Presence Of Fibroids Research Articles

Prevalence of and risk factors for endometrial polyps among asymptomatic postmenopausal women with uterovaginal prolapse

The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are cause for clinical concern. To estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women, and evaluate risk factors associated with their presence. This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women undergoing hysterectomy for uterovaginal prolapse. Patients were excluded if undergoing hysterectomy for other indications including postmenopausal bleeding. Chart review included eligible patients who received care at a single-site in Washington state from 2009 to 2018. The primary outcome was presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression. Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13 +/- 10mm and 1.4 +/- 1.5mm. Most cases, 78%, had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); one had endometrial carcinoma and one had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and without endometrial polyps, including the presence of fibroids, endometriosis and adenomyosis. Multivariate logistic regression showed that presence of polyps was independently associated with high body mass index (OR 1.06, 95%-CI 1.01-1.12, p-value 0.02) and use of menopausal hormone therapy (OR 1.67, 95%-CI 1.02 - 2.72, p-value 0.04). Asymptomatic postmenopausal women undergoing hysterectomy for uterovaginal prolapse exhibit a high prevalence of endometrial polyps. Those with use of menopausal hormone therapy and high body mass index are at a higher risk of developing endometrial polyps. While the malignant risk seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.

P-761 Four-dimensional ultrasound using an electronic probe to guide embryo transfer: a feasibility study

Abstract Study question Is four-dimensional ultrasound (4D-US) guided embryo transfer feasible and safe? Summary answer 4D trans-abdominal US with electronic probe is feasible and safe and justifies a formal study for non-inferiority to two-dimensional ultrasound (2D-US) for embryo transfer guidance. What is known already The use of 2D-US to guide embryo transfer is the usual procedure (Eshre/ASRM guidelines, evidence A), and investigations of the benefits of 3D and 4D-US have been inconclusive. 3D-US can locate the embryo flash in the coronal plane immediately after performing embryo transfer but furnishes only retrospective information. 4D-US requires two operators at transfer, and there has been slow image acquisition and poor image quality, not allowing satisfactory comparison of accuracy and precision with other methods. Study design, size, duration Using a high-end ultrasound device (Voluson E10, GE Healthcare, Zipf, Austria) with an electronic 3D-4D probe (eM6C G2), a prospective observational trial with 29 women undergoing mock embryo transfer in a private infertility clinic was performed between October 2023 and January 2024. Exclusion of subjects included BMI greater than 35 (3 cases) and an intramural myoma that impeded 4D-US visualization (3 cases). Participants/materials, setting, methods Two operators expert in U/S performed each procedure. Electronic probe settings were adapted for each subject. To simulate the embryo transfer, a Wallace catheter containing air and fluid was inserted and monitored transabdominally by 4D-US using the electronic probe. The catheter was observed until it reached 1 cm from the fundus and the embryo flash (bubble) identified. Entrance through the cervix was controlled by 2D and 4D. Main results and the role of chance The following variables were recorded: age, BMI, cycle day, use of hormones, endometrial thickness, position of the uterus, presence of fibroids, image quality, difficulty of entrance, visualization of the cervix. The 23 subjects had the following characteristics: mean age 39±6.4, BMI 24.14±4.4. Image quality was optimal in 18 patients and due to a retroverted uterus was suboptimal in 5 subjects. Cannulation of the cervix was difficult in 1. Eight patients were on birth control pills and 15 were on day 6-10 of spontaneous cycles. The mean endometrial thickness was 7.13±3mm. Mean hysterometry was 7.10±0.9mm. Visualization of the cervix with 4D-US was good in 12 subjects, fair in 7 and poor in 4. Visualization of the catheter in the cavity with 4D-US was good in 16 subjects, fair in 2 and poor in 5. The embryo flash was adequately visualized by 4D-US in 18 subjects and less well in 5. Catheter position was correctly identified by comparison 3D-US in 20/23 subjects. There were no adverse effects during or following the procedure. Limitations, reasons for caution Patients with poor image quality, due to obesity, retroverted uterus or fibroids, are not candidates for this technique. The need for two operators limits the practicability of the procedure, increasing the need to show its superiority over the usual practice before it could be adopted clinically. Wider implications of the findings 4D-US for embryo placement is feasible and safe. Studies that compare the accuracy and precision of 4D-US vs 2D-US to guide embryo transfer and the cost/benefit ratio of 4D ultrasound guided embryo transfer are in order.. Trial registration number not applicable for non-clinical trials

Perioperative Venous Thromboembolism Risk in Patients Undergoing Hysterectomy for Fibroids: A US Retrospective Cohort Study

