization times were 10.0±5.5 (median 7.8 [range 4.2–25.5]) hours for the RFVTA group and 29.9±14.2 (median 22.6 [range 16.1–68.1]) hours for the LM group (P<0.001, Wilcoxon test). Intraoperative blood loss was 16±9 (median 20 [range: 0–30]) mL for the RFVTA procedures and 51±57 (median 35 [range 10–300]) mL for the LM procedures. The percentage of fibroids imaged by laparoscopic ultrasound that were treated/excised was 98.6% for RFVTA and 80.3% for LM. Two complications were reported: vertigo (n=1; RFVTA) and port site hematoma (n=1; LM). ConclusionRadiofrequency volumetric thermal ablation resulted in the treatment of more fibroids, a significantly shorter hospital stay, and less intraoperative blood loss than laparoscopic myomectomy.ClinicalTrials.gov:NCT01750008

Ulipristal acetate: a novel pharmacological approach for the treatment of uterine fibroids

Uterine fibroids are the most common benign tumors of the female genital tract. The management of symptomatic fibroids has traditionally been surgical; however, alternative pharmacological approaches have been proposed to control symptoms. To date, gonadotropin-releasing hormone analogs are the only available drugs for the preoperative treatment of fibroids. However, the US Food and Drug Administration recently authorized ulipristal acetate (UPA), an oral selective progesterone-receptor modulator, for the same indication. UPA is a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms of uterine fibroids in women of reproductive age. According to clinical data, UPA shows several advantages: it is faster than leuprolide in reducing the fibroid-associated bleeding, it significantly improves hemoglobin and hematocrit levels in anemic patients, and it grants a significant reduction in the size of fibroids, which lasts for at least 6 months after the end of the treatment. Furthermore, UPA displays a better tolerability profile when compared to leuprolide; in fact, it keeps estradiol levels at mid follicular phase range, thereby reducing the incidence of hot flushes and exerting no impact on bone turnover. On the grounds of this evidence, the administration of 5 mg/day ulipristal acetate for 3 months is suggested for different patient categories and allows for planning a treatment strategy tailored to meet an individual patient’s needs.

Commentary on the article "Pre-treatment with ulipristal acetate before ICSI procedure: a case report" published in Menopause Review 6/2013 (Przegląd Menopauzalny 2013; 6: 496-500).

Failure to become and remain pregnant after IVF depends on multiple factors including but not limited to the ability of the uterus to implant embryo and to carry a pregnancy to term. One of the factors which adversely affect fertility is the presence of uterine fibroids [1]. The closer the fibroids are to the uterine cavity, the greater their effect is on female fertility [2]. Reproduction is adversely affected mainly by intramural fibroids, which modulate endometrium and also by submucosal fibroids [2]. In patients with uterine fibroids, the course of pregnancy is often complicated. These are high-risk pregnancies as they may end in miscarriage, premature delivery or intrauterine death [3-5]. The factors predisposing to uterine fibroids include age, African ancestry, obesity and nulliparity. Although studies performed to date have extended our knowledge on fibroid pathology, their etiology has not been fully elucidated. There is a need for further research on predisposing factors and for prevention of uterine fibroids in women. Mini

Single or repeated gonadotropin‐releasing hormone agonist treatment avoids hysterectomy in premenopausal women with large symptomatic fibroids with no effects on sexual function

The aim of our study was to explore the effects on symptoms and female sexual function of the medical management with gonadotropin-releasing hormone agonist (GnRHa) in women of more than 45 years old compared to surgical management. Women with symptomatic uterine fibroids were enrolled to participate to the present open-label study. We offered two different treatment options: medical with GnRHa for 6 months (group A) or hysterectomy (group B). The patients were reviewed in follow-up for 24 months. The impact of medical or surgical therapy on sexual life was evaluated. No significant differences were found in population characteristics between the two groups. GnRHa treatment was efficient in reducing symptoms in 88% of patients but 22% of patients needed adjunctive cycles of medical therapy. After 24 months, 16% of the patients did not complete the study. The failure percentage of the medical treatment was 12%. No severe side-effects were recorded, and eight patients had reached menopause. No significant differences were observed in the Female Sexual Function Index score in each domain between the medical and surgical groups, with total scores of 18.94 ± 10.16 and 22.00 ± 8.86, respectively (mean ± standard deviation), and the prevalence of dysfunction was 12% and 22%, respectively, similar to the general population of the same age. We found that medical therapy with GnRHa is a satisfactory alternative to surgery for fibroids in women of more than 45 years old.

