Prevalence Of Uterine Leiomyomas Research Articles

Surgical menopause and its management. Analysis of literature data and own data

The article presents the main clinical variants of the surgical menopause syndrome (SMS), provides modern views on the treatment of this pathology.The purpose of the study was to identify the features of the clinical course of SMS compared to the typical climacteric syndrome, to present modern views on its management, and to determine ways of prevention.To achieve this goal, a literature search and analysis was conducted in the PubMed scientometric database for the last 15 years, and domestic scientific publications related to the mechanisms of development, clinical course, and management of SMS were selected. At the current stage, there is a significant increase in the prevalence of uterine leiomyomas, as well as a tendency to increase the frequency of this pathology in young women. Given that 50% of uterine leiomyomas have symptomatic course, the number of surgical interventions for leiomyomas is also increasing.Hysterectomy occupies a significant place among operative interventions for benign tumors of the uterus and ovaries. As a result of hysterectomy (with or without oophorectomy) in women, SMS occurs. The main pathogenetic mechanism of SMS is hypoestrogeny. As a result, a symptom complex of menopausal disorders develops: vegetative-vascular, neuropsychic, metabolic and urogenital disorders. Compared to the classic climacteric syndrome, the clinical condition in surgical menopause is more acute and progresses faster.The management of SMS depends on the volume of surgical intervention, the age of the patient, and concomitant pathology. Treatment of SMS should be individualized and include the use of menopausal hormone therapy, herbal preparations, multivitamin complexes against the background of lifestyle modification.The prevention of SMS consists in the wide use of modern conservative and minimally invasive operations in the case of surgical treatment of benign tumors of the uterus and ovaries, a balanced approach to determining the volume of operations.

Dietary intake is associated with the prevalence of uterine leiomyoma in Korean women: A retrospective cohort study.

Uterine leiomyoma (UL), the most prevalent benign gynecologic tumor among reproductive-aged women, lacks sufficient research on the potential association between dietary intake and its occurrence in Korean women. Addressing this research gap, this study aims to evaluate the potential link between dietary intake and the prevalence of UL in Korean women. In this cross-sectional study, a cohort of 672 women, aged 23 to 73, were enrolled, with 383 (57%) being premenopausal. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and UL presence was determined through ultrasonography. The analysis focused exclusively on items within ten categories, including vegetables/fruit, vegetables, fruits, red meat, processed meat, poultry, fish, dairy product, milk, and alcohol. Multiple logistic regression models were employed to explore the relationship between dietary intake and the prevalence of UL, calculating odds ratios (ORs) and 95% confidence intervals (CIs) while adjusting for confounding factors. Within the total cohort, 220 (32.7%) women were diagnosed with UL. High intakes of fish and poultry showed an association with higher UL prevalence. Odds ratios (95% CIs) for the upper quartiles compared to the lower quartiles were 1.68 (1.01-2.81; p trend = 0.05) for fish intake and 1.87 (1.11-3.17; p trend = 0.06) for poultry intake. Conversely, an inverse relationship emerged between dairy product intake and UL prevalence, with an odds ratio of 0.58 (95% CI 0.35-0.96; p trend = 0.05). Stratifying the analysis by menopausal status revealed a parallel pattern, with heightened UL prevalence with fish intake and reduced prevalence with dairy product intake. However, the link between poultry intake and UL prevalence was primarily observed among postmenopausal women. Among premenopausal women, elevated vegetable intake was linked to a decreased UL prevalence (OR 0.45, 95% CI 0.21-0.97 for top vs. bottom quartiles; p trend = 0.01). We found that high consumption of fish and poultry, coupled with low intake of dairy products, correlated with an elevated prevalence of UL. Furthermore, vegetable intake exhibited an inverse relationship with UL prevalence, particularly among premenopausal women.

