Symptoms Of Abnormal Uterine Bleeding Research Articles

Prostaglandin Injection for Myoma Expulsion (PRIME): Case Series of a Novel Approach to Hysteroscopic Resection of FIGO Type 2 Myomas

Study ObjectiveTo evaluate the use of dilute carboprost tromethamine injection at the endometrium/myoma junction during hysteroscopy to facilitate myoma expulsion and removal in a single procedure. DesignCase series. SettingSingle high-volume academic medical center. PatientsSeven patients aged 32 to 51 years old with FIGO type 2 uterine myomas and symptoms of abnormal uterine bleeding or infertility undergoing hysteroscopic resection with a morcellation device from November 2022 to July 2023. InterventionDilute injection of carboprost tromethamine (10 µg/mL) at time of hysteroscopic myomectomy. Measurements and Main ResultsThe main outcome measure was ability to complete the hysteroscopic myomectomy in a single procedure using a hysteroscopic morcellator. Secondary outcomes included total operative time, fluid deficit, and postoperative pharmacologic side effects and/or surgical complications. Among our 7 patients, all had successful single procedure complete resections of myomas ranging from 0.9 to 4.6 cm in maximal diameter. Average operative time was 30 minutes, and average fluid deficit was approximately 839 mL. The carboprost dosages used ranged from 30 to 180 µg. One patient experienced prolonged postoperative nausea and vomiting that resolved with antiemetics. One patient experienced postoperative endometritis that improved with antibiotics. ConclusionIn this pilot study, injection of dilute carboprost intraoperatively facilitated one-step hysteroscopic myomectomy of FIGO 2 myomas, via enhanced extrusion of the intramural portion of the fibroid into the uterine cavity, with both short operative times and acceptable fluid deficits.

Transcriptomic Analysis Reveals Intrinsic Abnormalities in Endometrial Polyps.

Endometrial polyps (EPs) are benign overgrowths of the endometrial tissue lining the uterus, often causing abnormal bleeding or infertility. This study analyzed gene expression differences between EPs and adjacent endometrial tissue to elucidate intrinsic abnormalities promoting pathological overgrowth. RNA sequencing of 12 pairs of EPs and the surrounding endometrial tissue from infertile women revealed 322 differentially expressed genes. Protein-protein interaction network analysis revealed significant alterations in specific signaling pathways, notably Wnt signaling and vascular smooth muscle regulation, suggesting these pathways play critical roles in the pathophysiology of EPs. Wnt-related genes DKK1 and DKKL1 were upregulated, while GPC3, GREM1, RSPO3, SFRP5, and WNT10B were downregulated. Relevant genes for vascular smooth muscle contraction were nearly all downregulated in EPs, including ACTA2, ACTG2, KCNMB1, KCNMB2, MYL9, PPP1R12B, and TAGLN. Overall, the results indicate fundamental gene expression changes promote EP formation through unrestrained growth signaling and vascular defects. The intrinsic signaling abnormalities likely contribute to clinical symptoms of abnormal uterine bleeding and infertility common in EP patients. This analysis provides molecular insights into abnormal endometrial overgrowth to guide improved diagnostic and therapeutic approaches for this troublesome women's health condition. Confirmation of expanded cohorts and further investigations into implicated regulatory relationships are warranted.

Myomectomy - Choosing the Surgical Approach

In patients who are desirous of future pregnancy and choose to preserve the uterus, myomectomy is the best surgical option where medical management is not suitable for the patient. Myomectomy was initially performed successfully in 1840 by Amussat and the procedure has evolved from open laparotomy to laparoscopy, hysteroscopy, VNOTES and robotic myomectomy. The surgical approach in doing myomectomy depends on the type and location of the myoma and the surgeon’s expertise. Minimally invasive surgery has been the preferred approach due to the benefit of shorter hospital stay, lesser postoperative pain, earlier recovery, minimal blood loss and the cosmetic appearance of the scar. The success of this procedure depends also on the incision technique, enucleation, blood loss prevention by employing hemostatic techniques as well as suturing techniques. Performing myomectomy for a large uterine myoma is a laparoscopic challenge; however, with the use of Lee-Huang point (midpoint between umbilicus and xiphoid) as the primary insertion and camera port, one can easily navigate thru the abdominal cavity in case the uterus is huge obscuring the umbilical port. Laparoscopic Myomectomy can be safely and efficiently performed by experienced laparoscopic surgeons regardless of myoma size, number, and location. Removal of large myoma specimen from the abdominal cavity through the laparoscope became a challenge after the use of power morcellator was abandoned. To overcome this problem, the large myoma is placed inside an Endo bag and its edges brought extracorporeally through the port site. The myoma is incised in a C-manner using a scalpel to reduce the size. Myoma can also be removed using in-bag morcellation. Fertility preservation is the long-term aim of doing myomectomy instead of hysterectomy in the management of leiomyoma aside from alleviating symptoms of abnormal uterine bleeding, urinary frequency, and abdominal pain. Thus, every procedure should perform under patient centered concept.