ObjectivesVenous thromboembolism (VTE) occurs in 0.4%–0.7% of benign hysterectomies. Pelvic vascular compression secondary to fibroids may elevate VTE risk. We aimed to evaluate the incidence and timing of VTE among individuals undergoing hysterectomy for fibroids and other benign indications. MethodsRetrospective cohort study of patients who underwent a hysterectomy for fibroid and non-fibroid indications from January 2015 to December 2021. Main outcome measure was VTE consisting of pulmonary embolism or deep venous thrombosis diagnosed during 3 periods: (1) preoperative (1 year before surgery until day before surgery), (2) early postoperative (surgery date through 6 weeks after surgery), and (3) late postoperative (6 weeks to 1 year after surgery). Demographics, comorbidities, surgical characteristics, and VTE rates were compared by indication. ResultsA total of 263 844 individuals with fibroids and 203 183 without were identified. In total, 1.1% experienced VTE. On multivariable regression (adjusted demographic confounders and route of surgery), the presence of fibroids was associated with increased odds of preoperative (adjusted odds ratio [aOR] 1.12; 95% CI 1.03–1.22, P = 0.011) and reduced odds of late postoperative VTE (aOR 0.81; 95% CI 0.73–0.91, P < 0.001). For individuals with fibroids, uterine weight ≥250 g and undergoing laparotomy were independently associated with preoperative (aOR 1.29; 95% CI 1.09–1.52, P = 0.003 and aOR 2.32; 95% CI 2.10–2.56, P < 0.001) and early postoperative VTE (aOR 1.32; 95% CI 1.08–1.62, P = 0.006 and aOR 1.72; 95% CI 1.50–1.96, P < 0.001). ConclusionsPatients with fibroids were at increased odds of having VTE 1 year before hysterectomy. For those with fibroids, elevated uterine weight and laparotomy were associated with greater risk of preoperative and early postoperative VTEs.

FRI414 Association Between Uterine Leiomyoma Prevalence And Metabolic Syndrome In A Reproductive Aged Latina/Latinx Population

Abstract Disclosure: E.L. Ferrell: None. S. Schon: None. L. Jiang: None. F. Valbuena: None. E. Manuel: None. M. Castillo-Mackenzie: None. M. Carnethon: None. D.D. Baird: None. L. Neff: Employee; Self; Eli Lilly &amp; Company. Stock Owner; Self; Eli Lilly &amp; Company. E.E. Marsh: Consulting Fee; Self; Pfizer, Inc., Myovant Sciences. Objectives: Uterine leiomyomas, commonly known as fibroids, are benign tumors in the wall of the uterus that affect approximately 30% of females by the age of 35, and 70% of females by the age of 50. Greater fibroid prevalence has been observed in certain cohorts, with some studies reporting &amp;gt; 85% prevalence in African American women by the age of 50. Increasing evidence suggests that cardiometabolic risk factors contribute to uterine fibroid development. Few studies have assessed either the prevalence of fibroids or their relationship with Metabolic Syndrome (MetS) in the Latina/Latinx population. The objective of this study was to assess the relationship between MetS and fibroid prevalence in a large cohort of Latina/Latinx females. Materials &amp; Methods: This is a cross-sectional analysis of data collected as part of a prospective longitudinal cohort study. The Environment, Leiomyomas, Latinas, and Adiposity Study (ELLAS) follows 707 Latina women over a 4-year period. All participants in this study were between the ages of 21-50 at the time of enrollment. Demographic and baseline information was collected by trained bilingual study staff. Anthropometric measurements were performed, and fasting blood samples were collected. Participants underwent a baseline pelvic ultrasound to assess for the presence of fibroids. MetS diagnosis was based on the 2005 AHA/NHLBI criteria. The association between MetS and fibroids were assessed as categorical variables. Statistical associations were determined using chi-squared tests and logistic regression. Results: Of the 707 participants enrolled in ELLAS, 621 completed the first study visit, and data from the criteria used to diagnose MetS were available from 590 participants. Of those 590, 578 participants completed ultrasound evaluation for fibroids and were included in final analysis. The mean age was 37.4±6.95 years and the mean BMI was 30.1±6.76 kg/m2. A total of 143 participants met criteria for MetS (24.7%). Prevalence of MetS was positively correlated with age. The prevalence of fibroids in this Latina population was 10.7%. There was no statistically significant association between MetS and the presence of fibroids (p value &amp;gt;0.05). Conclusion: Among a large cohort of Latinx females, MetS was not significantly associated with fibroids. The prevalence of fibroids in this population was lower than observed in other populations, suggesting a possible protective factor yet to be identified amongst Latinx females. Given the low prevalence, we were likely underpowered to detect an association. Further research is needed to determine the relationship between cardiovascular, metabolic, and reproductive outcomes in this understudied population. Presentation: Friday, June 16, 2023

