Symptomatic Uterine Fibroids Research Articles

The UPFRONT project: tailored implementation and evaluation of a patient decision aid to support shared decision-making about management of symptomatic uterine fibroids

ObjectiveTo evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States.MethodsWe used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use.ResultsThe decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16–2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61–1.22).ConclusionWhen patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making.Trial registrationClinicalTrials.gov NCT03985449; registered 6 June 2019.

Post-Uterine Artery Embolization: 3-Day MRI Changes and Their Predictive Value for Therapeutic Efficacy in Symptomatic Uterine Fibroids.

To summarize and discuss3-days MRI changes after uterine artery embolization (UAE) and their predictive value for efficacy. From August 2016 to April 2023, 52 patients underwent enhanced MRI within 3 days post-embolization. We retrospectively analyzed clinical and imaging data, focusing on MR characteristics at the 3-day mark, comparing pre- and post-embolization images. Patients were categorized based on 3-day MR findings into complete and incomplete necrosis groups, with clinical efficacy compared over 6 months. Our study included 30 cases of multiple leiomyomas and 22 of single leiomyomas. Postoperative MRI revealed complete necrosis in 31 tumors and incomplete necrosis in 21 tumors. At 3 days, MR ADC imaging showed increased signals in necrotic areas, mildly increased signals on T2-weighted images, and minimal changes on T1-weighted images. Six-month follow-up showed no significant difference in symptom improvement between groups (p = 0.524, p = 0.587, p = 0.615). However, a significant difference was found in leiomyoma volume reduction, with 70.63 ± 15.53% in the complete necrosis group and 51.36 ± 25.20% in the incomplete necrosis group (p＜0.001), highlighting the impact of necrosis extent on volumetric reduction. Short-term MRI changes after UAE can reflect changes in blood supply to fibroids and normal uterine tissue, and have good predictive value for medium-term embolization efficacy. This study describes short-term MR manifestations of complete and incomplete embolism, aiding in predicting long-term outcome.

Health-Related Quality of Life Among Iranian Women With Uterine Fibroids: A Cross Sectional Study.

Uterine fibroids (UFs) are the most common benign tumors in women, and their prevalence varies between 5.4 and 77.0% in reproductive-aged women. Patients with UFs may experience severe symptoms that they can affect different aspects of their lives, including quality of life. This study aimed to investigate the health-related quality of life among Iranian women with UFs. This cross-sectional study was conducted at Imam Hossein Hospital, Tehran, Iran, between November 2023 and February 2024, Data collection was based on the census method. Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire was used to assess symptom severity and health-related quality of life (HRQOL) of women with UFs. Data were analyzed using the SPSS software version 23.0. Overall, 220 patients with a mean age of 43.10±5.01 years were included in the study. Patients had total UFS-QOL score of 64.11±20.35 with the following subscales' scores: symptom severity: (19.00±6.39), concern: (60.79±26.47), activities: (71.76±23.02), energy/mood: (54.39±25.14), control: (66.52±22.82), self-consciousness: (77.63±26.39), and sexual function: (59.40±31.18). Furthermore, patients with multiparity history (P= 0.001), obesity (P<0.001), increased menstrual duration (P<0.001), irregular menstruation (P<0.001), and hyper menorrhea (P<0.001) had lower HRQOL scores. All subscales' scores of HRQOL were over 50 in patients with UF. HRQOL in these patients can be affected by certain factors, such as features of the menstrual cycle, multiparity, and obesity.

Continuous adaptation of conversation aids for uterine fibroids treatment options in a four-year multi-center implementation project