The Prevalence and Post-Operative Complications of Uterine Leiomyomas in South-Western Nigeria and Northern Nigeria: A Comparative Review

Background: Uterine Leiomyoma are benign tumors which commonly affect women of reproductive age, however only a subset of women has their fibroids clinically detected, symptomatic or warrant surgical treatment. Its removal is associated with complications. To control the occurrence of this complication requires the understanding of the factors associated with the complications. Methods: The study was carried at two large tertiary hospitals in South-western and Northern region of Nigeria. It was a descriptive cross-sectional study that was conducted among patients in these regions. Information such as sociodemographic characteristics was recorded in questionnaire including retrospective review of case records of all surgically managed cases of uterine leiomyoma (from one hundred and fifty-nine women) was obtained after formal consent from the hospital’s ethics committee. Results: In Both regions of Nigeria, the common presenting complaints from 36-40 years old patients were menstrual irregularities, Abdominal swelling, and infertility. The commonest anatomical position of the nodules were multiple positions and intramural. The majority (79.9%) of the women in South-Western Nigeria presented with multiple leiomyomas. While the majority (48.8%) of the women in Northern Nigeria presented multiple leiomyomas which accounted for almost half of the patients diagnosed in that region. In the South-western region of Nigeria, post-operative complications occurred in 20.9 % of cases with post-operative pyrexia (13.5%), blood loss warranting transfusion (12.8%) and post-operative anemia (10.4%) been the most common complications. While in the Northern region of Nigeria no complications were recorded. Conclusion: Uterine leiomyomas is common in Nigeria and usually presents with menorrhagia, pelvic pain, recurrent miscarriage, and infertility. The surgery may be complicated by post operative pyrexia, blood loss, wound infection and even death. Midline incision, closure of rectus sheet with chromic catgut and myomectomy were associated with postoperative complications in this review. To avoid postoperative morbidities associated with surgical management of fibroid, Pfannenstiel incision where feasible, use of non-absorbable or delayed absorbable sutures and hysterectomy in women who have completed family should be adopted in the Southwestern region of Nigeria. Whereas prevalence of uterine leiomyomas is generally prevalent in the Southwest, there are varying age prevalence’s in the North and Southwest.

Does prior uterine surgery increase the risks of uterine leiomyoma and adenomyosis? a retrospective study

Aim: Women frequently undergo obstetric and gynecologic surgeries throughout their life, and the two common gynecologic conditions are uterine leiomyoma (UL) and adenomyosis. This study aims to investigate the relationship between the presence and the types of prior uterine surgery and the risks of developing UL and adenomyosis.
 Material and Method: This study is a single-center eleven-year cross-sectional study, in which we studied the effects of previous uterine surgery on developing UL and adenomyosis in patients who underwent hysterectomy for any indication in our hospital between 01/01/2004 and 31/12/2014.
 Results: During the time period, 1299 eligible patients were included in the study. The median age was 49.0 years and the study population was mostly consisted of multigravid women. The overall prevalence of UL was 61.9% and the overall prevalence of adenomyosis was 18.3%.In the univariate analysis of patient characteristics for UL, age, gravida and parity were found as statistically significant protective factors for UL (OR [95.0% CI]: 0.92 [0.91-0.93], 0.91 [0.88-0.95], 0.88 [0.83-0.93], respectively). On the other hand, women who underwent previous any uterine surgery had 1.28 folded (95.0% CI: 1.02-1.61) risk for UL. However, we found that only undergoing myomectomy statistically significantly increased the risk of UL (OR [95.0% CI]: 8.59 [2.62-27.91]) among the types of uterine surgery. In the multivariate model, the protective effect of age remained (adjusted OR [95.0% CI]: 0.92 [0.91-0.94]), and the risk-increasing effect of having previous myomectomy dropped slightly with retaining its statistical significance (adjusted OR [95.0% CI]: 5.87 [1.78-19.41]). We also conducted similar analysis for adenomyosis, and we found that gravida was a risk factor (OR [95.0% CI]: 1.06 [1.01-1.12]), conversely to its risk-decreasing effect for UL. Also, women who had a history of any uterine surgery had 1.42 folded (95.0% CI: 1.07-1.88), and women who had a history of D&C had 1.62 folded (95.0% CI: 1.02-1.61) risk adenomyosis. In the multivariate model for the risk of adenomyosis, the risk-increasing effects of the gravida and the history of D&C decreased very slightly with saving their statistical significances (adjusted OR [95.0% CI]: 1.06 [1.01-1.12], 1.44 [1.07-1.95], respectively).
 Conclusion: According to our findings, the frequency of adenomyosis is higher but, the frequency of UL is compatible with the literature. Patients, who underwent uterine surgery previously, diagnosed with adenomyosis and UL more than the others who did not, but this seems to be a correlation rather than a causative association.