What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers.

To identify variables predictive of durable clinical success after MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids. In this prospective, multicenter trial, 99 women with symptomatic uterine fibroids were treated using MRgFUS. Pelvic MRI was obtained at baseline and treatment day. The Uterine Fibroid Symptom-Quality of Life questionnaire was used to calculate a symptom severity score (SSS) at baseline and 6, 12, 24, and 36months following treatment. Clinical, imaging, and treatment variables were correlated with symptom reduction sustained through the 12- and 24-month time points using univariable and multivariable logistic regression analyses. A novel parameter, the ratio of non-perfused volume to total fibroid load (NPV/TFL), was developed to determine association with durable outcomes. Post-treatment, mean symptom severity decreased at the 6-, 12-, 24-, and 36-month follow-ups (p < 0.001, all time points). In univariable analysis, three variables predicted treatment success (defined by ≥ 30-point improvement in SSS) sustained at both the 12-month and 24-month time points: increasing ratio of NPV/TFL (p = 0.002), decreasing total fibroid load (p = 0.04), and the absence of T2-weighted Funaki type 2 fibroids (p = 0.02). In multivariable analysis, the NPV/TFL was the sole predictor of durable clinical success (p = 0.01). Patients with ratios below 30% had less improvement in SSS and lacked durable clinical response compared with those between 30-79 (p = 0.03) and ≥ 80% (p = 0.01). Increased non-perfused volume relative to total fibroid volume was significantly associated with durable reduction of symptoms of abnormal uterine bleeding and bulk bother. Patient selection for sustained clinical benefit should emphasize those with likelihood of achieving high ablation ratios, as determined by imaging (e.g., device access, Funaki type) and by considering the total fibroid load, not just the primary symptomatic fibroid. Clinical trial ID: NCT01285960. • Patient selection/treatment approach associated with durable symptom relief in MRI-guided focused ultrasound ablation of uterine fibroids remains unclear. • The ablation ratio, non-perfused volume/total fibroid volume, was positively associated with sustained symptom relief in both bleeding and bulk bother at 1- and 2-year follow-ups. • Selecting patients with imaging features that favor a high ratio of ablation to total fibroid load (including non-targeted fibroids) is the main factor in predicting durability of symptom relief after uterine fibroid treatment.

Histopathologic study of endometrium in cases of abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the most common presenting symptoms among women visiting the gynecology outpatient department. Sonography and endometrial biopsy are the usual methods of evaluation; rarely, invasive procedures like hysteroscopy may be needed. Endometrial sampling can be used as a first step in the evaluation. This study was done to analyze the histopathology of the endometrium and to evaluate the causes of abnormal uterine bleeding. Materials and Methods: Endometrial samples were obtained using dilation and curettage from 50 women presenting to the gynaecology outpatient department with abnormal uterine bleeding symptoms in a medical college hospital. Results: Among the 50 cases, 21 were found to have endometrial hyperplasia (72.4%); 24 were diagnosed to have an organic lesion (48%). The endometrium was found to be in the proliferative phase in the majority of the cases (40%). The most common age group was 31-40 years and simple cystic hyperplasia was the commonest endometrial pattern. Single-parity women were most commonly affected and they showed a secretory endometrium under microscopy. Conclusions: Endometrial sampling should be carried out in every patient with abnormal uterine bleeding to study the histopathology of the endometrium and to evaluate the causes of the disease.