BackgroundFibroids are non-cancerous uterine growths that can cause symptoms impacting quality of life. The breadth of treatment options allows for patient-centered preference. While conversation aids are known to facilitate shared decision making, the implementation of these aids for uterine fibroids treatments is limited. We aimed to develop two end-user-acceptable uterine fibroids conversation aids for an implementation project. Our second aim was to outline the adaptations that were made to the conversation aids as implementation occurred.MethodsWe used a multi-phase user-centered participatory approach to develop a text-based and picture-enhanced conversation aid for uterine fibroids. We conducted a focus group with project stakeholders and user-testing interviews with eligible individuals with symptomatic uterine fibroids. We analyzed the results of the user-testing interviews using Morville’s Honeycomb framework. Spanish translations of the conversation aids occurred in parallel with the English iterations. We documented the continuous adaptations of the conversation aids that occurred during the project using an expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME).ResultsThe first iteration of the conversation aids was developed in December 2018. Focus group participants (n = 6) appreciated the brevity of the tools and suggested changes to the bar graphs and illustrations used in the picture-enhanced version. User-testing with interview participants (n = 9) found that both conversation aids were satisfactory, with minor changes suggested. However, during implementation, significant changes were suggested by patients, other stakeholders, and participating clinicians when they reviewed the content. The most significant changes required the addition or deletion of information about treatment options as newer research was published or as novel interventions were introduced into clinical practice.ConclusionsThis multi-year project revealed the necessity of continuously adapting the uterine fibroids conversation aids so they remain acceptable in an implementation and sustainability context. Therefore, it is important to seek regular user feedback and plan for the need to undertake updates and revisions to conversation aids if they are going to be acceptable for clinical use.

Successful pregnancy outcome after sonographic control and gasless laparoscopic removal of 810-gram fibroid during pregnancy: case report.

The management of symptomatic uterine fibroids during pregnancy is a challenging situation. In some cases, surgical therapy can be required. Reports indicate that both laparotomy and laparoscopy are safe methods. However, laparoscopy is associated with less morbidity. This paper describes the case of a 31-year-old woman with a symptomatic uterine fibroid which was removed by gasless laparoscopy.

Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study

BackgroundWe aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids.MethodsIn this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed.ResultsData from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75–87.50), 57 (44.75–80.00), and 52 (40.75–69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16–3.28) ng/ml, 1.12 (0.18–2.52) ng/ml, 1.15 (0.19–2.08) ng/ml and 1.18 (0.36–2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels.ConclusionsUSgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.

Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. A meta-analysis was performed on all available studies that evaluated the relative benefits and harms of MYO and UEA for the management of patients suffering from UFs. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and other complications. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR 1.84; 95% CI 1.62–2.10; P < 0.01; I2 = 39%), hysterectomy rate (OR 4.04; 95% CI 3.45–4.72; P < 0.01; I2 = 59%), and symptom-severity score (OR − 4.02; 95% CI 0.82, 7.22; P = 0.01; I2 = 0%) compared to MYO at a four-year follow-up. However, UAE was associated with a lower rate of early complications (OR 0.44; 95% CI 0.20–0.95; P = 0.04; I2 = 25%), and readmission rate (OR 1.16; 95% CI 1.01–1.33; P = 0.04; I2 = 0%) compared to MYO. Furthermore, both procedures had comparable improvement in pregnancy rates and abnormal uterine bleeding. In conclusion, UAE and MYO are effective in treating symptomatic UFs but they have different outcomes. The decision on which procedure to choose should be made based on individual preferences and the physician’s expertise.

Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong.

Introduction: This study evaluated the efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) in treating symptomatic uterine fibroids and adenomyosis. Methods: HIFU treatments performed in premenopausal women with symptomatic uterine fibroids and adenomyosis were analyzed retrospectively. Lesion volume reduction, change in symptoms of menstrual pain, and quality of life were examined. Major and minor complications, together with re-intervention rates, were evaluated. Results: Eighty-one HIFU treatments were performed in seventy-nine premenopausal women. The follow-up period was up to 95 months. A total of 65 women underwent treatment for uterine fibroids and 14 were treated for adenomyosis. For patients with uterine fibroids, the baseline fibroid volume median was 190.1 cm3 (18.5-1729.4 cm3). Fibroid volume was reduced by 50.1% (-26.2-97.8, p < 0.0001) at 6 months and 66.9% (-33.7-98.3, p < 0.0001) at 12 months after treatment. The modified Uterine Fibroid Symptom and Quality of Life (UFS-QOL) scores had decreased by 43.5% (0-62.5%, p < 0.0001) at 6 months and 50% (0-73%, p < 0.0001) at 12 months after treatment. In the adenomyosis arm, the median baseline uterine volume was 97.7 cm3 (43.7-367.4 m3). Uterine volume was reduced by 19.6% (range: 1.2-42.0, p = 0.28) at 6 months and 41.9% (18.9-69.2, p = 0.04) at 12 months after treatment. UFS-QOL scores were reduced by 38.1% (6-66.7%, p < 0.0001) at 6 months and 40% (0-70%, p < 0.0001) at 12s month after treatment. Fourteen (21.5%) patients with uterine fibroid and five (35.7%) patients with adenomyosis required subsequent interventions. Conclusions: HIFU provides symptomatic relief to most patients with uterine fibroids and adenomyosis. It is a promising uterus-sparing treatment for patients with these conditions.