P–296 Examining the link between environmental toxin exposure and uterine leiomyoma: a systematic review

Abstract Study question Is there an association between exposure to certain environmental toxins and the prevalence of uterine leiomyoma in women? Summary answer Some evidence was obtained to suggest an association between phthalate esters, bisphenol A, heavy metals, persistent organic pollutants and the prevalence of uterine fibroids. What is known already Environmental toxins are naturally occurring, or human made chemicals that can act as endocrine disrupting chemicals (EDCs) by binding and activating estrogen receptors in the body. Uterine fibroids, often called leiomyoma are non-cancerous growths occurring in the uterus. Though often asymptomatic, they can cause pain, infertility, pregnancy complications and are a leading cause for hysterectomy. The aetiology of leiomyoma is not fully understood but both estrogen and progesterone have been implicated in their growth. We aimed to investigate the epidemiological evidence for the association between EDCs and the prevalence of fibroids. Study design, size, duration We undertook a systematic review and in keeping with PRISMA guidelines, a structured search of Medline, Embase, Scopus, and Web of Science was conducted (to October 2020). Case-control, cross-sectional, cohort and experimental studies were included. Participants/materials, setting, methods The included studies analyzed the association between one or more toxins and the occurrence, or growth of leiomyoma in humans, including human cell lines. The types of toxins, patient characteristics, association and outcome, body concentration of toxin and confounding variables were extracted and analyzed. Quality assessment was performed using the Newcastle-Ottawa Scale. Main results and the role of chance In total, 34 studies were included. The majority (76%) of studies revealed a significant association between the exposure studied and the prevalence of uterine leiomyoma. In examining body burden in cases vs controls, phthalate esters showed an association with increased odds of uterine leiomyoma, except in one case where a negative association was observed. In vitro experimental studies examining the effect of alkyl-phenols such as bisphenol A (BPA), octylphenol (OP) and nonylphenol (NP) demonstrated that these environmental estrogens can act to promote the proliferation of leiomyoma cells through a number of mechanisms, typically including the estrogen receptor alpha (ERa) signalling pathway. There were conflicting results for the association between alkyl-phenols and fibroids in case-control studies. A positive association between cadmium was demonstrated in only two studies. There were conflicting results for the association between lead, mercury, arsenic and uterine fibroids. Several metabolites of organophosphate esters, alternative plasticizers, and persistent organic pollutants were associated with an increased risk of uterine fibroids. Limitations, reasons for caution Separating these exposures from the multiple other factors that could affect the outcome of leiomyoma is challenging, but an important issue for future research. Wider implications of the findings: The link between some environmental toxins and uterine fibroids discussed is in agreement with previous literature. However, our review provides a more in depth analysis on specific dosage effects, odds ratios, and potential gene mechanisms of the exposures. This information could contribute to more accurate preventative measures. Trial registration number Not applicable

P-296 Examining the link between environmental toxin exposure and uterine leiomyoma: a systematic review

