Symptomatic Fibroids Research Articles

Preoperative Uterine Volume: Does It Predict Symptomatic Fibroid Recurrence After Robotic Myomectomy: A Retrospective Cohort Study.

Preoperative Uterine Volume: Does It Predict Symptomatic Fibroid Recurrence After Robotic Myomectomy: A Retrospective Cohort Study.

Seeing red: impaired quality of life in women with symptomatic uterine fibroids

While the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL) is a validated and helpful tool in determining response to treatment, it does not allow for the texture and intensity of fibroid related experiences to be conveyed. The purpose of this study is to qualitatively identify and characterize challenges that impact quality of life and emotional well-being of women with symptomatic fibroids.

Uterine artery embolization for symptomatic fibroids in postmenopausal women

PurposeThe aim of the current study was to evaluate the efficacy of uterine artery embolization (UAE) for symptomatic fibroids in postmenopausal women. Materials and methodsAmong 900 cases who underwent UAE between 2007 and 2013, a total of 9 postmenopausal women with symptomatic fibroids (n=6) and fibroid with adenomyosis (n=3) were included in this retrospective study. Ages ranged from 49 to 55years (median of 52). The embolic agent was nonspherical polyvinyl alcohol particles. We evaluated 18 uterine arteries in nine patients and compared the size of the uterine artery relative to inferior mesenteric artery (IMA) in preprocedural magnetic resonance (MR) angiography. Magnetic resonance imaging (MRI) was performed before and 3months after UAE. Predominant fibroid and uterine volumes were calculated from MR images. ResultsUrinary frequency was the most common symptom, observed in seven patients (77.8%). Of two patients (22.2%) with vaginal bleeding from submucosal myomas, one patient had been on hormone replacement therapy (HRT). One patient underwent UAE due to growing leiomyoma after HRT. All of the 18 uterine arteries were bigger than the corresponding IMAs in MR angiography. Contrast-enhanced MRI revealed complete necrosis of the predominant fibroid in all patients. Eight (88.9%) of the nine participants demonstrated resolution of symptoms. The mean predominant fibroid and uterine volume reduction rates were 39.7% and 36.9%, respectively. ConclusionsIn postmenopausal women, UAE was effective to treat symptomatic fibroids, and it could be considered as an alternative treatment to hysterectomy.

Can (1)H MR Spectroscopy be Used to Assess the Success of Uterine Artery Embolisation?

Absence of contrast on contrast enhanced MRI (CEMRI) and reduction in uterine volume at 6months post-uterine artery embolisation (UAE) currently indicate the successful disruption of the fibroid blood supply by UAE. This study assesses whether (1)H MR spectroscopy ((1)H MRS) can also indicate the success of UAE. 20 patients with symptomatic fibroids were randomised 1:1 to undergo UAE with either Gelfoam or Embospheres. CEMRI and spectra (1.5T) were acquired pre-, 24-h and 6months post-UAE. LCModel was used to detect significant levels of choline, creatine and lactate in fibroid spectra. Uterine volumes were measured and paired t tests (p<0.05) assessed volume reduction over time. Qualitative assessments of CEMRI were performed. Choline was detected in 17/18 spectra pre-UAE, 12/14 at 24-h and 6/16 at 6months post-UAE. Choline was not detected in the 7/7 spectra available for the Embospheres group at 6months. These fibroids were non-enhancing on CEMRI and associated with a significant reduction in mean uterine volume at 6months (mean/min/max 396.5/84.1/997.5cm(3), p=0.003). Choline was detected in 6/9 fibroid spectra available for the Gelfoam group at 6months. Of these fibroids, four demonstrated persistent enhancement on CEMRI and two were non-enhancing. This group did not demonstrate significant uterine volume reduction (mean/min/max 117.2/-230.6/382.6cm(3), p=0.15). The negative minimum value indicates fibroid growth. This study has demonstrated the potential of (1)H MRS to provide an additional marker of the success of UAE.

