Treatment Of Uterine Fibroids Research Articles

Advancements and Emerging Therapies in the Medical Management of Uterine Fibroids: A Comprehensive Scoping Review.

Uterine fibroids, benign tumors originating from uterine smooth muscle cells, vary in prevalence depending on patient ethnicity, hormonal exposure, and genetics. Due to their high incidence, these neoplasms pose a significant burden on healthcare systems. Current treatment strategies range from routine monitoring in asymptomatic cases to surgical procedures such as myomectomy or hysterectomy in symptomatic patients, with an increasing trend toward uterus-preserving or non-surgical alternatives. This review examines the existing medical treatments for uterine fibroids and delves into the potential of emerging therapies. A scoping review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Medical therapies are divided into hormonal and non-hormonal treatments; however, long-term, safe, and effective treatments in the treatment of uterine fibroids are limited. In addition to established therapies, there is an increasing number of studies investigating the effect of substances such as vitamin D or green tea extract on uterine fibroids. Some studies investigate acupuncture as a possible alternative therapy. While existing treatments offer symptomatic relief and preparation for surgery, our findings point to a significant need for further research into long-term solutions, especially owing to recent limitations in the use of ulipristal acetate due to risk of liver damage. Initial studies involving vitamin D and epigallocatechin gallate are encouraging; however, additional research is required to establish definitive therapeutic roles.

Surgery and minimally invasive treatments for uterine fibroids

Surgery and minimally invasive treatments for 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.

Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment: A prospective study.

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques. To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment. The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment. UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Achieving NPVR ≥ 80% as technical success of high-intensity focused ultrasound ablation for uterine fibroids: a cohort study

ObjectiveTo report the long-term re-intervention of patients with uterine fibroids after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation and to analyse the influencing factors of re-intervention in patients in the NPVR ≥ 80% group.Materials and methodsPatients with a single uterine fibroid who underwent USgHIFU at our hospital from January 2012 to December 2019 were enrolled. The patients were divided into four groups according to different nonperfusion volume ratio (NPVR). Kaplan–Meier survival curve was used to analyse long-term re-intervention in different NPVR groups, and Cox regression was used to analyse the influencing factors of re-intervention in the NPVR ≥ 80% group.Main resultsA total of 1,257 patients were enrolled, of whom 920 were successfully followed up. The median follow-up time was 88 months, and the median NPVR was 85.0%. The cumulative re-intervention rates at 1, 3, 5, 8 and 10 years after USgHIFU were 3.4%, 11.8%, 16.8%, 22.6% and 24.1%, respectively. The 10-year cumulative re-intervention rate was 37.3% in the NPVR < 70% group, 31.0% in the NPVR 70–79% group, 18.2% in the NPVR 80–89% group and 17.8% in the NPVR ≥ 90% group (P < 0.05). However, no difference was found between the group of NPVR 80−89% and the group of NPVR ≥ 90% (P = 0.499). Age of patients and signal intensity on T2-weighted imaging (T2WI) of tumours were found to be independent risk factors for long-term re-intervention in the NPVR ≥ 80% group. A younger age and greater signal intensity on T2W images corresponded to a greater risk of re-intervention.ConclusionUSgHIFU, an alternative treatment for uterine fibroids, has reliable long-term efficacy. NPVR ≥ 80% can be used as a sign of technical success, which can reduce re-intervention rates. However, an important step is to communicate with patients in combination with the age of patients and the signal intensity on T2WI of fibroids.Trial registrationThis retrospective study was approved by the ethics committee at our institution (Registration No. HF2023001; Date: 06/04/2023). The Chinese Clinical Trial Registry provided full approval for the study protocol (Registration No. CHiCTR2300074797; Date: 16/08/2023).

Uterine artery embolization in the treatment of uterine fibroids and the preservation of reproductive health in women 40 years of age and older: A retrospective study

