Treatment Option For Uterine Fibroids Research Articles

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

BACKGROUND 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. AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). METHODS 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. RESULTS 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. CONCLUSION 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.

“In our community, we normalize pain”: discussions around menstruation and uterine fibroids with Black women and Latinas

BackgroundUterine fibroids are non-cancerous neoplasms that arise from the uterus affecting over 75% of women. However, there is a disparity with Black women having an increased prevalence of nearly 80%. Black women also experience increased symptom burden, including younger age at the time of diagnosis and increased number and volume of fibroids. Less is known about other ethnoracially diverse women such as Latinas and the potential cultural impacts on fibroid burden and treatment.MethodsCommunity engagement studios were conducted to facilitate discussions with stakeholders on their uterine fibroid and menstruation experience. We recruited Black women (n = 6) diagnosed with uterine fibroids and Latinas (n = 7) without uterine fibroids. We held two virtual community engagement studios split by uterine fibroid diagnosis. The studios were not audio recorded and notes were taken by four notetakers. The notes were thematically analyzed in Atlas.ti using content analysis.ResultsParticipants felt there was a lack of discussion around menstruation overall, whether in the home or school settings. This lack of menstruation education was pronounced when participants had their first menstruation experience, with many unaware of what to expect. This silence around menstruation led to a normalization of painful menstruation symptoms. When it came to different treatment options for uterine fibroids, some women wanted to explore alternative treatments but were dismissed by their healthcare providers. Many participants advocated for having discussions with their healthcare provider about life goals to discuss different treatment options for their uterine fibroids.ConclusionDespite uterine fibroid diagnosis, there is silence around menstruation. Menstruation is a normal biological occurrence and needs to be discussed to help prevent delayed diagnosis of uterine fibroids and possibly other gynecological disorders. Along with increased discussions around menstruation, further discussion is needed between healthcare providers and uterine fibroid patients to explore appropriate treatment options.

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.

Obstetric Outcome in Patients with Previous Abdominal Myomectomy at a Tertiary Hospital in South-South Nigeria

Background: Abdominal myomectomy refers to the surgical removal of fibroids from the uterus through an abdominal incision. It is one of the treatment options for uterine fibroids. Women who had this form of treatment may be faced with increased risks and complications during future pregnancies and deliveries. Aim: To assess the obstetric risk and delivery outcome of pregnancies achieved after abdominal myomectomy. Methodology: This was a retrospective study of pregnancy outcome in women who had abdominal myomectomy at University of Port Harcourt Teaching Hospital (UPTH) from 2018 to 2022. The case records of the patients were retrieved, and data on socio-demographic characteristics, mode of delivery, obstetric complications, and foetal outcome was extracted and analysed using SPSS version 25. Results: There were 7,602 antenatal clinic attendees during the study period, out of which 83 of the women had previous myomectomy and were delivered in UPTH. This accounted for 1.1% of booked patients who attended antenatal care and delivered at the hospital. Seventy-two case notes were retrieved, giving a case retrieval rate of 86.7%. The mean age was 34.89 ± 4.27 years (range from 18 to 47 years). The total Live birth post myomectomy was 56 (77.8%). There were 14 (19.4%) miscarriages and 2 (2.8) stillbirths. Patients that conceived spontaneously were 61 (84.7%), while 11 (15.3%) had in-vitro fertilization (IVF). Caesarean section was used in 67 (93.1%) of deliveries with elective caesarean section accounting for 45 (62.5%) of the deliveries. The commonest indication for caesarean section was previous myomectomy with breached endometrium in 53 (79.1%) cases. Forty-one (56.9%) of the deliveries occurred at 38-40 weeks of gestation. Conclusion: Obstetric outcome after abdominal myomectomies was good with high live birth rate and no maternal mortality recorded. Women who had abdominal myomectomy should be counselled to attend antenatal care and deliver in adequately equipped centres with skilled personnel to avert adverse pregnancy outcomes.