Uterine artery embolisation for uterine fibroids: Our experience at a tertiary care service hospital

BackgroundUterine artery embolisation (UAE) has evolved as a minimally invasive and effective alternative, treatment modality for women with symptomatic fibroids. We discuss our initial experience of UAE in the management of symptomatic fibroids. MethodsTwenty five symptomatic patients of uterine fibroids were treated with UAE by selectively cannulating and injecting poly vinyl alcohol particles into the uterine arteries. Post treatment follow up was done at 2 and 6 months respectively. ResultsPre-treatment, the sizes of fibroids were between 3.9 and 10.9 cm (mean 7.4) on ultrasonography. Of the total 25 patients, 49 uterine arteries were embolised with a technical success rate of 98%. Menorrhagia persisted in 7 patients, dysmenorrhea in 4 patients and pressure symptoms in 2 patients respectively in follow up study of six months which corresponds to a reduction in symptoms by 68% for menorrhagia, 71% for dysmenorhoea and 75% for those with pressure symptoms respectively. At 2 months follow-up post embolisation, the mean diameter of the fibroid was 4.03 cm (range 2–5.2 cm) and at 6 months 3.2 cm (range 1.3–4.1 cm), corresponding to size reduction of 45.5% and 57%, respectively. Follow up with ultrasonography at 2 and 6 months period showed successful fibroid reduction in 24 patients with corresponding reduction in the symptomatology. One patient remained symptomatic with increase in fibroid size and had to undergo hysterectomy. ConclusionUterine artery embolisation can be considered as an alternative to hysterectomy in appropriately selected symptomatic patients of uterine fibroids.

Pubertal Menorrhagia: Evaluation and Management

Background: Puberty menorrhagia is a common gynecological problem. Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in adolescent and adult women and importantly has both reproductive and metabolic consequences. . It is challenging to make a diagnosis during the 1-2 years following menarche because normal pubertal changes can mimic features of PCOS. Aims: To determine the cause of puberty menorrhagia and evaluate the efficacy of medical management. Materials and Methods This is a prospective observational study included 48 patients who presented with menorrhagic cycles in the pubertal age group to Princess Esra Hospital, DCMS from January 2013 to December 2013. Each case was assessed by thorough history, physical examination and relevant laboratory investigations. Results: In 28 patients immaturity of hypothalamic pituitary ovarian endometrial axis was considered to be the cause as their ultrasound and hormonal assays were normal. 10 had PCOS, 3 had hypothyroidism, 4 had tuberculosis, 1 patient had thrombocytopenia, 2 patients had symptomatic fibroid uterus. Blood and its components were given to 8 patients. Conclusions: Puberty menorrhagia is a distressing condition which can lead to severe complications and may require blood transfusion. Most of the cases are due to anovulatory cycles with immaturity of the hypothalamo-pitutuary-ovarian-endometrial axis. The current epidemic of childhood obesity may increase the symptoms of polycystic ovarian disease and underscores the importance of its early and accurate diagnosis with emphasis on lifestyle modification. Key-words: Pubertal Menorrhagia, Medical Management, Prospective study

English

OBJECTIVES: To determine the causes of puberty menorrhagia and to evaluate the efficacy of medical management. MATERIALS AND METHODS: This is a prospective observational study included 48 patients who presented with menorrhagic cycles in the pubertal age group to Princess Esra Hospital, DCMS from January 2013 to December 2013.Each case was assessed by thorogh history, physical examination and relevant laboratory investigations. RESULTS: In 28 patients immaturity of hypothalamic pitutuary ovarian endometrial axis was considered to be the cause as their ultrasound and hormonal assays were normal. 10 had PCOS, 3 had hypothyroidsm, 4 had tuberculosis, 1 patient had thrombocytopenia, 2 patients had symptomatic fibroid uterus. Blood and its components were given to 8 patients. CONCLUSION: Puberty menorrhagia is a distressing condition which can lead to severe complications and may require blood transfusion. Most of the cases are due to anovulatory cycles with immaturity of the hypothalamo - pitutuary - ovarian - endometrial axis. The current epidemic of childhood obesity may increase the symptoms of polycystic ovarian disease and underscores the importance of its early and accurate diagnosis with emphasis on lifestyle modification.

Uterine fibroid embolization for symptomatic fibroids: study at a teaching hospital in kenya.

Objective:Characterization of magnetic (MRI) features in women undergoing uterine fibroid embolization (UFE) and identification of clinical correlates in an African population.Materials and Methods:Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations between short-term imaging features and mid-term symptom scores was also done.Results:UFE resulted in statistically significant reduction (P < 0.001) of dominant fibroid, uterine volumes, and reduction of symptom severity scores, which were 43.7%, 40.1%, and 37.8%, respectively. Also, 59% of respondents had more than 10 fibroids. The predominant location of the dominant fibroid was intramural. No statistically significant association was found between clinical and radiological outcome.Conclusion:The response of uterine fibroids to embolization in the African population is not different from the findings reported in other studies from the west. The presence of multiple and large fibroids in this study is consistent with the case mix described in other studies of African-American populations. Patient counseling should emphasize the independence of volume reduction and symptom improvement. Though volume changes are of relevance for the radiologist in understanding the evolution of the condition and identifying potential technical treatment failures, it should not be the main basis of evaluation of treatment success.

