Uterine Myoma Size Research Articles

TO THE QUESTION ON UTERINE FIBROIDS DURING PREGNANCY

Uterine fibroids is an extremely common tumor of the female reproductive system, among whose manifestations are infertility, spontaneous abortions, incorrect fetal position, placenta previa, premature delivery, bleeding during and after delivery, and an increased risk of cesarean section. According to the literature, myomas are changing in size during pregnancy and in the postpartum period. Aim of the study. To assess the dynamics of uterine fibroid size change during pregnancy and the effect of an existing uterine fibroid on the course of pregnancy and labor. Materials and methods. Outpatient records of patients aged 24 to 45 years (mean age 33.36 ± 4.63 years) who were diagnosed with Pregnancy and uterine fibroids from 2016 to 2021 at Verum Medical Center were evaluated (n = 57). The size of the fibroids (volume and diameter) before, during (I or II prenatal screening) and after pregnancy (first pelvic ultrasound after delivery) was used for statistical analysis. Forty-one of the 57 patients had pelvic ultrasound before, during, and after pregnancy and were included in the statistical analysis of changes in uterine myoma size. Results. Among the patients included in the statistical analysis, uterine fibroids increased in volume by 194.38% ± 86.9 (40.98% ± 18.4 in diameter) during pregnancy, and decreased by 53.98% ± 14.93 in diameter and by 54.28% ± 29.62 of baseline in the postpartum period. A significant number of fibroids (39.47%) did undergo involutionary changes and were not visualized in the first postpartum ultrasound. The live birth rate was high at 90% (64% of deliveries were through natural childbirth and 26% through cesarean section). Conclusions. There was no effect of intramural, intramural-subserosal, and subserosal uterine fibroids with an average diameter of £20 mm on pregnancy and live birth in women. A great amount of uterine fibroids nearly triple in size during pregnancy, but after delivery they return to their original size and even halve in size. This can be regarded as a confirmation of the absence of a negative effect of pregnancy, or, possibly, a positive effect on uterine fibroid size, which requires further investigation.

Hysteroscopic Myomectomy of a Large Submucosal Leiomyoma with Novel Use of Fluid Warming

Uterine myoma size is often considered a limiting factor when choosing the surgical approach to myomectomy. In this case, a 35-year-old woman presented with heavy menstrual bleeding and desire for fertility. Ultrasound performed 3 months earlier could not assess the endometrium and suggested leiomyoma. Magnetic resonance imaging of the pelvis identified a fundal submucosal myoma measuring 6.8 × 7.1 × 3.5cm. A planned staged hysteroscopic resection of the large submucosal myoma with intramural component was achieved. Unassisted conception occurred 2 months later. She delivered by cesarean section at term without complications. This case demonstrates that hysteroscopic mechanical tissue removal device combined with ultrasound guidance and a fluid warming system can complete myomectomy for very large uterine myomas without the need for laparoscopy or laparotomy.

POSSIBILITIES TO APPLY PROGESTERONE RECEPTOR SELECTIVE MODULATORS IN WOMEN OF REPRODUCTIVE AGE WITH UTERINE MYOMA

Uterine myoma is the most common benign monoclonal tumor. The frequency of uterine myoma is 20–35% in women of reproductive age and reaches 70% after the age of 50. Modern strategy of treatment of uterine myomas are largely individualized and depends on the patient’s age, her desire to preserve reproductive function, as well as the size, location, nodes growth rate, hormone therapy possibility. In recent years more and more articles have been published about the successful use of the progesterone receptor selective modulator progesterone ulipristal acetate (UPA) for the treatment of uterine myoma. It is important to note that the interest in the problem of uterine myoma therapy by progesterone receptor selective modulators is not only associated with their inhibiting effect on the growth and size of uterine myoma, but with the effect on the endometrium, the mechanisms of occurrence of amenorrhea and anovulation without reducing endogenous secretion of estrogen. Drug therapy gives a possibility to postpone or to avoid surgical treatment. In this respect long-term intermittent courses of UPA therapy are currently regarded as the most promising. They allow you expanding the possibilities of conservative treatment of uterine myoma, providing a regression of symptoms of the disease and maintaining the effect after completion of therapy.