Aim. To evaluate the effect of uterine artery embolization (UAE) on reproductive health in women 40 years and older. Materials and methods. A retrospective study was conducted at the perinatal center of the District Clinical Hospital of Khanty-Mansiysk. Patients were divided into two groups: the main group (group 1; n=57) included women with uterine fibroids after UAE, and the control group (group 2; n=42) included women without a history of uterine fibroids. Results. Women with uterine fibroids were statistically more likely to have grade 1 obesity (χ2=4.39; p=0.04) and less likely to have normal body weight (χ2=8.73; p=0.00) compared to women without fibroids. Smoking increased the risk of uterine fibroids twofold (χ2=4.49; p=0.03; odds ratio 1.97; confidence interval 0.64-6.11). More women with uterine fibroids had a history of abortions (n=42; 73.7%) than those without uterine fibroids (n=19; 45.2%; χ2=8.27; p=0.01). The most common gynecological comorbidities in women with uterine fibroids included inflammatory disease of the uterus (N71), endometrial polyp (N84), and endometriosis (N80); p0.05. The most common extragenital diseases in patients with uterine fibroids included thyroid disease, hypertension, and iron deficiency anemia (p0.05). Contour SE embolization agent with spherical particles was more often associated with pain (χ2=0.18; p=0.67) and less often with fever (χ2=4.47; p=0.03). There was a decrease in the number of short menstrual cycles (less than 24 days) from the moment before surgical treatment and after 24 months (χ2=34.580; p0.001) and an increase in the number of cycles of 24–38 days (χ2=14.887; p=0.005). At 24 months after UAE, there were more women with a menstrual period of less than 3 days (χ2=10.385; p=0.035) and fewer with a menstrual period of more than 8 days (χ2=34.573; p0.001). Ultrasound showed a decreased ovarian reserve at 6, 12 and 24 months after UAE (p0.05). Conclusion. When assessing the reproductive health of women 40 years and older after embolization of the uterine arteries, it was found that this method of treatment of symptomatic uterine fibroids leads to a decrease in the duration and heaviness of menstruation but increases the risk of an ovarian reserve decrease.

Ethnicity and In Vitro Fertilization Outcomes in an Equal Access to Care Setting [ID 2683634

INTRODUCTION: Many studies report racial disparities in assisted reproductive technology (ART) outcomes, specifically, lower pregnancy rates and higher miscarriage rates in Black women. In an equal access to care setting, we wanted to delineate causes of this ongoing racial disparity. METHODS: This is a retrospective review of ART cycles at Brooke Army Medical Center (BAMC) from 2013 to 2021 via the Society for Assisted Reproductive Technology database. This study received a nonresearch designation from the BAMC IRB. RESULTS: A total of 1,211 in vitro fertilization (IVF) cycles were reviewed, comparing outcomes by race from first-time embryo transfers, fresh or frozen after “freeze-all” IVF cycles. Black women (19% of all cycles) experienced a lower live birth rate (27.3% versus 34.6%; risk ratio [RR] 0.75; 95% CI 0.6–0.94), but did not experience a statistically significant increase in pregnancy loss (36.8% versus 30.6%; RR 1.26; 95% CI, 0.94–1.68] compared to all other patients. Black women were found to have a higher prevalence of uterine factor infertility (RR 2.87; 95% CI, 2.24–3.66) and tubal factor infertility (RR 1.79; 95% CI, 1.51–2.12). When controlling for uterine factor infertility, Black racial identity was no longer a risk factor for decreased live birth rate (adjusted RR 0.85; 95% CI, 0.69–1.07). CONCLUSION: Recent literature demonstrates poorer ART outcomes for Black women. Our study suggests that this may be attributable to uterine fibroids, and an increased research focus on uterine fibroid treatment in patients desiring fertility may improve ART outcomes in Black women.

The Predictive Effect of Quantitative Analysis of Signal Intensity Heterogeneity on T2-Weighted MR Images for High-intensity Focused Ultrasound Treatment of Uterine Fibroids

Rationale and ObjectiveTo investigate whether the quantitative index of signal intensity (SI) heterogeneity on T2-weighted (T2W) magnetic resonance images can predict the difficulty and efficacy of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids. Materials and MethodsThe standard deviation (SD) of T2W image (T2WI) SI was used to quantify SI heterogeneity. The correlation between SD and the non-perfused volume ratio (NPVR) in 575 patients undergoing HIFU treatment was retrospectively analyzed, and the efficacy of SD in predicting NPVR was discussed. Three classifications were made based on the SD, and the ablation difficulty and ablation effect of different grades were compared. A total of 65 cases from another center were used as an external validation set to verify the classification performance of SD. ResultsThe SD of SI was negatively correlated with NPVR (r=-0.460, p<0.001). The predictive efficiency of SD for the ablation effect was higher than that of the scaled signal intensity (0.767 vs. 0.701, p=0.006). Univariate and multivariate logistic regression analyses showed that SD was an independent predictor of ablation effect. Based on SD, the three classifications were divided into SD I: SD<101.0, SD II: 101.0≤SD<138.7, and SD III: SD≥138.7. The treatment time, sonication time, treatment intensity, and total energy of SD I were lower than those of SD II and III (p<0.05). ConclusionThe heterogeneity of T2WI SI of uterine fibroids is negatively correlated with NPVR. The SD of SI can be used to predict the ablation difficulty and ablation effect of HIFU.