Single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) versus single port laparoscopic myomectomy: a randomized controlled trial

ObjectiveTo evaluate whether single-port laparoscopically assisted-transumbilical ultraminilaparotomic myomectomy (SPLA-TUM) has a shorter operating time than single port laparoscopic myomectomy (SP-LM), without negatively affecting postoperative pain and cosmesis. Study designWe performed a randomized controlled trial at a University teaching hospital. A total of 92 premenopausal women with symptomatic, superficial intramural or subserosal fibroids were randomized to receive either SPLA-TUM or SP-LM. The primary outcome measured was the operating time. The secondary outcome measures included postoperative pain, as measured by a visual analog scale (VAS) at 2, 6, 12, 24, and 48h after the operation, and cosmetic outcomes, as measured by the Vancouver scar scale (VSS) and patient satisfaction with the scars, using a VAS at 3 postoperative months. ResultsThere were no differences in the patient demographics or in the clinical characteristics of the resected fibroids between the two groups. The operation results showed no differences in the hemoglobin changes, return of bowel activity, hospital stay, and complication rate between the groups. The mean operating time in the SPLA-TUM group was shorter than that in the SP-LM group (87.0±32.7min compared with 102.3±32.9min, P=0.026). The patients in each group demonstrated no differences in their postoperative pain levels, VSS scores, and satisfaction with the scars, but the SPLA-TUM group had a longer umbilical wound compared with the SP-LM group. Two (4.3%) patients in the SPLA-TUM group received SP-LM. One (2.2%) patient in the SP-LM group and two (4.3%) patients in the SPLA-TUM group were converted to two or three port laparoscopic myomectomy. ConclusionsSPLA-TUM has a shorter operating time than SP-LM due to convenient suturing and knotting; the two procedures have comparable postoperative pain levels and cosmetic outcomes. However, further study is needed to evaluate the long-term outcomes of SPLA-TUM.

Clinical utility of ulipristal acetate for the treatment of uterine fibroids: current evidence.

Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20%–25% of the worldwide population. No currently approved medical treatment is able to completely eliminate fibroids. Surgery, particularly hysterectomy, predominates as the treatment strategy of choice, even though it is associated with risks and complications and causes infertility. Until recently, gonadotropin-releasing hormone agonists were the only available drugs for the preoperative treatment of fibroids. However, ulipristal acetate (UPA), an oral selective progesterone receptor modulator, was recently licensed in Europe for the same indication. Recent studies have demonstrated the efficacy and safety of UPA in the medical management of fibroids before surgery, with a better tolerability profile than leuprolide acetate. Analyzing the literature, we identified new management strategies involving UPA and surgery, considering advantages of both medical and surgical therapy. The advent of UPA will undoubtedly modify the surgical approach to fibroids, but the heterogeneity of these possible indications now requires various original clinical studies to identify the optimal indications for UPA in patients with symptomatic fibroid(s).

The management of uterine leiomyomas.