Changes in symptom burden and quality of life among women with uterine fibroids receiving relugolix combination therapy: a plain language summary.

This is a summary of findings from two research studies (known as clinical trials). The studies looked at how well a medicine called relugolix combination therapy worked in women with heavy menstrual bleeding (heavy bleeding during a period) with uterine fibroids (noncancerous or benign growths in the uterus). In this analysis of the studies, researchers looked at how patients self-reported their uterine fibroid symptoms before and after taking relugolix combination therapy. Researchers also looked at how patients self-reported the impact of uterine fibroids on their health-related quality of life before and after taking relugolix combination therapy. Women took either relugolix combination therapy or placebo (a pill that contains no medicine) by mouth once daily for 24weeks. Women completed the Uterine Fibroid Symptom and Quality of Life questionnaire (where "quality of life" refers to the women's health-related quality of life related to uterine fibroids) before, during, and after treatment. The questionnaire let researchers see if the women felt that relugolix combination therapy decreased the burden of uterine fibroid symptoms and improved the women's health-related quality of life related to uterine fibroids. More women said that they felt less distress due to their uterine fibroid symptoms and that their health-related quality of life related to uterine fibroids was better after taking relugolix combination therapy compared with women who took placebo. Relugolix combination therapy may lessen distress associated with uterine fibroid symptoms and improve health-related quality of life related to uterine fibroids.

Management of Intramural Uterine Fibroid by Ayurveda - A case study

Too many female gynaecological issues are a result of shifting food habits and lifestyles. One of the main concerns for women who are of reproductive age is uterine fibroids. The symptoms of uterine fibroids have a detrimental effect on women's well-being, their ability to engage in social and physical activities, and their productivity at work. A 25-year-old married female patient arrived at the outpatient clinic complaining of lower abdominal pain, heavy menstrual flow, burning during micturition, and white discharge coming from her vagina six months ago . An intrauterine fibroid measuring 24 x 10 mm size with an ET of 10.5 mm was seen during the ultrasound examination. The ovaries' B/L measurements were normal, and the wall of the gallbladder was slightly enlarged. Surgery was recommended for the same condition, but the patient refused to have it done and preferred non-hormonal treatment. The patient refused to take any allopathic medication. The patient sought Ayurvedic treatment at the OPD. She received treatment in accordance with the Ayurvedic regimen prescribed by Kanchanar Guggulu, Kuberaksha vati, Raktavardhak vati, Ashoka-arishta, Hingwashtak churna, Chandraprabha vati, Kumaryaasawa.After three months of treatment and a follow-up every 15 days, a repeat scan showed normal results and symptom alleviation.

Transvaginal radiofrequency ablation: a therapeutic option for managing symptomatic uterine fibroids in women with reproductive desires

To evaluate whether transvaginal radiofrequency (RF) ablation of fibroids is a technique that can be offered to women with reproductive desires. Unicentric, prospective, observational study. University Hospital. Twenty-seven individuals who desired to become mothers after undergoing RF ablation for symptomatic fibroids. Transvaginal RF ablation for symptomatic fibroids with a maximum total volume of 145 cm3. The reduction in the size of the fibroids, improvement of symptoms, and reproductive outcomes during the 24 months after the ablation. For patients who achieved pregnancy, we assessed the type of conception, course of gestation, type of delivery, neonatal outcomes, and occurrence of both maternal and fetal complications. A statistically significant reduction in symptoms related to the fibroids 6 months after the ablation was demonstrated through the implementation of the Symptom Severity Scale. No patient required hospitalization after the procedure, and on average from the third day after intervention, they resumed their work activities without the need for analgesics. Among those patients who attempted pregnancy during the 24-month follow-up period, 73.68 % (14/19) achieved motherhood. There were no cases of uterine rupture, premature birth, or intrauterine fetal death. Radiofrequency ablation for fibroids seems to be a promising, safe, and low-complexity alternative that does not appear to interfere with the development of a normal term gestation.