The Role of Nanomedicine in Benign Gynecologic Disorders.

Nanomedicine has revolutionized drug delivery in the last two decades. Nanoparticles appear to be a promising drug delivery platform in the treatment of various gynecological disorders including uterine leiomyoma, endometriosis, polycystic ovarian syndrome (PCOS), and menopause. Nanoparticles are tiny (mean size < 1000 nm), biodegradable, biocompatible, non-toxic, safe, and relatively inexpensive materials commonly used in imaging and the drug delivery of various therapeutics, such as chemotherapeutics, small molecule inhibitors, immune mediators, protein peptides and non-coding RNA. We performed a literature review of published studies to examine the role of nanoparticles in treating uterine leiomyoma, endometriosis, PCOS, and menopause. In uterine leiomyoma, nanoparticles containing 2-methoxyestradiole and simvastatin, promising uterine fibroid treatments, have been effective in significantly inhibiting tumor growth compared to controls in in vivo mouse models with patient-derived leiomyoma xenografts. Nanoparticles have also shown efficacy in delivering magnetic hyperthermia to ablate endometriotic tissue. Moreover, nanoparticles can be used to deliver hormones and have shown efficacy as a mechanism for transdermal hormone replacement therapy in individuals with menopause. In this review, we aim to summarize research findings and report the efficacy of nanoparticles and nanotherapeutics in the treatment of various benign gynecologic conditions.

Demographic Disparities in Uterine Fibroid Incidence Are Not Reflected in Treatment Practice Patterns Among U.S. Women: A Systematic Review and Meta-analysis [ID 2683522

INTRODUCTION: Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UF) and experience severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than hysterectomy and may improve UF outcomes. We reviewed demographic characteristics associated with UAE utilization compared to hysterectomy for symptomatic UF among U.S. women. METHODS: Systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051). 1,350 articles (January 1, 1995, to July 15, 2023) outlining demographic characteristics of UAE versus hysterectomy patients were identified. Two readers screened for inclusion criteria, yielding 11 full-text U.S.-based cohort and randomized controlled-trial studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed (STATA v18.0). Egger’s regression test was used to quantify publication bias. RESULTS: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio [OR] 3.35; p50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. CONCLUSION: Current knowledge of demographic characteristics of UF patients receiving UAE versus hysterectomy is sparse (n=11 studies). Among these studies, racial disparities in UF incidence do not appear to affect UAE utilization; rather, Black race may predict utilization of UAE compared to hysterectomy. Further research is warranted to determine the effects of clinical and demographic covariates on UF treatment outcomes.

Diffusion-weighted imaging as a potential non-gadolinium alternative for immediate assessing the hyperacute outcome of MRgFUS ablation for uterine fibroids.

The aim of this study was to investigate the value of diffusion-weighted imaging (DWI) as a potential non-gadolinium alternative for promptly assessing the hyperacute outcome of magnetic resonance-guided focused ultrasound (MRgFUS) treatment for uterine fibroids. In this retrospective study we included 65 uterine fibroids from 44 women, who underwent axial DWI (b-value: 800s/mm2) and contrast-enhanced (CE) MR within 15min post-ablation. Two blinded observers independently reviewed the DWI findings of ablated necrotic lesions and measured their volumes on DWI and CE images. The post-ablation DWI images revealed clear depiction of ablative necrotic lesions in all fibroids, which were classified into two types: the bull's eye sign (type 1) and the bright patch sign (type 2). The inter-observer intraclass correlation coefficient for classifying DWI signal types was 0.804 (p < 0.001). Volumetric analysis of ablated necrosis using DWI and CE T1-weighted imaging showed no significant variance, nor did the non-perfused volume ratios (all p > 0.05). Bland-Altman analysis revealed a mean difference of 2.38% and 1.71% in non-perfused volume ratios between DWI and CE, with 95% limits of agreement from - 19.06 to 23.82% and - 18.40 to 21.82%, respectively. The findings of this study support the potential of DWI as a viable non-gadolinium alternative for evaluating the hyperacute outcomes of MRgFUS ablation in uterine fibroids.