Ulipristal Acetate Versus Leuprolide Acetate for Uterine Fibroids

Current intervention strategies for management of uterine fibroids in women of reproductive age are primarily surgical or radiological. There are limited options for medical therapy. Two small placebo-controlled trials showed that ulipristal acetate, a selective progesterone-receptor modulator (SPRM), reduced fibroid and uterine sizes in women with symptomatic fibroids. The aim of this randomized, double-blind, controlled noninferiority trial was to determine whether ulipristal acetate was noninferior to leuprolide acetate in controlling bleeding before planned surgery in premenopausal women with symptomatic fibroids. Another aim was to compare the adverse effect profile of the 2 drugs. The participants, 307 patients with heavy uterine bleeding, were randomized to receive 3 months of daily therapy with oral ulipristal acetate (either 5 or 10 mg) or once-monthly intramuscular injections of leuprolide acetate (3.75 mg). The primary study outcome was the proportion of patients with controlled uterine bleeding at week 13. A prespecified noninferiority margin of −20% was used. Bleeding was controlled at 13 weeks in all 3 treatment groups; there was 90% control with the 5-mg dose of ulipristal acetate: 98% with the 10-mg dose versus 89% with the leuprolide acetate injection; the difference between ulipristal acetate and leuprolide acetate was 1.2 percentage points (95% confidence interval, −9.3 to 11.8) for the 5-mg dose and 8.8 percentage points (95% confidence interval, 0.4 to 18.3) for the 10-mg dose. Bleeding was attenuated more rapidly with ulipristal acetate than leuprolide acetate: median times to amenorrhea were 7 days in patients receiving 5 mg of ulipristal acetate and 5 days in those receiving 10 mg versus 21 days in those receiving leuprolide acetate. Moderate-to-severe hot flashes occurred less frequently in patients treated with ulipristal acetate than in those treated with leuprolide acetate: 11% with the 5-mg dose of ulipristal acetate and 10% with the 10-mg dose compared with 40% in those treated with leuprolide acetate (P < 0.001 for both comparisons). These findings show that daily doses of oral ulipristal acetate of both 5 and 10 mg were noninferior to once-monthly injections of leuprolide acetate in controlling bleeding in patients with fibroids and were less likely to cause hot flashes.

Myxoid Leiomyoma of Cervix

Leiomyoma, a benign smooth muscle tumour of uterus, is the most common pelvic tumour which occurs in women of reproductive age group. Uterine leiomyomas are frequently seen in women who are older than 30 years of age and they are very rarely seen in women who are below the age of 18 years. They tend to regress after menopause. Incidence is 4% in women who are below 30 years of age. However , lifetime risk of fibroids in women who are over the age of 45 years is more than 60%, with an incidence which is higher in blacks than in whites Cervical leiomyomas constitute 1-2% of the total leiomyoma cases and they rarely occur. There are three types of cervical leiomyomas, namely; interstitial, supravaginal, and polypoidal. Supravaginal leiomyoma is the commonest type. Large cervical fibroids present with abdominal masses, incarcerated procidentia, uterine inversion, cervical malignancy, etc. The prevalence of fibroids during pregnancy, irrespective of site, has been reported to be 1-4%. Degeneration in leiomyomas have been described in 65% of the cases. Myxoid leiomyoma is characterized by absence of mito tic activity and the presence of myogenic phenotype. The higher end of prevalence for a myxoid degeneration has been reported in upto 50% of all degenerations in uterus, but myxoid leiomyoma has been rarely described in cervix. Cause of a myxoid change in pregnancy is unknown.