The objective of this document is to serve as a guideline to the investigation and management of uterine leiomyomas.The areas of clinical practice considered in formulating this guideline are assessment, medical treatments, conservative treatments of myolysis, selective artery occlusion, and surgical alternatives including myomectomy and hysterectomy. The risk-to-benefit ratio must be examined individually by the woman and her health-care provider.Implementation of this guideline should optimize the decision-making process of women and their health-care providers in proceeding with further investigation or therapy for uterine leiomyomas, having considered the disease process and available treatment options, and reviewed the risks and anticipated benefits.English-language articles from MEDLINE, PubMed, and the Cochrane Database were reviewed from 1992 to 2002, using the key words "leiomyoma," "fibroid," "uterine artery embolization," "uterine artery occlusion," "uterine leiomyosarcoma," and "myomectomy." The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination.The majority of fibroids are asymptomatic and will not require intervention or further investigations. For the symptomatic fibroid, hysterectomy offers a definitive solution. However, it is not the preferred solution for women who wish to preserve their uterus. The predicted benefits of alternative therapies must be carefully weighed against the possible risks of these therapies. In the properly selected woman with symptomatic fibroids, the result from the selected treatment should be an improvement in the quality of life. The cost of the therapy to the health-care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat treatment modalities.1. Medical management should be tailored to the needs of the woman presenting with uterine fibroids and geared to alleviating the symptoms. Cost and side effects of medical therapies may limit their long-term use. (III-C) 2. In women who do not wish to preserve fertility and who have been counselled regarding the alternatives and risks, hysterectomy may be offered as the definitive treatment for symptomatic uterine fibroids and is associated with a high level of satisfaction. (II-A) 3. Myomectomy is an option for women who wish to preserve their uterus, but women should be counselled regarding the risk of requiring further intervention. (II-B) 4. Hysteroscopic myomectomy should be considered as first-line conservative surgical therapy for the management of symptomatic intracavitary fibroids. (I-B) 5. It is important to monitor ongoing fluid balance carefully during hysteroscopic removal of fibroids. (I-B) 6. Laparoscopic myolysis may present an alternative to myomectomy or hysterectomy for selected women with symptomatic intramural or subserous fibroids who wish to preserve their uterus but do not desire future fertility. (II-B) 7. Uterine artery occlusion may be offered as an alternative to selected women with symptomatic uterine fibroids who wish to preserve their uterus. (I-C) 8. Women choosing uterine artery occlusion for the treatment of fibroids should be counselled regarding possible risks, and that long-term data regarding efficacy, fecundity, pregnancy outcomes, and patient satisfaction are lacking. (III-C) 9. Removal of fibroids that distort the uterine cavity may be indicated in infertile women, where no other factors have been identified, and in women about to undergo in vitro fertilization treatment. (III-C) 10. Concern of possible complications related to fibroids in pregnancy is not an indication for myomectomy, except in women who have experienced a previous pregnancy with complications related to these fibroids. (III-C) 11. Women who have fibroids detected in pregnancy may require additional fetal surveillance when the placenta is implanted over or in close proximity to hen the placenta is implanted over or in close proximity to a fibroid. (III-C) 12. In women who present with acute hemorrhage related to uterine fibroids, conservative management consisting of estrogens, hysteroscopy, or dilatation and curettage may be considered, but hysterectomy may become necessary in some cases. (III-C) 13. Hormone replacement therapy may cause myoma growth in postmenopausal women, but it does not appear to cause clinical symptoms. Postmenopausal bleeding and pain in women with fibroids should be investigated in the same way as in women without fibroids. (II-B) 14. There is currently no evidence to substantiate performing a hysterectomy for an asymptomatic leiomyoma for the sole purpose of alleviating the concern that it may be malignant. (III-C) VALIDATION: This guideline was reviewed and accepted by the Clinical Practice Gynaecology Committee, and by Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.The Society for Obstetricians and Gynaecologists of Canada.

A Review of Treatment Options Available for Women with Uterine Fibroids

Background: The quest for ideal treatment and understanding of fibroid biology has resulted in further studies in pharmacological, radiological and surgical options with the goals of being safe, less invasive, cost - effective and enhancing reproductive potentials. However, surgery remains the mainstay of present effective management for large symptomatic fibroids. Aim: The aim is to review the treatment options available for women with uterine fibroids. Methods: Publications on the management of uterine fibroids were accessed using medline, google scholar and pubm ed databases. Relevant materials on treatment of uterine fibroids, selected references from internet services, journals, textbooks and lecture notes on management of uterine fibroids were also accessed and critically reviewed. Results: The mainstay of management for large symptomatic fibroids is surgical (myomectomy or hysterectomy). Minimally invasive procedures are becoming more commonly performed via b oth laparoscopic or hysteroscopic approaches, minimizing recovery time, postoperative pain and

Minimal invasive laparoscopic myomectomy with endometrial preservation and fertility enhancement

Objective: To evaluate the uterine scar and endometrial viability after laparoscopic myomectomy by two-dimensional (2D) ultrasound (US). To examine reproductive performance after surgery. Study Design: We performed a prospective, single-case, nonrandomized study in patients at the Dubai London Hospital: 107 patients with symptomatic fibroids who underwent laparoscopic myomectomy between January 2012 and May 2013. Methods: A total of 107 who underwent lap myomectomy were identified. An inclusion/exclusion criteria applied of which - 76 fulfilled the same. Their endometrial lining and uterine scar evaluated with the 2D US. Doppler study of the uterine artery and endometrial region performed alongside. The reproductive performance of these patients was then followed up over a 2 year period. Outcome: The endometrial sparing technique seems to be fertility sparing without the use of traction and minimal coagulation intraoperatively. The myometrial scar and endometrial lining can be followed up with 2D US, and the multiple suturing technique helps in improving scar integrity and ensures the absence of hematomas while preserving the endometrial thickness. The low resistance index (RI) of the ipsilateral uterine artery in a fibroid uterus shows an increase after surgery and goes back to normal between day 30-day 60. The subendometrial region had some increase but could not be quantified adequately due to lack of a method for the same. The RI of the uterine artery and the measurement of subendometrial color voxels still can be used as a measure of fertility prognosis and uterine receptivity after myomectomy. Limitations: This is a cohort investigation on a limited number of patients and does not compare the different number/size of myoma prior to removal in the US follow-up. Endometrial Doppler studies cannot be used as a prognostic tool of endometrial viability especially due to the lack of an accepted standard criteria to evaluate and measure the subendometrial perfusion.