Ulipristal acetate versus levonorgestrel-releasing intrauterine system for heavy menstrual bleeding: the UCON randomised controlled trial and mechanism of action study

Background Heavy menstrual bleeding affects one in four women and negatively impacts quality of life. The levonorgestrel-releasing intrauterine system is an effective long-term treatment but is discontinued by many due to unpredictable bleeding, or adverse effects. The selective progesterone receptor modulator ulipristal acetate is used to treat symptomatic fibroids but long-term efficacy for the symptom of heavy menstrual bleeding, irrespective of presence of fibroids, is unknown. Objectives To determine whether ulipristal acetate is more effective at reducing the burden of heavy menstrual bleeding than levonorgestrel-releasing intrauterine system after 12 months of treatment in women with and without fibroids. We investigated mechanism of action of ulipristal acetate in a subset of 20 women. Design Randomised, open-label, parallel group, multicentre trial with embedded mechanistic study. Setting Ten UK hospitals. Participants Women with heavy menstrual bleeding aged 18 and over with no contraindications to levonorgestrel-releasing intrauterine system or ulipristal acetate. Interventions Three 12-week treatment cycles of 5 mg ulipristal acetate daily, separated by 4-week treatment-free intervals, or continuous levonorgestrel-releasing intrauterine system following allocation in a 1 : 1 ratio using a web-based minimisation procedure. Main trial outcome measures Primary outcome was quality-of-life measured by menorrhagia multi-attribute scale at 12 months. Secondary outcomes included menstrual bleeding and patient satisfaction. Impact on fibroid size, endometrial appearance and liver function was also collected. Mechanistic study outcome Cellular markers for endometrial cell structure and function, determined from endometrial biopsies; volume of uterus and fibroids and microcirculation parameters were determined from magnetic resonance images. Results Sample size was increased from 220 to 302 as a result of temporary halt to recruitment due to concerns of ulipristal acetate hepatoxicity. Subsequent withdrawal of ulipristal acetate and the COVID-19 pandemic led to a premature closure of recruitment, with 118 women randomised to each treatment and 103 women completing 12-month menorrhagia multi-attribute scale scores prior to this point. Primary outcome scores substantially improved in both arms, but at 12 months there was no evidence of a difference between those receiving three cycles of ulipristal acetate [median score category: 76–99, interquartile range (51–75 to 100), n = 53] and levonorgestrel-releasing intrauterine system [median score category: 76–99, interquartile range (51–75 to 100), n = 50; adjusted odds ratio 0.55, 95% confidence interval 0.26 to 1.17; p = 0.12]. Rates of amenorrhoea were much higher in those allocated ulipristal acetate compared with the levonorgestrel-releasing intrauterine system (12 months: 64% vs. 25%, adjusted odds ratio 7.12, 95% confidence interval 2.29 to 22.2). There was no evidence of a difference in other participant-reported outcomes. There were no cases of endometrial malignancy and no hepatotoxicity due to ulipristal acetate use. Mechanistic study results Ulipristal acetate produced a reversible reduction in endometrial cell proliferation, as well as reversible alteration of other endometrial cellular markers. Ulipristal acetate did not produce a reduction in the volume of the uterus irrespective of coexisting fibroids, nor an effect on uterine microvascular blood flow. Limitations The urgent safety measures and premature closure of recruitment impacted final sample size. Conclusions We found no evidence of a difference in quality of life between the two treatments, but ulipristal acetate was superior to levonorgestrel-releasing intrauterine system at inducing amenorrhoea. Ulipristal acetate currently has restricted availability due to concerns regarding hepatotoxicity. Future work There is a need to develop new, safe, effective and fertility-sparing medical treatments for heavy menstrual bleeding. The observed acceptability and effectiveness of ulipristal acetate warrants further research into the selective progesterone receptor modulator class of pharmacological agents. Study registration This trial is registered as ISRCTN 20426843.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ ЗРЕЛОЙ ТЕРАТОМЫ ЯИЧНИКА