Selective Progesterone Receptor Modulator(ulipristal acetate – a new option in the pharmacological treatment of uterine fibroids in women

Uterine leiomyomata (fibroids) are very common, mostly benign tumors in women of reproductive age. Symptomatic fibroids cause significant morbidity and are characterized by heavy prolonged menstrual bleeding, by pain and pelvic pressure and, in some cases, they may lead to reproductive dysfunctions. Up to date, surgical procedures (hysterectomy or myomectomy) have been the dominant managements but recently uterine artery embolization and focused ultrasound surgery have also been taken into consideration. Hysterectomy is curative but for women of reproductive age the need for uterus-sparing medical therapy is evident. There are convincing data that progesterone and its receptors increase the proliferation activity of the cells in uterine leiomyomata, hence treatment with antiprogestins and progesterone receptor modulators seems to be reasonable. Results of a successfully completed phase III clinical trials with the application of ulipristal acetate (UPA) (first-in-class selective progesterone receptor modulator--SPRM) have been published at the beginning of this year Administration of 5 mg or 10 mg UPA daily has been shown to rapidly stop (within a week) excessive uterine bleeding, reduce the volume of the three largest fibroids by -44.8% and -54.8% for UPA 5 mg and 10 mg, respectively The effect on fibroid volume has been observed for up to 6 months after treatment cessation. It is also important that UPA restores patient Quality of Life scores to the level of healthy women and in the majority of patients resumes menstruation and ovulation within one month after treatment cessation. When compared with the Gn-RH agonist (leuprolide acetate), UPA has controlled uterine bleeding faster and more consistently (7 days vs. 30 days), fibroid reduction for up to 6 months has been smaller for Gn-RH a (-16.5%) and UPA has shown a superior safety profile as estradiol levels are maintained in the mid-follicular range. The UPA has caused temporary changes in endometrial morphology but 6 month after the treatment the endometrium returned to normal histology in the majority of cases. The presented results on the application UPA in the medical treatment of symptomatic uterine fibroids are very promising and gynecologists are given a new treatment option.

Therapeutic management of uterine fibroid tumors: updated French guidelines

The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids. When pregnancy is desired, whether or not infertility is being treated by assisted reproductive technology, hysteroscopic resection in one or two separate procedures of submucosal fibroids less than 4 cm in length is recommended, regardless of whether they are symptomatic. Interstitial, also known as intramural, fibroids have a negative effect on fertility but treating them does not improve fertility. Myomectomy is therefore indicated only for symptomatic fibroids; depending on their size and number, and may be performed by laparoscopy or laparotomy. Physicians must explain to women the potential consequences of myomas and myomectomy on future pregnancy. For perimenopausal women who have been informed of the alternatives and the risks, hysterectomy is the most effective treatment for symptomatic fibroids and is associated with a high rate of patient satisfaction. When possible, the vaginal or laparoscopic routes should be preferred to laparotomy for hysterectomies for fibroids considered typical on imaging. Because uterine artery embolization is an effective treatment with low long-term morbidity, it is an option for symptomatic fibroids in women who do not want to become pregnant, and a validated alternative to myomectomy and hysterectomy that must be offered to patients. Myolysis is under assessment, and research on its use is recommended. Isolated laparoscopic ligation of the uterine arteries is a potential alternative to uterine artery embolization; it also complements myomectomy by reducing intraoperative bleeding. It is possible to use second-generation techniques of endometrial ablation to treat submucosal fibroids in women whose families are complete. Subtotal hysterectomy is a possible alternative to total hysterectomy for fibroid treatment, given that by laparotomy the former has a lower complication rate than the latter, while by laparoscopy, these rates are the same. In each case, the patient is informed about the benefit and risk associated with each therapeutic option.

The management of fibroids based on immunohistochemical studies of their pseudocapsules

Background: We examined the presence of collagen IV and laminin in the pseudocapsule of uterine myomata to clarify different ultra-structural characteristics and their possible role in the management of this condition.Methods: Twenty non-pregnant patients underwent laparoscopic intracapsular myomectomies. Samples of the removed fibroids pseudocapsules were analyzed by immunochemical staining for collagen IV, immunohistochemical location of the vascular membrane-bound laminin and quantitative analysis of their images.Results: In the blood vessels of the pseudocapsules, a reduction in laminin and increase in collagen IV with increasing diameter of fibroids was noted. These proteins are related to loss of the basal membrane and to ageing of the tissue. The increase of collagen IV is linked to the increase of amorphous substance, including glycosaminoglycans and glycoproteins.Conclusion: Based on immunohistochemical findings, the authors propose to remove fibroids in women seeking pregnancy whilst respecting the pseudocapsule by neurofibre sparing in the incision site. This is essential for optimal muscular healing and myometrial function in future pregnancies, and also when fibroids remain under 6 cm diameter, especially in young women wishing pregnancies. Fibroid removal should be performed before the myoma reaches a size causing compression of the surrounding tissues, which results in the loss of regenerative potential.