First Reported Death in India during MRgFUS: A Case Report

Uterine adenomyosis is an important problem for women of reproductive age. Although hysterectomy has been the traditional treatment for symptomatic fibroids, many child bearing women are interested in a less invasive therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) is a new technique for treating a variety of solid tumors. The procedure is completely noninvasive. It is performed as an outpatient procedure and the patient can resume her normal activities the day following the procedure. A 39 years female came with c/o dysmenorrheal, menorrhagia and polymenorrhagia since 5 years. Patient's vitals were normal before procedure but patient suddenly collapsed and died after procedure. Dead body was forwarded for postmortem examination. During postmortem it was found that there was 3 liter of blood in peritoneum. As this is the safest outpatient procedure then what was the reason for this 3 liter of blood in abdominal cavity…?

Efficacy and safety of repeated use of ulipristal acetate in uterine fibroids

To investigate the efficacy and safety of repeated 12-week courses of 5 or 10 mg daily of ulipristal acetate for intermittent treatment of symptomatic uterine fibroids. Double-blind, randomized administration of two 12-week courses of ulipristal acetate. Gynecology centers. A total of 451 patients with symptomatic uterine fibroid(s) and heavy bleeding. Two repeated 12-week treatment courses of daily 5 or 10 mg of ulipristal acetate. Amenorrhea, controlled bleeding, fibroid volume, quality of life (QoL), pain. In the 5- and 10-mg treatment groups (62% and 73% of patients, respectively) achieved amenorrhea during both treatment courses. Proportions of patients achieving controlled bleeding during two treatment courses were >80%. Menstruation resumed after each treatment course and was diminished compared with baseline. After the second treatment course, median reductions from baseline in fibroid volume were 54% and 58% for the patients receiving 5 and 10 mg of ulipristal acetate, respectively. Pain and QoL improved in both groups. Ulipristal acetate was well tolerated with less than 5% of patients discontinuing treatment due to adverse events. Repeated 12-week courses of daily oral ulipristal acetate (5 and 10 mg) effectively control bleeding and pain, reduce fibroid volume, and restore QoL in patients with symptomatic fibroids. NCT01629563 (PEARL IV).

The conservative and interventional treatment of fibroids.

Fibroids are the most common benign tumors in women. One-third of all women of reproductive age undergo treatment for symptomatic fibroids. In recent years, the spectrum of available treatments has been widened by the introduction of new drugs and interventional procedures. Selective literature review on the treatment of uterine fibroids, including consideration of several Cochrane Reviews. Fibroids can be treated with drugs, interventional procedures (uterine artery embolization [UAE] and focused ultrasound treatment [FUS]), and surgery. The evidence regarding the various available treatments is mixed. All methods improve symptoms, but only a few comparative studies have been performed. A meta-analysis revealed that recovery within 15 days is more common after laparoscopic enucleation than after open surgery (odds ratio [OR], 3.2). A minimally invasive hysterectomy, or one performed by the vaginal route, is associated with a shorter hospital stay and a more rapid recovery than open transabdominal hysterectomy. UAE is an alternative to hysterectomy for selected patients. The re-intervention rates after fibroid enucleation, hysterectomy, and UAE are 8.9-9%, 1.8-10.7%, and 7-34.6%, respectively. The main drugs used to treat fibroids are gonadotropin-releasing hormone analogs and selective progesterone receptor modulators. Multiple treatment options are available and enable individualized therapy for symptomatic fibroids. The most important considerations in the choice of treatment are the question of family planning and, in some cases, the technical limitations of the treatments themselves.