Abstract Study question Is there an association between exposure to certain environmental toxins and the prevalence of uterine leiomyoma in women? Summary answer Some evidence was obtained to suggest an association between phthalate esters, bisphenol A, heavy metals, persistent organic pollutants and the prevalence of uterine fibroids. What is known already Environmental toxins are naturally occurring, or human made chemicals that can act as endocrine disrupting chemicals (EDCs) by binding and activating estrogen receptors in the body. Uterine fibroids, often called leiomyoma are non-cancerous growths occurring in the uterus. Though often asymptomatic, they can cause pain, infertility, pregnancy complications and are a leading cause for hysterectomy. The aetiology of leiomyoma is not fully understood but both estrogen and progesterone have been implicated in their growth. We aimed to investigate the epidemiological evidence for the association between EDCs and the prevalence of fibroids. Study design, size, duration We undertook a systematic review and in keeping with PRISMA guidelines, a structured search of Medline, Embase, Scopus, and Web of Science was conducted (to October 2020). Case-control, cross-sectional, cohort and experimental studies were included. Participants/materials, setting, methods The included studies analyzed the association between one or more toxins and the occurrence, or growth of leiomyoma in humans, including human cell lines. The types of toxins, patient characteristics, association and outcome, body concentration of toxin and confounding variables were extracted and analyzed. Quality assessment was performed using the Newcastle-Ottawa Scale. Main results and the role of chance In total, 34 studies were included. The majority (76%) of studies revealed a significant association between the exposure studied and the prevalence of uterine leiomyoma. In examining body burden in cases vs controls, phthalate esters showed an association with increased odds of uterine leiomyoma, except in one case where a negative association was observed. In vitro experimental studies examining the effect of alkyl-phenols such as bisphenol A (BPA), octylphenol (OP) and nonylphenol (NP) demonstrated that these environmental estrogens can act to promote the proliferation of leiomyoma cells through a number of mechanisms, typically including the estrogen receptor alpha (ERa) signalling pathway. There were conflicting results for the association between alkyl-phenols and fibroids in case-control studies. A positive association between cadmium was demonstrated in only two studies. There were conflicting results for the association between lead, mercury, arsenic and uterine fibroids. Several metabolites of organophosphate esters, alternative plasticizers, and persistent organic pollutants were associated with an increased risk of uterine fibroids. Limitations, reasons for caution Separating these exposures from the multiple other factors that could affect the outcome of leiomyoma is challenging, but an important issue for future research. Wider implications of the findings The link between some environmental toxins and uterine fibroids discussed is in agreement with previous literature. However, our review provides a more in depth analysis on specific dosage effects, odds ratios, and potential gene mechanisms of the exposures. This information could contribute to more accurate preventative measures. Trial registration number not applicable

Recent Advances in Uterine Fibroid Etiology.

Uterine fibroids, also known as uterine leiomyoma (UL), are monoclonal tumors of the smooth muscle tissue layer (myometrium) of the uterus. Although ULs are considered benign, uterine fibroids are the source of major quality-of-life issues for approximately 25% of all women, who suffer from clinically significant symptoms of UL. Despite the prevalence of UL, there is no treatment option for UL which is long term, cost-effective, and leaves fertility intact. The lack of understanding about the etiology of UL contributes to the scarcity of medical therapies available. Studies have identified an important role for sex steroid hormones in the pathogenesis of UL, and have driven the use of hormonal treatment for fibroids, with mixed results. Dysregulation of cell signaling pathways, miRNA expression, and cytogenetic abnormalities have also been implicated in UL etiology. Recent discoveries on the etiology of UL and the development of relevant genetically modified rodent models of UL have started to revitalize UL research. This review outlines the major characteristics of fibroids; major contributors to UL etiology, including steroid hormones; and available preclinical animal models for UL.

Prevalence, morbidity, and current medical management of uterine leiomyomas.

Uterine leiomyoma is the most common pelvic tumor in women, but the actual prevalence is unknown. To review the literature on the prevalence of uterine leiomyoma, presenting symptoms, and medical management. On April 1-30, 2014, a PubMed search for studies reported in English was conducted using the terms "uterine leiomyoma," "prevalence," and "symptoms." Another search was performed using the terms "uterine leiomyoma" and "treatment." All trial types other than internet-only studies were included. Animal studies were excluded from the prevalence/symptom review, but included in the medical management review. Prevalence rates were recorded on the basis of imaging modality, cohort studied, ethnic origin, and age. Studies involving asymptomatic women revealed a trend in prevalence similar to that in symptomatic women, and showed that leiomyomas are more common in this cohort than previously recognized. Affected patients can present with many complaints, but no single symptom has been shown to be specific for this tumor. Various medical therapies are reviewed, summarizing efficacy and toxicity. Further research needs to be conducted on the prevalence in asymptomatic women. Current and future medical management options provide promising results in symptom reduction.