Role of the aromatase inhibitor letrozole in the management of uterine leiomyomas in premenopausal women

BackgroundUterine myomas are benign tumours affecting 20–40% women. Various medical and surgical therapeutic options are available but the search for an ideal medical option continues. Aromatase inhibitors have recently been reported to have a potential role in the management of oestrogen-dependent conditions like endometriosis and leiomyoma. ObjectiveTo evaluate the effect of letrozole on uterine myoma size and symptomatology in perimenopausal women. Study designProspective interventional study conducted on 30 premenopausal women aged between 30 and 55 years with menstrual or pressure symptoms and having a single intrauterine myoma of size 4cm or more with or without one or more additional myomata each of size 2cm or less. They received tablet letrozole 2.5mg a day for 12 weeks, and the effect of the drug on myoma size and volume and symptomatology was studied along with the adverse effect profile and patient satisfaction. ResultsThe mean myoma size reduced from 5.4±1.3cm to 4.3±0.9cm (p<0.05) and the myoma volume exhibited a reduction of 52.45% (p=0.00) at the end of 3 months. The symptomatology score showed a significant improvement that persisted up to 3 months after cessation of therapy. No significant effect was observed on lipid profile, serum estradiol, progesterone, testosterone and FSH and LH levels during the therapy. Nausea and hot flushes were the main adverse effects observed and were self-limiting. ConclusionLetrozole significantly reduces myoma size and volume and also improves the associated symptoms. It has a good adverse effect profile and appears to be a promising medical option for management of uterine myomas.

P14.17: Change in the size of uterine myoma during pregnancy and its association with maternal BMI

P14.17: Change in the size of uterine myoma during pregnancy and its association with maternal BMI

Embolización selectiva de las arterias uterinas en el tratamiento de miomas sintomáticos: dos años de seguimiento

Leiomyoma is the most common gynecologic tumor. Uterine artery embolization (UAE) is used as an alternative to myomectomy or hysterectomy to treat uterine leiomyoma. Objective To determinate the epidemiological and clinical characteristics of patients undergoing UAE and to analyze the results of UAE at 2 years. Material and methods An observational, descriptive study was carried out in 93 patients who underwent UAE for the treatment of uterine myoma. A complete history and physical examination were performed and laboratory data were collected. Follow-up visits were performed at 2, 6, 12 and 24 months after the procedure. Results The mean number of days of bleeding was 6.74 (4–14). The mean hemoglobin was 11.94 g/dl (7–16). The mean length of hospital stay was 4.2 days (2–10), and the number of subsequent days of pain was 5.8 (1–15). There were three cases of transient amenorrhea (3.2%) and three of permanent amenorrhea (3.2%). The volume and size of uterine myoma were significantly reduced at each follow-up visit until 2 years after the embolization. A significant decrease in symptoms, bleeding and pain was confirmed in this period. Discussion UAE is a well-tolerated and effective technique, with a statistically significant response of all clinical and ultrasonographic parameters. The indications for UAE should be clearly defined and followed to maintain the efficacy and utility of this procedure.

Use of an agonistic analog of gonadotropin-releasing hormone (nafarelin) to treat leiomyomas: Assessment by magnetic resonance imaging

The purposes of this study were to investigate the effect of a superactive agonistic analog of gonadotropin-releasing hormone, nafarelin, on uterine leiomyomas and to assess the use of magnetic resonance imaging in monitoring uterine and myoma size. Eleven women with uterine leiomyomas were treated with 800 μg of nafarelin per day for 6 months. Serum gonadotropin and estradiol concentrations were suppressed during treatment. The mean ± SEM serum luteinizing hormone level decreased from 11.1 ± 1.4 to 5.6 ± 0.42 mlU/ml and follicle-stimulating hormone from 9.5 ± 0.66 to 7.5 ± 0.72 mlU/ml by 3 months of treatment (p < 0.01). The estradiol level decreased from a pretreatment follicular phase mean ± SEM of 43 ± 8.3 to 19.8 ± 3.1 (p < 0.05) and 14.8 ± 2.2 pg/ml (p < 0.01) at 3 and 6 months of treatment, respectively. Mean pretreatment androgen levels (testosterone, androstenodione, and dehydroepiandrosterone sulfate) were low in these women and did not change significantly during treatment. Ten women had magnetic resonance imaging, which provided excellent resolution of individual uterine myomas. As assessed by magnetic resonance imaging, the largest myoma decreased in size in nine of 10 women; the mean decrease was 46% ± 9%. Uterine volume decreased in all 10 patients; the mean decrease was 57% ± 7%. In several women myomas reenlarged after discontinuance of nafarelin treatment. Posttreatment myomectomy was carried out in four women; there was minimal blood loss and no surgical complications. These data indicate that suppression of ovarian estrogen production with nafarelin is associated with a decrease in uterine myoma size in many women but that myomas may regrow with reinstitution of ovarian function. Magnetic resonance imaging is an excellent method by which to monitor treatment as changes in the size of the uterus, as well as individual myomas, can be assessed. The optimal use of gonadotropin-releasing hormone analogs may be in perimenopausal women or as presurgical treatment to decrease uterine and myoma size to facilitate myomectomy.