Comparison between Pipelle Sampling and Hysteroscopy Guided Biopsy in Histologic Evaluation of Endometrium in Tertiary Care Hospital in Pakistan

Introduction: Abnormal uterine bleeding is one of the commonest issues in perimenopausal age group. The proportion is 9-30% in reproductive age group. This extent rises to 70% in perimenopausal and postmenopausal women’s. Irregular uterine dying (AUB) warrants an intensive assessment in perimenopausal females and subsequently it’s vital to perform it in a cost-effective way with available resources. Objective: To compare the efficacy of Hysteroscopic guided biopsy and endometrial cytology To find out the efficacy of endometrial cytology in detecting different normal and abnormal endometrial patterns Study design &amp; Settings: It is a prospective comparative study conducted at Social Security Hospital, Multan Road, Lahore included patients 30 years and above with the chief complaints of abnormal uterine bleeding. Study Duration: 01 year January 2020 to December 2020 Sample: 100 patients Inclusion Exclusion Criteria: Females having symptoms of abnormal uterine bleeding and age above than 30 years are included in the study. The females who are pregnant and having infection or malignancy are excluded from the research Results: This Planned comparative hospital-based study was done in one hundred patients with abnormal uterine bleeding taken after the informed consent, inclusion and exclusion criteria. Endometrial thickness was assessed and all cases with &lt;5 mm thickness will be avoided from the study. Mean age of the patient was found 45 and standard deviation 7.43. Practical implication Conclusion: To get the endometrial sample by pipelle technique is a safe procedure. It has high specificity, sensitivity, positive and negative predictive values when compared to hysteroscopy. In this way, to obtain adequate endometrial sample, Pipelle biopsy should be considered as important way of investigation. Keywords: Abnormal uterine bleeding, Pipelle, Endometerial sampling, FIGO

National survey of abnormal uterine bleeding according to the FIGO classification in Japan.

To investigate the status of abnormal uterine bleeding (AUB) in Japan using the International Federation of Gynecology and Obstetrics (FIGO) classification (AUB system 1 and 2; PALM-COEIN) and to clarify the relationship between AUB symptoms and the diseases causing AUB. In a nationwide study, we enrolled first-time patients who visited target facilities during two consecutive weeks from December 1, 2019 to January 31, 2020. The FIGO classification was used to investigate patients with symptoms and causative diseases of AUB. Based on the proportion of patients in the nationwide study, 373 cases were included in the detailed survey. Survey items included symptoms of AUB according to AUB system 1, examination details, and causative diseases according to the PALM-COEIN classification. Within the study period, we encountered 61 740 first-time patients, of which 8081 (13.1%) were diagnosed with AUB. Among them, 39.9% had abnormal menstrual cycles and 56.9% had abnormal menstrual bleeding. In the survey, PALM had the highest percentage of AUB-L and COEIN had the highest percentage of AUB-O. Correspondence analysis showed that COEIN was strongly associated with abnormal menstrual cycles and PALM with abnormal menstrual bleeding. We conducted the first nationwide survey of AUB in Japan. The FIGO classification was a useful tool for the diagnosis of AUB, with a strong correlation between symptoms of AUB by AUB system 1 and the causative disease of AUB by PALM-COEIN. Conversely, a high percentage of AUB-N and AUB-E suggests that AUB system 1 and PALM-COEIN are ambiguous as diagnostic tools.

Causes of Abnormal Uterine Bleeding in Females of Reproductive Age Group attending Gynaecology Dept of UOL Hospital

Background: Abnormal uterine bleeding is a prevalent problem that prompts a female to seek medical help. The most common symptom of abnormal uterine bleeding is heavy menstrual bleeding. The impact of abnormal uterine bleeding on one's quality of life is important. Aim: To determine the causes of abnormal uterine bleeding. Methods: This cross-sectional study was conducted at Department of Gyneacology University of Lahore Teaching Hospital Lahore over a period of one year from Nov 2020 to Nov 2021. Eighty females of reproductive age with Abnormal Uterine Bleeding were selected. All females were examined for the etiology of abnormal uterine bleeding. The females with menstrual blood loss lasting &gt;8 days, passage of blood clots or haemoglobin concentration &lt; l0 gm/dl were enrolled. The exclusion criteria includes the females less than 20 years of age, or with pubertal menorrhagia or postmenopausal females. Results: Out of total eighty females, 25% females belong to 42 years age group. The most prevalent etiology of abnormal uterine bleeding was fibroid uterus i.e. 62.5% cases, followed by adenomyosis (15%), endometrial polyp (10%) and endometrial hyperplasia (12.5%). Fifty females (50%) were multipara, 20 (25%) were grand multipara and 10(12.5%) were great grand multipara. Severe anemia was noted in almost 10 females (12.5%), moderate anemia in 56 cases (70%) and mild anemia in 14 cases (17.5%). Transabdominal scan was done to confirm the diagnosis of fibroid uterus, adenomyosis, endometrial hyperplasia and endometrial polyp. Conclusion: Fibroid uterus was the commonest cause in females presenting with abnormal uterine bleeding to University of Lahore Teaching Hospital affecting quality of life in females and causing psychological problems. Keywords: Abnormal uterine bleeding, Menorrhagia, Metrorrhagia, Fibroid uterus, Endometrial polyps.