The estimated volume of the fibroid uterus: a comparison of ultrasound and bimanual examination versus volume at MRI or hysterectomy

ObjectivesThe volume of a fibroid uterus before performing hysterectomy is typically estimated through bimanual examination and confirmed by ultrasonography. This study compares estimated volumes by bimanual examination and ultrasound examination with MRI and actual volumes obtained from histopathology, as gold standards. Study designWe used data from a previous prospective randomized multi-center trial that compared hysterectomy and uterine artery embolization (UAE) for the treatment of symptomatic fibroids. All patients underwent bimanual vaginal examination and pelvic ultrasonography. Those women randomized to UAE received a pelvic MRI. For women randomized to hysterectomy, the exact uterine volume was based on histopathologic examination. We compared the calculated volumes based on ultrasound parameters and estimated volume based on bimanual examination with either the calculated volumes of the pelvic MRI parameters or the calculated volume based on the exact weight during histological examinations. ResultsOur study demonstrated poor agreement between ultrasound and bimanual examination compared with exact volume during histopathologic examination and MRI-based volume. The agreement within the patient group with uterine volume >233g and >747g was fair to good. For those women with a uterine volume between 233 and 747g, the agreement was poor when comparing bimanual estimates with volume obtained from MRI or histolopathologic examination. Within this volume group, the agreement on uterine volume between ultrasound and MRI or histopathologic examination was fair. ConclusionsOur study shows that uterine volume as estimated by ultrasound and bimanual examination can be used for small or large uteri. For uteri with an intermediate volume, bimanual examination and ultrasound are less reliable.

Magnetic Resonance-Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids in Singapore

Uterine fibroids are the most common type of gynaecologic benign tumours, occurring in 25% to 50% of women during their reproductive lives. About half of the affected women have clinically significant symptoms, including abnormal bleeding, menstrual pain, frequent urination, constipation and abdominal distension. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has been used to treat patients with benign lesions and a variety of malignancies. The objective of this study is to evaluate symptom relief before and after MR-guided ultrasound ablation of fibroids. A total of 37 patients with symptomatic uterine fibroids were treated in this study. MRgFUS treatment led to a significant, time-dependent decrease in not only Symptom Severity Scores (SSS), but also the mean fibroid volume. The average reductions in volume were 41.6% and 52.6% at 6 months and 12 months respectively (P <0.05). The mean SSS of the 37 patients was 41.7 ± 2.8 before treatment whereas the average SSS was 26.9 ± 3.6, 20.7 ± 3.4, 18.5 ± 3.6, 16.5 ± 7.1, 9.8 ± 3.6 at 3 months, 6 months, 1 year, 2 years, and 3 to 4 years respectively. The decrease in scores was significant at all time points up to 3 to 4 years (P <0.05 and P <0.001). MRgFUS is a safe and effective non-invasive treatment for patients with symptomatic fibroids.

Ulipristal acetate for use in moderate to severe symptoms of uterine fibroids.

Although it has been known for a long time that uterine fibroids respond to changes in sex steroid concentrations, it is the availability of selective progesterone receptor modulators such as ulipristal acetete that has provided the gynecologist with a novel option for medical management of uterine fibroids. Ulipristal acetate is presently licensed in Europe for use in women with symptomatic fibroids up to 3 months prior to surgery and has demonstrated good clinical efficacy and safety for this indication. Future trials will define the long-term safety of this drug and its role in medical management of uterine fibroids.

Subjective Social Status and Depression Symptoms: A Prospective Study of Women with Noncancerous Pelvic Problems

ObjectiveSubjective social status (SSS) may be a stronger determinant of health than objective measures of socioeconomic status. We sought to examine the effect of community and national SSS on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions. MethodsWe conducted a secondary analysis of data obtained from 634 women who enrolled in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) in 2003 and 2004. SOPHIA was a longitudinal study of women aged 31 to 54 who were experiencing abnormal uterine bleeding, symptomatic fibroids, or pelvic pain. The primary outcome for this analysis consisted of symptoms suggesting major or other depressive disorder, as measured by the Patient Health Questionnaire-9, 2 years after study enrollment. We hypothesized that women who had low community and national SSS at baseline, as measured by the MacArthur SSS ladder, would be at higher risk of experiencing symptoms of depression at follow-up. ResultsWomen with low community SSS had an increased odds of experiencing depression symptoms 2 years later compared with women with high SSS, after adjusting for age, pelvic problem impact and baseline depression (odds ratio, 2.93; 95% CI, 1.11–7.77). Odds remained elevated after further adjusting for income and education. Results for the national ladder were not significant. ConclusionLow perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions. Asking about perceived community social status can help clinicians to identify patients who may be at increased risk for depressive disorders. Asking about perceived national social status does not seem to add value beyond that provided by income and education.