Clinical case of treatment of giant uterine fibroid

Uterine leiomyomas are the most common type of benign tumor that occurs in the female pelvis. Uterine leiomyoma is a tumor of smooth muscles. Its prevalence is higher in the reproductive age group and decreases after menopause. Giant uterine fibroids are a rare tumor of the uterus. Giant uterine fibroids, especially subcutaneous types, are complicated by malnutrition due to deterioration of their blood supply. The complaints of the patients are non-specific: an increase in the size of the abdomen, aching pains, sometimes difficulty urinating and defecating. A physical examination reveals a giant abdominal and pelvic formation. Ultrasound with Dopplerometry and contrast-enhanced MRI diagnoses a giant tumor next to the uterus with a heterogeneous structure and the presence of cystic cavities, which is difficult to distinguish from a true large ovarian tumor. The article illustrates the complexity of differential diagnosis of giant tumor of the uterus and ovaries. There are no significant differences between these tumors during ultrasound and MRI examinations. The final diagnosis can be made intraoperativery. The article presents a clinical observation of the giant uterine fibroids of a 48-year-old female patient. Ultrasound and contrast-enhanced MRI revealed a giant tumor of the right ovary, which occupied the entire abdominal cavity, of a heterogeneous structure. Intraoperatively, two tumors, intimately adjacent to each other, 31 cm and 28 cm in diameter, emanating from the isthmus of the uterus, were found. The final diagnosis of uterine fibroids was established histologically. Difficulties in differential diagnosis between uterine fibroids and ovarian tumors before surgery are associated with the large size of the tumor and the heterogeneity of the structure due to its malnutrition.

Racial Disparities in Surgical Treatment of Uterine Fibroids During the COVID-19 Pandemic

Racial Disparities in Surgical Treatment of Uterine Fibroids During the COVID-19 Pandemic

MR Diffusion-Weighted Imaging in Evaluating Immediate HIFU Treatment Response of Uterine Fibroids.

Nowadays, High Intensity Focused Ultrasound (HIFU) is a common surgery option for the treatment of uterine fibroids in China, the immediate response of which is clinically evaluated using Contrast Enhanced (CE) imaging. However, the injection of gadolinium with its potential adverse effect is of concern in CE and therefore, it deserves efforts to find a better imaging method without the need for contrast agent injection for this task. To assess the role of diffusion-weighted imaging (DWI) in evaluating the immediate therapeutic response of HIFU treatment for uterine fibroids in comparison with CE. 68 patients with 74 uterine fibroids receiving HIFU treatment were enrolled, and immediate treatment response was assessed using post-surgical DWI images. Semi-quantitative ordinal ablation quality grading and quantitative nonperfusion volume (NPV) measurement based on DWI and CE imaging were determined by two experienced radiologists. Agreement of ablation quality grading between DWI and CE was assessed using the weighted kappa coefficient, while intraobserver, interobserver and interprotocol agreements of NPV measurements within and between DWI and CE were evaluated using the intraclass correlation (ICC) and Bland-Altman analysis. Grading of immediate HIFU treatment response showed a moderate agreement between DWI and CE (weighted kappa = 0.446, p < 0.001). NPV measured in 65 fibroids with DWI of Grade 3~5 showed very high ICCs for the intraobserver and interobserver agreement within DWI and CE (all ICC > 0.980, p < 0.001) and also for the interprotocol agreement between DWI and CE (ICC = 0.976, p < 0.001). DWI could provide satisfactory ablation quality grading, and reliable NPV quantification results to assess immediate therapeutic responses of HIFU treatment for uterine fibroids in most cases, which suggests that non-contrast enhanced DWI might be potentially used as a more costeffective and convenient method in a large proportion of patients for this task replacing CE imaging.