Endometrial assessment of premenopausal women prior to uterine artery embolization: A cross sectional survey of Interventional Radiologists

Uterine artery/fibroid embolization (UAE/UFE) is a minimally invasive treatment for symptomatic uterine fibroids and/or adenomyosis. The terms menorrhagia, metrorrhagia, and dysfunctional uterine bleeding have been abandoned by the International Federation of Gynaecology and Obstetrics (FIGO) due to confusion surrounding their use; in their place abnormal uterine bleeding (AUB) has been adopted. [1] Munro M.G. Critchley H.O.D. Fraser I.S. Committee tFMD. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018; 143: 393-408 Crossref PubMed Scopus (150) Google Scholar This is an overarching term to describe any symptomatic variation from normal menstruation incorporating prolonged menstrual bleeding (>8 days), heavy menstrual bleeding (HMB), and intermenstrual bleeding. Premenopausal AUB affects up to one third of women during their life and the risk of cancer in those who proceed to endometrial biopsy has been estimated at 0.33% (95% CI 0.23–0.48%), and 0.11% (95% CI 0.04–0.32) in the subset with HMB. [2] Pennant M.E. Mehta R. Moody P. et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG. 2017 Feb; 124 ([PubMed PMID: 27766759. Pubmed Central PMCID: PMC5297977. Epub 2016/10/22. eng]): 404-411 Crossref PubMed Scopus (41) Google Scholar

Clinical factors associated with anxiety and depression in Korean women with abnormal uterine bleeding

Objective: This study was conducted to investigate the prevalence and the relationship of anxiety and depression in Korean women with abnormal uterine bleeding (AUB). Methods: The study was a questionnaire study of 124 Korean women aged 1555 who visited a single university hospital due to AUB between September 2015 and December 2019. Anxiety, depression were assessed using the Korean Beck Anxiety Inventory (K-BAI), the Korean Beck Depression Inventory-II (K-BDI-II). The obstetrical and clinical data were analyzed to assess the association of anxiety and depression with AUB. Results: Out of 124 patients, 47 (37.9%) met the criteria for anxiety, and 24 (19.5%) met the criteria for depression. The most common menstrual problems seen were heavy menstrual bleeding (80.7%), followed by irregular bleeding (62.9%), dysmenorrhea (55.7%), and irregular menstrual cycles (33.9%). More women with AUB in our study had anxiety as measured by the K-BAI and depression as measured by the K-BDI-II. A history of abortion and cesarean section (C/sec) were related with anxiety, whereas a history of minor surgery was related to depression. Anxiety and depression (r = 0.629, p < 0.001) were correlated with AUB. Conclusion: A history of abortion and C/sec were associated with a risk of anxiety state and a history of minor surgery was associated with depression in women with AUB symptoms. Anxiety and depression are underdiagnosed and undertreated in Korean women with AUB symptoms. Screening and appropriate mental health management are needed for women with AUB for womens health.

A Literary Review of AsrigdarainAyurvedw.s.r. to Menometrorrhagia

In PrasutitantraOPD, Menometrorrhagia is the most common gynaecological illness. It is a symptom that can be detected in the majority of gynecological issues. The irregular, massive blood loss per vaginum is a symptom of abnormal uterine bleeding. Bleeding in excess of regular amounts and for a longer period of time during the menstrual cycle. Abnormal uterine bleeding is known as Asrigdara in Ayurvedic samhitas, which implies pradirana(extreme excretion) of raja (menses) per vaginum. The causative factor or Dosa In Asrigdarais Vayu, and the vitiated Dhatu Or Dusya is Rakta(blood), or blood is also vitiated. Because the qualities of rakta and pittaare so similar, vitiating Raktawould aggravate pitta as well. As a result, management should be centered on the usage of medications with Kashaya Rasa and Pittashamak Guna.Due to its Stambhanafeature, Kashaya rasais mostly used to treat bleeding symptoms.There is loss of Rakta Dhatu, so we use the drugs and diet that increases Rakta Dhatu.Management mainly based on the principle of Raktastambhakaand Raktavardhaka.