The study of the described clinical case is of undoubted interest, taking into account the peculiarities of the clinical picture. In this clinical case, there was an asymptomatic course of the disease, which did not manifest itself as the occurrence of clinical symptoms during the patient's pregnancies, despite the change in the architectonics of the pelvis. In addition, there were no complications associated with the presence of a mature ovarian teratoma. The patient was not regularly monitored by an obstetrician – gynecologist, despite the presence of fibroids and adenomyosis. A detailed ultrasound examination of the pelvic organs carried out earlier would have made it possible to diagnose this pathology and carry out treatment. Despite the low frequency of malignancy of this histological type of true ovarian tumors, such a probability is not completely excluded with their long-term existence. In addition, in the presence of a mature teratoma, complications such as infection, torsion or rupture of the formation capsule are often found. Such complications may occur suddenly and lead to vital complications, require emergency surgical intervention. At the same time, there may be no possibility of intraoperative histological examination of the removed drug, which in case of ovarian tumors may lead to an inadequate amount of surgical intervention. In addition, without surgical treatment and subsequent histological examination of the removed ovarian formation, it is impossible to carry out differential diagnosis of mature and immature teratomas as well as other true ovarian tumors, including malignant ones. Therefore, after conducting a study of this clinical case, the following conclusions can be drawn. It is necessary to carry out preventive examinations of patients without gynecological pathology and careful dispensary observation of patients with gynecological diseases carefully, with ultrasound of the pelvic organs, which will allow timely diagnosis and treatment, to avoid possible complications.

The use of a short course of Ulipristal Acetate for acute abnormal uterine bleeding in women without uterine fibroids.

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. 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. 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. The main outcome measured was the bleeding control within 10 days. 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. 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. A short course of Ulipristal acetate as promising treatment for acute uterine bleeding without fibroids.

The myometrial-cervical ratio: Can a simple sonographic measurement improve diagnosis of adenomyosis in a regional setting?

Adenomyosis is histologically defined by the presence of endometrial glands and stroma in the myometrium. Ultrasound findings of adenomyosis are being redefined to better diagnose adenomyosis pre-operatively. A single-centre retrospective study was performed at a regional hospital. The myometrial-cervical ratio was calculated on pre-operative ultrasounds, and histopathology reviewed for each case. Logistic regression was used to estimate the association between the myometrial-cervical ratio and adenomyosis confirmed on histopathology, and the area under the receiver operating characteristic curve was calculated. Comparisons were performed based on the presence of fibroids on ultrasound. Complete data were available for 136 benign hysterectomies between 1 January 2015 and 31 December 2020. When the myometrial-cervical ratio was treated as a continuous variable in a logistic regression of adenomyosis on histopathology, there was no statistical evidence (χ2(1) < 0.01, p = 0.98) of an association. When cases including fibroids in the myometrial-cervical ratio were excluded, there was a non-significant association between myometrial-cervical ratio and adenomyosis on histopathology (odds ratio = 3.435, 95% confidence interval = 0.964, 12.235; χ2(1) = 3.62, p = 0.057); area under the receiver operating characteristic = 0.637 (95% confidence interval = 0.504, 0.770). The optimal myometrial-cervical ratio cutpoint was 1.875 (95% confidence interval = 1.698, 2.051), which achieved 71.43% sensitivity and 60.00% specificity. There was strong statistical evidence (χ2(1) = 9.02, p = 0.003) that the myometrial-cervical ratio outperformed standard pre-operative ultrasound identification of adenomyosis. While accuracy remains suboptimal, the myometrial-cervical ratio outperformed standard ultrasound diagnostic features of adenomyosis in a regional setting. The myometrial-cervical ratio may offer a simple imaging measurement for adenomyosis in inexperienced hands when fibroids are absent.

Factors Predicting Failure of Endometrial Ablation

Objective: To find out the probable reasons for endometrial ablation failure. Study design: This retrospective observational study was conducted in Basildon and Thurrock University Hospitals. Patients undergoing microwave endometrial ablation or radiofrequency ablation but required additional treatment (medical/surgical) after the procedure were included in the study. The patients having the procedure between 2012 to 2019 were followed up and included in the study. Patient’s baseline characteristics including age, BMI, presenting complaint, clinical and sonographic findings including uterine cavity length, and details of the ablation procedure were collected. The endometrial biopsy results, further treatment, and histology in patients who underwent hysterectomy were also noted and appropriate statistical analysis was conducted. Result: Among the 653 patients that underwent endometrial ablation (either radio-frequency/ microwave), from 2012 to 2019, 100 patients had ablation failure. All patients had undergone hysteroscopy and had a normal histopathology examination prior to undergoing ablation. The most common symptom of failure was a recurrence of heavy bleeding. 67% of patients with ablation failure opted for hysterectomy, 15% for repeat ablation, and 18% had medical management. The results showed that increased age, higher BMI, a larger uterine cavity, and the presence of fibroids and/or adenomyosis are associated with a higher risk of endometrial ablation failure. Conclusion: This study provides insight into the salient factors contributing to ablation failure which may guide future decisions toward better patient selection and counseling for endometrial ablation.

Uterine fibroid: Woe of the womb

Uterine fibroids are smooth muscle tumors originating from myometrium of females between 30-50 years of age. The presence of fibroids does not lead to mortality, but it may be the cause of serious morbidity as well as greatly affect the quality of life of the affected females. Leiomyomas are the most significant pathological condition of females of child-bearing age group globally, still the options for treatment are limited. Homoeopathy addresses this problem as it is a safer, nonsurgical curative mode of treatment for females affected from uterine fibroids.