Intravoxel incoherent motion (IVIM)-derived perfusion fraction mapping for the visual evaluation of MR-guided high intensity focused ultrasound (MR-HIFU) ablation of uterine fibroids

Background A method for periprocedural contrast agent-free visualization of uterine fibroid perfusion could potentially shorten magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) treatment times and improve outcomes. Our goal was to test feasibility of perfusion fraction mapping by intravoxel incoherent motion (IVIM) modeling using diffusion-weighted MRI as method for visual evaluation of MR-HIFU treatment progression. Methods Conventional and T2-corrected IVIM-derived perfusion fraction maps were retrospectively calculated by applying two fitting methods to diffusion-weighted MRI data (b = 0, 50, 100, 200, 400, 600 and 800 s/mm2 at 1.5 T) from forty-four premenopausal women who underwent MR-HIFU ablation treatment of uterine fibroids. Contrast in perfusion fraction maps between areas with low perfusion fraction and surrounding tissue in the target uterine fibroid immediately following MR-HIFU treatment was evaluated. Additionally, the Dice similarity coefficient (DSC) was calculated between delineated areas with low IVIM-derived perfusion fraction and hypoperfusion based on CE-T1w. Results Average perfusion fraction ranged between 0.068 and 0.083 in areas with low perfusion fraction based on visual assessment, and between 0.256 and 0.335 in surrounding tissues (all p < 0.001). DSCs ranged from 0.714 to 0.734 between areas with low perfusion fraction and the CE-T1w derived non-perfused areas, with excellent intraobserver reliability of the delineated areas (ICC 0.97). Conclusion The MR-HIFU treatment effect in uterine fibroids can be visualized using IVIM perfusion fraction mapping, in moderate concordance with contrast enhanced MRI. IVIM perfusion fraction mapping has therefore the potential to serve as a contrast agent-free imaging method to visualize the MR-HIFU treatment progression in uterine fibroids.

Evaluation of the Efficacy and Effectiveness of Hysteroscopic Electroresection in the Treatment of Submucosal Uterine Fibroids

Objective: To evaluate the effect of hysteroscopic electroresection in treating submucosal uterine fibroids. Methods: Using the random number table method, 70 patients with submucosal uterine fibroids were divided into two groups, 35 cases/group. The control group underwent laparoscopic myomectomy, and the observation group underwent hysteroscopic electroresection. Surgical indicators, sex hormone indicators, inflammation indicators, and treatment effects were compared between the two groups. Results: The surgical indicators, sex hormone indicators, and inflammatory indicators three months after operation in the observation group were all more ideal than those of the control group. The total effective rate of the observation group (97.14%) was higher than that of the control group (P &lt; 0.05). Conclusion: Hysteroscopic electroresection for the treatment of submucosal uterine fibroids was less invasive, accelerates recovery, and is more effective.

Waste analysis and energy use estimation during MR-HIFU treatment: first steps towards calculating total environmental impact

ObjectivesTo assess the environmental impact of the non-invasive Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids, we aimed to perform a full Life Cycle Assessment (LCA). However, as a full LCA was not feasible at this time, we evaluated the CO2 (carbon dioxide) emission from the MRI scanner, MR-HIFU device, and the medication used, and analyzed solid waste produced during treatment.MethodsOur functional unit was one uterine fibroid MR-HIFU treatment. The moment the patient entered the day care-unit until she left, defined our boundaries of investigation. We retrospectively collected data from 25 treatments to assess the CO2 emission based on the energy used by the MRI scanner and MR-HIFU device and the amount and type of medication administered. Solid waste was prospectively collected from five treatments.ResultsDuring an MR-HIFU treatment, the MRI scanner and MR-HIFU device produced 33.2 ± 8.7 kg of CO2 emission and medication administered 0.13 ± 0.04 kg. A uterine fibroid MR-HIFU treatment produced 1.2 kg (range 1.1–1.4) of solid waste.ConclusionsEnvironmental impact should ideally be analyzed for all (new) medical treatments. By assessing part of the CO2 emission and solid waste produced, we have taken the first steps towards analyzing the total environmental impact of the MR-HIFU treatment of uterine fibroids. These data can contribute to future studies comparing the results of MR-HIFU LCAs with LCAs of other uterine fibroid therapies.Critical relevance statementIn addition to (cost-) effectiveness, the environmental impact of new treatments should be assessed. We took the first steps towards analyzing the total environmental impact of uterine fibroid MR-HIFU.Key points• Life Cycle Assessments (LCAs) should be performed for all (new) medical treatments.• We took the first steps towards analyzing the environmental impact of uterine fibroid MR-HIFU.• Energy used by the MRI scanner and MR-HIFU device corresponded to 33.2 ± 8.7 kg of CO2 emission.Graphical

The impact of health literacy on uterine fibroid awareness, diagnosis, and treatment in the United States: a mini literature review.