Laparoscopic Sentinel Node Mapping with Surgical Staging following Hysteroscopic Endometrial Resection in Endometrial Stromal Sarcoma

A 50-year-old woman presented with symptoms of abnormal uterine bleeding. Ultrasonography showed an intrauterine cavity nodule sized approximately 2 cm. A hysteroscopic resection was diagnosed. The histopathology revealed high-grade endometrial stromal sarcoma. The surgery was laparoscopic surgical staging with indocyanine green sentinel lymph node mapping. Two positive indocyanine green sentinel lymph node of the right and left pelvic nodes showed no nodal metastasis. Also, the five positive indocyanine green sentinel lymph node showed no nodal metastasis. The occult lymph nodes were dissected at the right and left pelvic nodes for nodes 4 and 9, respectively. Conclusively, hysteroscopic resection is beneficial for the diagnosis of uterine sarcoma. Notwithstanding, laparoscopy can be used for uterine cancer and the indocyanine green sentinel lymph node showed no false negative. The patient was stage IA.

Trastuzumab-Induced Severe Thrombocytopenia: A Case Report and Literature Review

We present a 29-year-old woman with pT2N0M0 breast cancer, histological diagnosis of invasive ductal carcinoma, ER and PR low positive, and HER-2 (3+). The patient developed trastuzumab-induced thrombocytopenia in 6 hours after an intravenous infusion of trastuzumab at the second cycle of trastuzumab treatment with the symptom of abnormal uterine bleeding. Laboratory exam revealed a sharp drop of platelet count down to 3×109/L. With the treatment of single-donor platelet transfusions, glucocorticoids, oxytocin and thrombopoietic drugs, the platelet count recovered completely in 11 days. This case was confirmed to be severe thrombocytopenia induced by trastuzumab, and retreatment with trastuzumab was not attempted. With increasing clinical utilization of trastuzumab, clinicians are likely to encounter more life-threatening trastuzumab induced severe thrombocytopenia. By this case report and literature review, we hope to increase the awareness, attach the attentions to this condition, and help with the effective treatment.

Analysis of influencing factors of endometrial disease of patients with breast cancer after operation

Objective: To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation. Methods: A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women's Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases. Results: The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05) . When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56±0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [ (0.33±0.23) cm] and no treatment group [ (0.44±0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05). Conclusions: The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.

Guideline No. 390-Classification and Management of Endometrial Hyperplasia.

The aim of this guideline is to aid primary care physicians and gynaecologists in the initial evaluation of women with suspected endometrial hyperplasia, to recommend the use of the 2014 World Health Organization classification for endometrial hyperplasia by all health care providers, and to guide the optimal treatment of women diagnosed with endometrial hyperplasia. Physicians, including gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; medical trainees, including medical students, residents, and fellows; and all other health care providers. Adult women (18 years and older) presenting with suspected or confirmed endometrial hyperplasia. The discussion relates to the medical therapy as well as surgical treatment options for women with and without atypical endometrial hyperplasia. For this guideline, relevant studies were searched in PubMed, Cochrane Wiley, and the Cochrane Systematic Reviews using the following terms, either alone or in combination, with the search limited to English language materials, human subjects, and published since 2000: (endometrial hyperplasia, endometrial intraepithelial neoplasia, endometrial sampling, endometrial curettage, diagnosis) AND (treatment, progestin therapy, surgery, LNG-IUS, aromatase inhibitors, metformin ), AND (obesity). The search was performed in April 2018. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional significant articles were identified through cross-referencing the identified reviews. The total number of studies identified was 2152, and 82 studies were included in this review. The content and recommendations were drafted and agreed upon by the authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. The interpretation of strong and weak recommendations was also included. The Summary of Findings is available upon request. It is expected that this guideline will benefit women with endometrial hyperplasia. This should guide patient informed consent before both medical and surgical management of this condition. Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. RECOMMENDATIONS.