Prevalence of Uterine Leiomyoma in an Adolescent Population

Prevalence of Uterine Leiomyoma in an Adolescent Population

Prevalence of uterine leiomyomas in lymphangioleiomyomatosis

To determine the frequency of uterine leiomyomas and hysterectomy in patients with lymphangioleiomyomatosis (LAM), a disease characterized by proliferation of abnormal-appearing smooth muscle-like cells. Retrospective study. Natural history study at the National Institutes of Health. 456 patients with sporadic LAM and LAM associated with tuberous sclerosis complex (LAM/TSC). Review of records and pelvic computed axial tomography scans. Prevalence of uterine leiomyomas and hysterectomy. A total of 174 women had uterine leiomyomas (38%). One hundred eighteen were diagnosed by computed tomographic scan and 56 were diagnosed by hysterectomy. Among 323 patients who did not have hysterectomy, 105 of 270 patients (39%) with sporadic LAM and 13 of 53 (25%) with LAM/TSC had uterine leiomyomas. Hysterectomy was performed in 108 of 378 subjects with sporadic LAM and 25 of 78 with LAM/TSC. Fifty-six patients were found to have uterine fibroids on hysterectomy. The most common indications for hysterectomy were uterine leiomyoma, LAM, and endometriosis. Uterine leiomyomas are not more common in LAM than in the general population. However, inLAM, the frequency of hysterectomy is higher because of it having been recommended for treatment of LAM.

Cervical and Prolapsed Submucosal Leiomyomas Complicating Pregnancy

Cervical and prolapsed submucosal leiomyomas are rarely seen in pregnancy. Depending on the size threshold used to diagnose a leiomyoma, the prevalence of uterine leiomyomas in pregnancy is approximately 3% to 10%. The prevalence of clinically evident cervical leiomyomas in pregnancy is less than 1%. Contrary to prior thought, the majority of uterine leiomyomas in pregnancy do not usually lead to complications. Indications for surgical intervention in pregnancy for cervical leiomyomas include bleeding, infection, degeneration, pain, and urinary stasis. Preoperative imaging with ultrasound and magnetic resonance imaging may help to delineate the location and nature (e.g., pedunculated) of the cervical leiomyoma when clinical examination is inconclusive. We reviewed the current literature in regard to cervical leiomyomas in pregnancy and summarize the major findings. After completing this CME activity, readers should be better able to evaluate the prevalence and natural history of uterine and cervical leiomyomas in pregnancy, assess indications for surgical intervention in pregnant patients, manage surgical complications, and select imaging modalities that may determine their origin. Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this educational activity, the reader should be better able to evaluate the prevalence and natural history of uterine leiomyomas in pregnancy; assess indications for surgical intervention in pregnant patients; manage surgical complications; and select imaging modalities that may determine their origin.

Prevalence of Uterine Leiomyomas in the First Trimester of Pregnancy

To estimate the proportion of pregnant women with one or more leiomyomas detected by research-quality ultrasound screening in the first trimester, to describe the size and location of leiomyomas identified, and to report variation in prevalence by race/ethnicity. Within an ongoing prospective cohort, we conducted 4,271 first-trimester or postmiscarriage ultrasound examinations. Sonographers measured each leiomyoma three separate times, recording the maximum diameter in three perpendicular planes each time. Sonographers and investigators classified type and location. Among 458 women with one or more leiomyomas (prevalence 10.7%), we identified a total of 687 leiomyomas. The mean size of the largest leiomyoma was 2.3 cm (95% confidence interval [CI] 1.8-2.8). Mean gestational age at ultrasonography was 61+/-13 days from last menstrual period. Prevalence varied by race/ethnicity: 18% in African-American women (95% CI 13-25), 8% in white women (95% CI 7-11), and 10% in Hispanic women (95% CI 5-19). The proportion of women with leiomyomas increased with age much more steeply for African-American women than for white women. Leiomyomas are common in pregnancy and occur more often among African-American women. Given the limited research on effects of leiomyomas on reproductive outcomes, the degree to which race/ethnic disparities in prevalence of leiomyomas may contribute to disparities in events such as miscarriage and preterm birth warrants investigation.

Prevalence of Uterine Leiomyomas in the First Trimester of Pregnancy: An Ultrasound-Screening Study

Prevalence of Uterine Leiomyomas in the First Trimester of Pregnancy: An Ultrasound-Screening Study

Sintomatología urológica aguda asociada al mioma uterino

While prevalence of uterine leiomyoma is high, its presentation affecting the urinary tract isuncommon. We contribute the cases of two adult women with symptoms of nephritic colic andurinary retention. Etiology was acute obstruction of the urinary tract due to previously asymptomaticurine myomas. Management in both patients was surgery, using hysterectomy to resolvethe urinary obstruction. A brief review of the literature is included.