Limited health literacy is a social health determinant leading to poor health outcomes. General and health literacy correlate and can impact diagnosis and treatment understanding. Limited literacy can lead to women receiving more significant rates of invasive surgical treatment, including hysterectomies. This review explores the impact of health literacy levels on uterine fibroid awareness, diagnosis, and treatment. PubMed, CINAHL, and Academic Search Premier searched articles published between January 1, 2012, and December 31, 2022. The keywords uterine fibroids, fibroids, myomas, leiomyomas, and health literacy were used. A total of four articles were returned. Increased rates of hysterectomies were found among participants with low income and education, as well as those with limited health literacy. Hysterectomies are the removal of the uterus and thus removes a woman's right to have children. While increased efforts are needed to understand the impact of health literacy levels on disparities and inequities in uterine fibroid diagnosis and treatment, there is still a need for targeted patient education and community-based education that ensures patient understanding of the diagnosis and treatment options for uterine fibroids.

Clinical experience of using the technique of uterine artery embolization in the treatment of submucous uterine fibroids in the Vidar Medical Center, Vinnytsia (2008–2022)

Myoma of the uterus is a benign neoplasm. The technique of uterine artery embolization (UAE) is used to treat uterine fibroids and is highly effective. The principle of embolization is based on the fact that all blood vessels that supply the uterus end in the endometrium.During UAE small parts are injected – emboli, which are spread along these vessels with the blood flow. In the vessels of the myoma the emboli cannot pass through the capsule of the myoma, so they block the vessels that supply it with blood. This leads to the cessation of blood supply to myomatous nodes, and subsequently there is a decrease in the size of these nodes, on average by 50–60% during the year, with a gradual decrease during the following years of life.This minimally invasive procedure is performed under local anesthesia – after femoral artery puncture, with X-ray control of angiography and intraoperative assessment of blood flow in fibroid nodes using ultrasound (US).Over 15 years of work, 1,400 UAE operations of uterine fibroids have been performed, of which more than 70 cases are UAE of submucosal myomas. Later, when the clinical picture of expulsion of these submucosal nodes appeared, transvaginal myomectomy was performed. Such a combined technique demonstrated high efficiency.The article describes clinical cases of patients who received treatment of large submucosal myoma by the UAE method followed by transvaginal myomectomy of the nascent node. In total, 5 clinical cases are described, the results of ultrasound, macropreparations, and colposcopic images are presented. A clinical case of a uterine myoma, the size of which corresponded to 21 weeks of pregnancy and a volume of 1500 cm3, is presented: after the above complex treatment method the volume of the uterus decreased according to ultrasound examination to 122 cm3. Also, a clinical case of a patient with uterine myoma, massive bleeding, whose hemoglobin level was 67 g/l is described. The patient was performed by UAE followed by transvaginal myomectomy for expulsion of the submucosal node.So, the described complex method of treatment of submucous uterine fibroids demonstrated high efficiency of clinical results.

Psychosocial Stress and MicroRNA Expression Profiles in Myometrial Tissue of Women Undergoing Surgical Treatment for Uterine Fibroids.

Uterine leiomyomas (fibroids) are the most common non-cancerous tumors affecting women. Psychosocial stress is associated with fibroid risk and severity. The relationship between psychosocial stress and fibroid pathogenesis may involve alterations in microRNAs (miRNAs) although this has yet to be examined. We investigated associations between two psychosocial stress measures, a composite measure of recent stressful life events and perceived social status, with expression levels of 401 miRNAs in myometrium (n = 20) and fibroids (n = 44; 20 with paired fibroid and myometrium samples) among pre-menopausal women who underwent surgery for fibroid treatment. We used linear regressions to identify psychosocial stressors associated with miRNAs, adjusting for covariates (age, body mass index, race/ethnicity, and oral contraceptive use). The association between psychosocial stressors and miRNAs was considered statistically significant at an FDR p < 0.10 and showed a monotonic response (nominal p-trend < 0.05). In the myometrium, 21 miRNAs were significantly associated with a composite measure of recent stressful events, and two miRNAs were associated with perceived social status. No fibroid miRNAs were associated with either stress measure. Pathway analyses revealed miRNA-mRNA targets were significantly enriched (FDR p < 0.05) in pathways relevant to cancer/tumor development. Of the 74 differentially expressed miRNAs between myometrium and fibroids, miR-27a-5p and miR-301b were also associated with stress exposure. Our pilot analysis suggests that psychosocial stress is associated with myometrial miRNA expression and, thus, may have a role in the pathogenesis of fibroids from healthy myometrium.