Perioperative Venous Thromboembolism in Patients Undergoing Hysterectomy for Fibroids: A Nationwide Sample

<h3>Study Objective</h3> Venous thromboembolism (VTE) occurs in 0.4-0.7% of benign hysterectomies. Pelvic vascular compression secondary to fibroids may represent a mechanism for elevated VTE risk. We aimed to evaluate the incidence and timing of VTE among women undergoing hysterectomy for fibroids and other benign indications. <h3>Design</h3> Retrospective cohort. <h3>Setting</h3> Vizient clinical database. <h3>Patients or Participants</h3> Adult women without thrombophilias who underwent benign hysterectomy between January 2015-December 2021. <h3>Interventions</h3> VTE included pulmonary embolism or deep venous thrombosis diagnosed during four time periods: 1) preoperative remote (6 weeks to 1 year before surgery), 2) preoperative acute (6 weeks before surgery), 3) perioperative (6 weeks after surgery), and 4) postoperative remote (6 weeks to 1 year after surgery). Demographics, comorbidities, surgical characteristics, and VTE rates were compared by surgical indication. <h3>Measurements and Main Results</h3> A total of 439,705 patients were identified (248,744 with fibroids and 190,961 without), and 0.98% (4,293) experienced VTE during the study period. On univariate analysis, individuals with fibroids were more likely than those without fibroids to have VTE during the preoperative remote (0.27% vs 0.22%, p<0.001), preoperative acute (0.27% vs. 0.19%, p<0.001), and perioperative periods (0.39% vs. 0.32%, p<0.001). On multivariable logistic regression adjusting for demographics, comorbidities, uterine weight < or ≥250g, and VTE prophylaxis, the presence of fibroids was associated with increased odds of VTE in the preoperative acute period (aOR 1.29, 95% CI 1.13 - 1.49, p<0.001). In contrast, the presence of fibroids was associated with reduced odds of VTE in the postoperative remote period (aOR 0.87, 95% CI 0.78-0.96, p=0.008). <h3>Conclusion</h3> In a nationwide database, patients with fibroids undergoing hysterectomy were more likely than those with other indications to have VTE diagnosed before surgery. VTE risk was not increased postoperatively and may reflect appropriate use of prophylactic VTE measures in this patient population.

Prevalence of Asymptomatic Uterine Leiomyoma in Western Turkey and Factors Affecting Myoma Presence

Objective: To reveal the prevalence of asymptomatic uterine leiomyomas among gynecologic patients and to evaluate risk factors associated with the presence of leiomyomas. Study Design:Two thousand five hundred eighty-three patients aged between 18 and 66 years who presented to the gynecology outpatient clinic of our hospital in January and February 2021 who had an intact uterus and underwent transvaginal ultrasound were included in the study. Patients withsymptoms due to fibroids were defined as symptomatic, and those without symptomswere defined as asymptomatic; then two groups were compared in terms of certain variables.The independent risk factors associated with the presence of fibroids were determined using univariate and multivariate logistic regression analysis. Results: Leiomyomas were detected in a total of 437 patients with an overall prevalence of 17.2%. Leiomyomas were detected in 12.2% of asymptomatic patients and 27.8% of symptomatic patients (p&lt;0.001). The prevalence of fibroids tended to increase with advancing age and decreased after age 50 years. It was observed that myoma diameter was significantly large (29.5 (6-123) mm and 18 (7-74) mm; p&lt;0.001) and the frequency of multiple myomas was significantly high in symptomatic patients (46.5% vs. 33.6%; p&lt;0.001). In the multivariate logistic regression analysis, high body mass index, younger age at menarche, and not using oral contraceptives were associated with the presence of fibroids. Conclusion: Approximately half of all leiomyomas, one of the important gynecological health problems of women, are asymptomatic.

Assessment of Pattern, Determinants and Treatment Practices of Menstrual Disorders Among Medical Undergraduate Students