How do we perform an open myomectomy?

31-year-old woman with symptomatic uterine fibroids who underwent open myomectomy. Despite prior treatment with goserelin, persistent symptoms and desire for future fertility warranted surgical intervention. The surgical technique aimed to optimize hemostasis and minimize morbidity by employing fusiform incisions.

Evaluation of the Efficacy and Complications of Different Hysterectomy Techniques in the Management of Uterine Fibroids.

Uterine fibroids, which are benign tumors affecting a significant proportion of women, often necessitate hysterectomy for suggestive relief. Understanding the relative efficiency and safety profiles of different techniques is crucial for optimizing patient care. This prospective cohort study enrolled women diagnosed with symptomatic uterine fibroids who underwent hysterectomy. Surgical techniques included "total abdominal hysterectomy (TAH)", "laparoscopic hysterectomy (LH)", and "vaginal hysterectomy (VH)". Efficacy outcomes included operative time, blood loss, and recurrence rates, while complications encompassed intraoperative and postoperative adverse events. Laparoscopic hysterectomy demonstrated the shortest operative time and least blood loss compared with TAH and VH. Total abdominal hysterectomy had the highest rates of both intraoperative and postoperative complications, followed by LH and VH. Recurrence rates were comparable among the three techniques. Laparoscopic hysterectomy offers advantages in operative efficiency and complication rates compared with total abdominal and vaginal hysterectomy techniques.

HMGA2 overexpression induces plasticity in myometrial cells and a transcriptomic profile more similar to that of uterine fibroids

ObjectiveTo study the possible role for HMGA2 overexpression in differentiated myometrial cells and its potential to induce a stem cell-like or dedifferentiating phenotype and drive fibroid development. DesignMyometrial cells were immortalized and transduced with an HMGA2 lentivirus to produce HMGA2hi cells. In vitro stem cell assays were conducted and RNA from HMGA2hi and control cells and fibroid-free myometrial (MyoN) and HMGA2 fibroid (HMGA2F) tissues were submitted for RNA-sequencing. SettingUniversity research laboratory SubjectsWomen undergoing hysterectomy for symptomatic uterine fibroids or other gynecological conditions. InterventionNot applicable. Main Outcome MeasuresIn-vitro stem-like properties from myometrium cell lines. RNA-sequencing and collagen production of HMGA2 overexpressing primary leiomyoma tissue and cell lines. ResultsHMGA2hi cells have enhanced self-renewal capacity, decreased proliferation, and have a greater ability to differentiate into other mesenchymal cell types. HMGA2hi cells exhibit a stem cell-like signature and share transcriptomic similarities with HMGA2F. Moreover, dysregulated extracellular matrix pathways are observed in both HMGA2hi cells and HMGA2F. ConclusionOur findings suggest that HMGA2 overexpression drives myometrial cells to dedifferentiate into a more plastic phenotype and provides evidence for an alternative mechanism for fibroid etiology, suggesting that fibroids may not only arise from a mutated stem cell but also from a mutated differentiated myometrial cell.

Effectiveness of a Hysteroscopic Tissue Removal System Device for Hysteroscopic Myomectomy on Patients’ Quality of Life: A Randomized Clinical Trial

Background: This is the first prospective randomized analysis comparing outcomes of medical therapy versus hysteroscopic myomectomy using the TruClearTM hysteroscopic tissue removal system to treat heavy menstrual bleeding from sub-mucosal leiomyoma(s). Objective: To evaluate the quality of life in patients treated for submucosal leiomyomas after hysteroscopy myomectomy compared to medical therapy. Study Design: Setting: private practice and community-based hospital; subjects: female patients with symptomatic submucosal leiomyomas from 2014-2017. A total of 69 patients enrolled, with 47 completed. Statistical analysis used: randomized clinical trial. Each patient was randomized to oral contraceptive pills/progesterone releasing intrauterine device or hysteroscopic myomectomy. Each patient was to complete the Uterine Fibroid Symptom and Health-related Quality of Life (UFS-QOL) questionnaire at baseline, one month, three months, and greater than or equal to six months after treatment. Primary outcome was the health-related quality of life (HR-QOL), as reflected from UFS-QOL scores. Contrasts were constructed from a linear mixed-effects model to compare the two treatment groups for changes from baseline in UFS-QOL scores. Results: UFS-QOL scores were similar at baseline between the two treatment groups. There was an overall improvement in all UFS-QOL scores within each group. Higher improvement scores were noted in the surgical group compared to the medical group for almost all UFS-QOL scores. At ≥6 months, in comparison to the medically managed patients, the most considerable score improvements for the surgical group were reported in HR-QOL concern, activities, self-consciousness and symptom severity scores having mean change scores (95% CIs) of 35.3 (22.3 – 48.2), 28.9 (16.3 – 41.5), 28.6 (15.0 – 42.1), and 32.2 (21.5 – 43.0), respectively. Conclusion: Patients with submucosal leiomyomas who received medical or surgical treatment reported similar improvement in overall HR-QOL scores.