Clinical recurrence of submucosal myoma after a mechanical hysteroscopic myomectomy: Review after 5 years follow up

ObjectiveEvaluation of five years follow up of the clinical recurrence after hysteroscopic myomectomies with MyoSure® morcellator in our district. Study designPremenopausal patients from April 2013 to October 2018, with symptoms of abnormal uterine bleeding, and/or infertility, and sonographic suspicion of submucosal myoma, confirmed by diagnostic hysteroscopy prior to myomectomy were included in the prospective, not randomized cohort study (N = 320). All patients had a follow up visit between three to six months post procedure. Further follow up was established by chart review. The information was extracted from the medical records.Patient characteristics were expressed as mean ± SD or median (interquartile range) for continuous data (assumption of normality assessed using the Kolmogorov-Smirnov test). Dependence relationship between presence of corporal myomas and the performance of a major long-term surgery, and between the amount of submucosal myomas and clinical recurrence throughout the 5 years of follow-up were studied were studied by χ2. ResultsAfter one year follow up, no recurrence or symptoms were noted. 53 (16.6%) re-morcellations were performed due to incomplete resection. At the second year, three women who were discharged previously were classified as recurrence (0.9%). There were 99 women remaining to be evaluated (30.90%) in the second year. A percentage estimation of 5–6 recurrences with the 100% of women evaluated. In the third year, only one woman was classified as recurrence (0.3%), with 176 (55%) women not evaluated. At the fourth and fifth year of follow-up, 75% are still awaiting complete of the study five years.No relationship was observed in the presence of corporal myomas and recurrence throughout the 5 years of follow-up (χ2 = 0.000, p = 0.994). Dependence relationship was observed between the presence of corporal myomas and the performance of a major long-term surgery (χ2 = 11.757, p = .001, OR = 3.528). ConclusionIn office hysteroscopic mechanical myomectomy with MyoSure® morcellator of submucosal fibromas was a highly effective therapy for women, at three years of follow-up. It appears to give satisfactory long-term results with a low recurrence rate and without significant complications.

Is it necessary to perform an endometrial sampling prior to hysterectomies for benign conditions

Aim: Hysterectomy is one of the most prevalent surgical intervention in gynecological field. This study concerns the requirement and necessity of an endometrial sampling to exclude an unpredictable uterine malignancy risk before hysterectomy for benign conditions. Methods: This is a retrospective and cross-sectional study involving 307 patients who had hysterectomy for benign conditions between years 2014-2018. Prior to hysterectomy, in 162 cases, an endometrial sampling was performed ahead (biopsy group) and in 145 cases, hysterectomy was performed without obtaining an endometrial sampling earlier on (control group). Pre- and post-surgical pathological evaluation reports were collected and compared between the groups. Results: Features of the patients as mean age, number of previous pregnancies, being at postmenopausal status did not vary significantly between two groups. In the biopsy group, 51.2% of the patients were in the premenopausal period, 40.7% of the patients had postmenopausal bleeding and 52.5% had abnormal uterine bleeding symptoms and these three features were significantly higher than in the control group. In the control group, one case (0.7%) had leiomyosarcoma and another case (0.7%) had endometrial adenocarcinoma. In the biopsy group, endometrial adenocarcinoma was detected in 5 patients (3.1%) as significantly higher than in the control group. Conclusion: If there are no symptoms, clinical and radiological findings suggesting an endometrial malignancy in patients who planned to undergo a hysterectomy for benign conditions, it is unnecessary to perform a routine endometrial biopsy.

National trends in hospitalization for uterine fibroids

Introduction: Uterine fibroids are the most common pelvic tumor in women, being a significant public health issue. They arise in reproductive-age women and typically present with symptoms of abnormal uterine bleeding.

Corrigendum to "The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions" [Int J Gynecol Obstet 143(2018) 393-408.

Corrigendum to "The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions" [Int J Gynecol Obstet 143(2018) 393-408.

The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions.

The International Federation of Gynecology and Obstetrics (FIGO) systems for nomenclature of symptoms of normal and abnormal uterine bleeding (AUB) in the reproductive years (FIGO AUB System 1) and for classification of causes of AUB (FIGO AUB System 2; PALM-COEIN) were first published together in 2011. The purpose was to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education, and clinical care. The systems were designed to be flexible and to be periodically reviewed and modified as appropriate. To review, clarify, and, where appropriate, revise the previously publishedsystems. To a large extent, the process has been an iterative one involving the FIGO Menstrual Disorders Committee, as well as a number of invited contributions from epidemiologists, gynecologists, and other experts in the field from around the world between 2012 and 2017. Face-to-face meetings have been held in Rome, Vancouver, and Singapore, and have been augmented by a number of teleconferences and other communications designed to evaluate various aspects of the systems. Where substantial change was considered, anonymous voting, in some instances using a modified RAND Delphi technique, was utilized.