Background: Menstruation-related symptoms (MRSs) have been observed to result in absenteeism from either work or education, more commonly among women below 21 years than women of any other age group. Despite its high prevalence and associated ill effects, it is generally ignored even by medical students. Objectives: This study was conducted to assess the pattern, determinants, and treatment practices of menstrual disorders among undergraduate medical students. Methods: This was a cross-sectional study conducted among 215 female medical students from first to final year. Data were collected by using a self-administered questionnaire. The height and weight of participants were measured using standard procedures. Results: The most common menstrual disorders reported by participants over the past six months were dysmenorrhoea (191(88.8%)) followed by irregular cycles (43(20.0%)). In multivariable analysis, the presence of polycystic ovarian syndrome (PCOS) and excessive consumption of coffee was associated with irregular menstrual cycles; the presence of anaemia was associated with menorrhagia, the presence of fibroids and age of participants were associated with polymenorrhoea, excessive chocolate consumption was related to intermenstrual bleeding, excessive chocolate consumption, presence of anaemia, and low body mass index (BMI) were associated with premenstrual syndrome. Self-medication was reported by 15 (42.9%) out of the 35 participants on treatment. Conclusion: Dysmenorrhoea and menstrual irregularities were common among participants. They need to limit potential risk factors like excessive consumption of coffee and chocolates. Additionally, screening for anaemia, PCOS, fibroids and low BMI needs to be done. Self-medication practices need to be also dissuaded in the setting.

Uterine Fibroids Causing Preterm Birth: A New Pathophysiological Hypothesis on the Role of Fibroid Necrosis and Inflammation.

According to recent studies and observations in clinical practice, uterine fibroids increase the risk of preterm birth. There are several theories on the pathogenesis of preterm birth in the presence of fibroids. One theory proclaims that fibroid necrosis leads to preterm birth, though pathophysiological mechanisms have not been described. Necrotic tissue secretes specific cytokines and proteins and we suggest these to be comparable to the inflammatory response leading to spontaneous preterm birth. We hypothesize that fibroid necrosis could induce preterm parturition through a similar inflammatory response. This new hypothesis generates novel perspectives for future research and the development of preventative strategies for preterm birth. Moreover, we emphasize the importance of the recognition of fibroids and especially fibroid necrosis by clinicians during pregnancy.

Prevalence and Sonographic Patterns of Uterine Fibroid Among Women of Reproductive Age in Jos, Plateau State, Nigeria

Background: Uterine leiomyoma represents a major public health problem and is regarded as the most common benign gynecologic tumors affecting premenopausal women. It is associated with considerable morbidity and hospitalization. Objectives: This research was carried out to establish the prevalence and sonographic characteristics of uterine leiomyoma as well as the histological diagnosis of the tumor among Nigerian women of reproductive age living in Jos, Plateau State. Materials and Methods: It was a prospective cross-sectional hospital-based study, in which 295 women of the age between 20 years and 50 years were recruited randomly after obtaining informed consent from each woman. Abdominopelvic ultrasound scan was performed on each participant using a GE Logic 5 machine fitted with 3.5-MHz probe with emphasis on the location, number, and characterization of uterine leiomyoma(s); thereafter, transvaginal ultrasound scan using 7.5-MHz frequency probe was done for the subjects that have uterine fibroid for better delineation and location of the mass(es), followed by sonohysterography where necessary to ascertain its/their location(s). The histologic findings/diagnosis of the tumor postsurgery for those who had myomectomy in course of the study was correlated to the sonographic diagnosis. The number of fibroid nodules, location in the uterus, sonographic patterns, classification, and histological diagnosis were assessed descriptively and inferentially using the Statistical Package for the Social Sciences version 20 (SPSS20). The results were presented in the form of tables and charts. Results: The mean age for the participants was 32.66 ± 7.66 years ranging from 21 to 50 years, and the mean age of the sonographically confirmed fibroid cases was 34.99 ± 6.79 years with a range of 21–48 years. This study indicated that 28.33% (83/295) of the subjects had fibroid; the highest prevalence (49.7%) of the fibroid case occurred among women in their fourth decade and the lowest (8.4%) at the extremes of reproductive age. A significant positive association (P = 0.043) between nulliparity and the presence of fibroid was noted. The average number of fibroid nodules and volume of the largest nodule were estimated as 2.76 ± 1.93 and 344 ± 69.24 cm3, respectively; 57.80% of the fibroid were intramural with only 9.6% been submucosal. Most (86.70%) of the fibroids were located within the uterine corpus and the most common (38.6%) sonographic pattern of the nodules was hypoechoic. The histological findings postmyomectomy for those that had surgery in the course of the study showed cellular leiomyoma to be the most common (95.23%) type; there was no evidence of malignant transformation. Conclusion: The prevalence and sonographic pattern of leiomyoma among women of reproductive age in Jos have been assessed; it was found that characteristics of the fibroid and its location determine the clinical presentation and possibly the reproductive outcome of the patient; this could help in appropriate management of cases in the North Central or the whole nation.