Current Perspectives on Uterine Fibroids

In this paper, we aimed to: 1) discuss the approaches for increasing the effectiveness of organ-preserving surgical treatment of uterine fibroids; 2) analyse pre-operative preparation options for the formation of a restitutive scar during myomectomy. The article addresses the epidemiology of uterine fibroids in women, particularly in the reproductive age, and discussed the role of inflammation, disrupted nutrition, and proteolysis in the development of myomatous nodules. We also consider the terminology, classification, primary clinical symptoms of uterine fibroids, and discuss the causes of uterine scar incompetence. Various growth factors and collagen types have a differential impact on myometrial and on the formation of a restitutive scar. Finally, we talk about the histological and immunohistochemical methods in the diagnosis of uterine scar incompetence.

Assessment of Uterine Fibroids in Pre and Post Menopausal Women by Transabdominal Ultrasound

Background: Uterine fibroids are common benign tumors of the uterus, affecting a significant proportion of women, particularly during their reproductive years. These growths can lead to symptoms such as heavy menstrual bleeding, pelvic pain, and reproductive issues, thus impacting women's quality of life. Objective: The objective of this study was to evaluate the prevalence of uterine fibroids in pre- and post-menopausal women and to assess the sensitivity of transabdominal ultrasound in diagnosing these fibroids. Methods: This cross-sectional study was conducted over six months in the Radiology Department of District Headquarter Hospital, Swabi, KP, Pakistan. The study included pre- and post-menopausal women presenting with abnormal vaginal bleeding or diagnosed with symptomatic uterine fibroids, excluding those with known endometrial hyperplasia, adenomyosis, pelvic inflammatory disease, gynecologic malignancies, adnexal pathology, or pregnancy. Transabdominal ultrasound was performed with patients in a supine position and a filled urinary bladder, using both longitudinal and transverse sections. Data were collected on demographic information, clinical presentation, and ultrasound findings, and were analyzed using SPSS version 25. Results: A total of 112 women participated in the study. Among these, 94 (83.9%) reported pelvic pain, while 18 (16.1%) did not. The locations of fibroids identified were anterior (44, 39.3%), fundal (25, 22.3%), and posterior (43, 38.4%). Intramural fibroids were present in 61 (54.5%) patients, submucosal fibroids in 32 (28.5%), and subserosal fibroids in 19 (17.0%). Premenopausal women had a higher prevalence of fibroids (80) compared to postmenopausal women (32). Conclusion: Transabdominal ultrasound is a sensitive and reliable diagnostic tool for detecting uterine fibroids. It should be considered the primary imaging modality for evaluating abnormal uterine bleeding across different age groups, providing accurate and non-invasive diagnosis.

Transarterial embolization of uterine arteries in emerging dysfunctional uterine bleeding: a single-center case series study