Application of International Endometrial Tumor Analysis in Abnormal Uterine Bleeding: A Case Report

BACKGROUND: Abnormal uterine bleeding (AUB) is one of the clinical symptoms found in malignant conditions where the incidence of newly diagnosed cancers reached 100,000 cases in Europe in 2012 with an incidence of around 14.7/100,000 women. The International Endometrial Tumor Analysis (IETA) group, formed in Chicago in 2008, published a consensus stating how to examine and measure the endometrium. CASE REPORT: Mrs. M, 49 years old, came to Gynecology Clinic of USU Hospital on February 22, 2021, at 13.00 WIB with the complaints of prolonged menstruation for 2 months with a volume of &gt;10 times changing pads. Menstrual pain was found. Low back pain was found. A history of bleeding between menstrual cycles was found. On ultrasound examination, anteflexed uterus was found with size of 6.95 × 4.2 × 3.85 cm, thickness of the endometrium: 1.64 cm and concluded as AUB-M (thickening of the endometrium). Then, the patient is diagnosed with AUB-M (thickening of the endometrium) and is planned to undergo a diagnostic curettage. Anatomical pathology results showed a complex hyperplasia endometrium without atypia cells. Acute AUB is defined as bleeding profusely so that prompt treatment is needed to prevent blood loss. Ultrasound examination is performed to assess the size, shape of the uterus, the presence of fibroids, polyps, adenomyosis, and uterine anomalies such as uterine didelphys, sometimes polycystic ovaries are also found. Endometrial biopsy can detect more than 90% of cancers. The pathology of the endometrium can diagnose endometrial cancer or determine the likelihood of cancer. These investigative modalities can assist in the diagnosis of endometrial polyps, adenomyosis, leiomyomas, uterine anomalies, and endometrial thickening associated with hyperplasia and malignancy. Curettage is considered to relieve ongoing menorrhagia. According to the SOGC, administration of nonsteroidal anti-inflammatory drugs can inhibit cyclo-oxygenase and reduce levels of endometrial prostaglandins. DISCUSSION: Acute AUB is defined as bleeding profusely so that prompt treatment is needed to prevent blood loss. Ultrasound examination is performed to assess the size, shape of the uterus, the presence of fibroids, polyps, adenomyosis, and uterine anomalies such as uterine didelphys, sometimes polycystic ovaries are also found. Endometrial biopsy can detect more than 90% of cancers. The pathology of the endometrium can diagnose endometrial cancer or determine the likelihood of cancer. These investigative modalities can assist in the diagnosis of endometrial polyps, adenomyosis, leiomyomas, uterine anomalies, and endometrial thickening associated with hyperplasia and malignancy. Curettage is considered to relieve ongoing menorrhagia. According to the SOGC, administration of nonsteroidal anti-inflammatory drugs can inhibit cyclo-oxygenase and reduce levels of endometrial prostaglandins. CONCLUSION: According to IETA, the vascular pattern in the endometrium is reported to be associated with the presence or absence of a “dominant vessel” or other specific pattern. Endometrial thickness is the maximum measurement in the sagittal plane. The accompanying ultrasound provides the measurement of endometrial thickness in the absence of intracavity fluid; the endometrium should be measured where it appears thickest. If intracavity pathology is present, total thickness of endometrium including the lesion should be recorded. Anatomic pathology by curettage is required in women with abnormal bleeding; histological evaluation of the endometrium may identify infectious or neoplastic lesions such as endometrial hyperplasia or cancer.

108 Uterine myoma and pregnancy in late reproductive age women: What to do?

Introduction and aims: of the study: Fibroids are one of the most common benign uterine tumors in women of reproductive age, occurring in 20-50%. The presence of fibroids not only affects a woman's chances of becoming pregnant, but can also lead to complications during gestation, childbirth and the postpartum period. Studydesign: The clinical case from our practice is considered. Woman U., 45 years old 2 years ago applied for a consultation about menorrhagia, lower abdominal pain and infertility during the year.

The risk of venous thromboembolism in patients with and without leiomyomas undergoing hysterectomy

Leiomyomas occur in 80% of women and can require hysterectomy for management. The risk for venous thromboembolism (VTE) is 0.7% for any hysterectomy. However, it has been theorized that large uterine size due to fibroids increases VTE risk due to pelvic vasculature compression. The objective of this study is to evaluate if the risk of VTE of women undergoing surgeries for fibroid-related indications is different compared to women undergoing hysterectomy for non-fibroid-related indications. We also aimed to determine the preexisting incidence of VTE between the groups and identify risk factors for VTE. Patients who underwent hysterectomy by any route at an academic center between January 2019-December 2019 were included. Demographic, pathology, and VTE diagnosis data were assessed. Preoperative VTE occurred prior to surgery. Perioperative VTE occurred within 6 weeks of surgery. Patients with malignancy and known thrombophilias were excluded. A total of 1,029 patients were included, of which 687 patients had fibroids and 342 had none. Patients with fibroids were likely to be older, have higher BMI, larger uterine size, and greater EBL (p<0.05). Of the total cohort, 22 patients (2.1%) had VTE, of which 19 (1.8%) were preexisting, and 3 (0.2%) occurred peri-operatively. Ten of the 22 patients (45%) with preexisting VTE had fibroids; none of whom developed perioperative VTE. The presence of fibroids did not increase the odds of perioperative VTE (OR 0.2, CI [0.02-2.7]). Those with preexisting VTE were more likely to have increased BMI, Charlson Comorbidity Index (CCI), postoperative length of stay, and ASA risk score (P<0.05). In both univariate analysis and logistic model, both fibroids and total uterine size were not associated with preexisting VTE (univariate p= 0.18, p=0.50; logistic model p=0.08, p=0.17 respectively). Higher BMI and ASA score of 3-4 are associated with higher odds of preexisting VTE (1 unit increase of BMI OR 1.06, CI [1.0-1.1]; OR 3.6 [1.4-9.3]). However, specifically in patients with fibroids, only ASA score of 3-4 is associated with higher odds of preexisting VTE (OR 4.2, CI 1.2-15.1). Patients undergoing hysterectomy for fibroid-related indications are not at increased risk for VTE compared to patients undergoing surgery for non-fibroid-related indications. Preexisting VTE in patients with fibroids did not increase the risk for perioperative VTE. Overall, for patients with fibroids, higher ASA scores are associated with VTE event.

Association between uterine fibroids and antimüllerian hormone concentrations among African American women

To evaluate the extent to which uterine fibroids are associated with antimüllerian hormone (AMH) concentrations. Cross-sectional study. Baseline data from the Study of the Environment, Lifestyle, and Fibroids, which is a 5-year longitudinal study of African American women. A total of 1,643 women aged 23-35 years without a known history of fibroids. Fibroid presence. None. The primary outcome was percent difference in the mean AMH concentration between participants with fibroids and those without fibroids. The secondary outcomes were percent differences in the mean AMH concentrations in participants with different numbers, sizes, types, and positions of fibroids and the percent difference in the mean AMH concentration in participants with different uterine volumes. At least 1 fibroid was identified on ultrasound in 362 (22%) participants. There was a small difference in the mean AMH concentrations in participants with fibroids (age-adjusted model: -4.6%, 95% confidence interval (CI): -14.5% to 6.5%; multivariable model: -4.6%, 95% CI: -14.4% to 6.3%). The mean AMH concentrations were found to decrease with increasing fibroid number. Although differences in AMH concentrations were not statistically significant, compared with no fibroids, the mean percent differences in AMH concentrations for 1, 2-3, and ≥4 fibroids were -1.2% (95% CI: -13.2% to 12.5%), -7.1% (95% CI: -23.3% to 12.5%), and -17.5% (95% CI: -38.2% to 10.0%), respectively. There were no consistent associations between AMH concentrations and fibroid location, size, or uterine volume. The presence of fibroids was not materially associated with AMH concentrations. Other than a monotonic inverse relationship between fibroid number and AMH concentrations, no other fibroid characteristics were consistently or appreciably associated, although associations were imprecise.

A consensus-based core feature set for surgical complexity at laparoscopic hysterectomy

There are no current standardized and accepted methods to characterize the surgical complexity of a laparoscopic hysterectomy. This leads to challenges when trying to understand the relationship between the patient and the surgical features and outcomes. The development of core feature sets for laparoscopic hysterectomy studies would enable future trials to measure the similar meaningful variables that can contribute to surgical complexity and outcomes. The purpose of this study was to develop a core feature set for the surgical complexity of a laparoscopic hysterectomy. This was an international Delphi consensus study. A comprehensive literature review was conducted to identify the features that were reported in studies on laparoscopic hysterectomy complexity. All the features were presented for evaluation and prioritization to key experts in 3 rounds of online surveys. A priori consensus criteria were used to reach agreement on the final outcomes for inclusion in the core feature set. Experts represented North America, South America, Europe, Africa, Asia, and Oceania. Most of them had fellowship training in minimally invasive gynecologic surgery. Sixty-four potential features were entered into round 1. Experts reached a consensus on 7 features to be included in the core feature set. These features were grouped under the following domains: 1) patient features, 2) uterine features, and 3) nonuterine pelvic features. The patient features include obesity and other nonobesity comorbidities that alter or limit the ability of a surgeon to perform the basic or routine steps in a laparoscopic hysterectomy. The uterine features include the size and presence of fibroids. The nonuterine pelvic features include endometriosis, ovarian cysts, and adhesions (bladder-to-uterus, rectouterine pouch, and other adhesions). Using robust consensus science methods, an international consortium of experts has developed a core feature set that should be assessed and reported in all future studies that aim to assess the relationship between the patient features and surgical outcomes of laparoscopic hysterectomy.