BackgroundUterine artery embolization is proven to be an effective treatment for symptomatic uterine fibroids. Yet, its role in the management of dysfunctional uterine bleeding is still debatable. Patients with dysfunctional uterine bleeding have abnormal bleeding from the uterine vascular bed with variable underlying mechanisms. Uterine artery embolization will reduce/prevent bleeding by occlusion of the vascular bed, with subsequent cutoff of the effect of hormones on the endometrium. The aim of this work is to demonstrate the safety, efficacy and possible short-term complications of uterine artery embolization in the treatment of dysfunctional uterine bleeding (DUB) as a first-line treatment modality rather than the current treatment options (hormonal and surgical treatment).MethodsThirty patients included in the study were clinically and laboratory diagnosed based on FIGO classification system (PALM-COEIN) as DUB, and the diagnosis was confirmed by MRI imaging. All patients were subjected to transcatheter uterine artery embolization with subsequent clinical and radiological follow-up to assess the treatment outcome.ResultsUterine artery embolization was able to control bleeding in patients diagnosed as DUB, with subsequent complete cessation of medical treatment; no surgical interference was needed with much less morbidity. We had 93.3% improvement in the frequency, volume of bleeding and 100% improvement of the presenting anemia. No significant change in uterine volume or in endometrial thickness has been noted.ConclusionsUterine artery embolization is safe, effective procedure to control dysfunctional uterine bleeding with the preservation of the uterus especially in critical age groups.

Treatment of uterine fibroid symptoms with relugolix combination therapy

Uterine fibroids are a common cause of heavy menstrual bleeding and pain. Treatment with the combination of relugolix (an oral gonadotropin-releasing hormonereceptor antagonist), estradiol, and norethindrone acetate, administered once daily, may have efficacy in women with uterine fibroids and heavy bleeding while avoiding hypoestrogenic effects. Methods. We conducted two replicate international, double-blind, 24-week, phase 3 trials involving women with fibroid-associated heavy menstrual bleeding. Participants were randomly assigned in a 1:1:1 ratio to receive once-daily placebo, relugolix combination therapy (40 mg of relugolix, 1 mg of estradiol, and 0.5 mg of norethindrone acetate), or delayed relugolix combination therapy (40 mg of relugolix monotherapy, followed by relugolix combination therapy, each for 12 weeks). The primary efficacy end point in each trial was the percentage of participants with a response (volume of menstrual blood loss &lt;80 ml and a ≥50% reduction in volume from baseline) in the relugolix combination therapy group, as compared with the placebo group. Key secondary end points were amenorrhea, volume of menstrual blood loss, distress from bleeding and pelvic discomfort, anemia, pain, fibroid volume, and uterine volume. Safety and bone mineral density were assessed.Result. A total of 388 women in trial L1 and 382 in trial L2 underwent randomization. A total of 73% of the participants in the relugolix combination therapy group in trial L1 and 71% of those in trial L2 had a response (primary end point), as compared with 19% and 15%, respectively, of those in the placebo groups (P&lt;0.001 for both comparisons). Both relugolix combination therapy groups had significant improvements, as compared with the placebo groups, in six of seven key secondary end points, including measures of menstrual blood loss (including amenorrhea), pain, distress from bleeding and pelvic discomfort, anemia, and uterine volume, but not fibroid volume. The incidence of adverse events was similar with relugolix combination therapy and placebo. Bone mineral density was similar with relugolix combination therapy and placebo but decreased with relugolix monotherapy.Conclusions. Once-daily relugolix combination therapy resulted in a significant reduction in menstrual bleeding, as compared with placebo, and preserved bone mineral density in women with uterine fibroids.

A plain language summary of the perspectives of women who were interviewed about their experiences with uterine fibroids.

This summary describes what researchers learned during interviews of women with uterine fibroids and heavy menstrual bleeding (or period bleeding). At this time, little is known about how women perceive the impact of uterine fibroids on their lives and more information is needed. The goal of this study was to provide new information about the symptoms women have and how these symptoms affect their everyday lives. These interviews were done to better understand how uterine fibroid symptoms affect the lives of women in their own words. Thirty women from the United States, who had completed a clinical trial for a new treatment for heavy menstrual bleeding and uterine fibroids, agreed to be interviewed. The women described what their experiences with uterine fibroids were and the impact these experiences with uterine fibroids had on their lives before participating in the clinical trial. The most common symptoms of uterine fibroids the women described were heavy bleeding with their menstrual periods, pain in the pelvis or groin area, the passing of blood clots, and anemia (or low hemoglobin in red blood cells). Women said their symptoms affected them physically, emotionally, socially, and financially. They also said their symptoms made it hard to do daily activities, sleep, have a sex life, and go to work or school. Women who have heavy menstrual bleeding and uterine fibroids experience various uterine fibroid symptoms, and these symptoms affect most parts of the their lives.