Relationship between myomectomy and risk of osteoporosis or fracture: A population-based cohort study

Myomectomy, a surgery to remove multiple leiomyomas from the uterus, is a treatment option for uterine fibroids (UF) in premenopausal patients. Osteoporosis and bone fractures are known to be strongly associated with menopausal status or hormonal changes. However, no studies have discussed the association between myomectomy and osteoporosis or fractures. This study investigated the risk of osteoporosis or fractures (vertebrae, hip, and others) in Korean patients who had undergone myomectomy without bilateral oophorectomy. We used data from the 10-year claims database of the Korean National Health Insurance from January 2009 to December 2020. Data for patients who had undergone myomectomy without oophorectomy (n = 211,969) and the control group (n = 450,124) who were randomly selected from the database were extracted. The incidence and hazard ratios (HRs) of osteoporosis or fracture between the myomectomy patients and the control group were calculated. A Cox proportional hazards model was used to analyze hazard ratios and 95% confidence intervals (CI). Subgroup analyses were performed based on age. The adjusted hazard ratios for osteoporosis and total fractures were 0.934 (95% CI: 0.916–0.954, P<0.001) and 0.919 (95% CI: 0.896–0.941, P<0.001), respectively, in the myomectomy group. The adjusted hazard ratios according to fracture site were 0.857 (95% CI: 0.799–0.92, P<0.001) for vertebral fractures, 0.706 (95% CI: 0.48–1.037, P = 0.076) for hip fractures, and 0.919 (95% CI: 0.896–0.943, P<0.001) for other fractures. In conclusion, patients who have undergone myomectomy might have a decreased risk of osteoporosis or fractures.

Current and Emerging Treatment Options for Uterine Fibroids.

Uterine fibroids are the most common benign neoplasm of the female reproductive tract in reproductive age women. Their prevalence is age dependent and can be detected in up to 80% of women by the age of 50 years. Patients affected by uterine fibroids may experience a significant physical, emotional, social, and financial toll as well as losses in their quality of life. Unfortunately, curative hysterectomy abolishes future pregnancy potential, while uterine-sparing surgical and radiologic alternatives are variously associated with reduced long-term reproductive function and/or high tumor recurrence rates. Recently, pharmacological treatment against uterine fibroids have been widely considered by patients to limit uterine fibroid-associated symptoms such as heavy menstrual bleeding. This hormonal therapy seemed effective through blocking the stimulatory effects of gonadal steroid hormones on uterine fibroid growth. However, they are contraindicated in women actively pursuing pregnancy and otherwise effective only during use, which is limited because of long-term safety and other concerns. Accordingly, there is an urgent unmet need for safe, durable, and fertility-compatible non-surgical treatment options for uterine fibroids. In this review article, we cover the current pharmacological treatments for uterine fibroids including their comparable efficacy and side effects as well as emerging safe natural compounds with promising anti-uterine fibroid effects.

Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis.

Novel treatment options for uterine fibroids, such as uterine artery embolization (UAE), ultrasound-guided and magnetic resonance-guided high-intensity focused ultrasound (USgHIFU and MRgHIFU), and transcervical radiofrequency ablation (TFA) methods, are widely used in clinical practice. This systematic review and meta-analysis (CRD42022297312) aims to assess and compare reproductive and obstetric outcomes in women who underwent these minimally invasive approaches for uterine fibroids. The search was performed in PubMed, Google Scholar, ScienceDirect, Cochrane Library, Scopus, Web of Science and Embase. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Cochrane guidelines. The articles were selected to meet the following eligibility criteria: (1) research article, (2) human subject research, and (3) the study of pregnancy outcomes after the treatment of uterine fibroids by either one of three methods-UAE, HIFU, and TFA. The analysis of 25 eligible original articles shows a similar rate of live births for UAE, USgHIFU, MRgHIFU, and TFA (70.8%, 73.5%, 70%, and 75%, respectively). The number of pregnancies varied considerably among these studies, as well as the mean age of pregnant women. However, the results of pregnancy outcomes for TFA are insufficient to draw firm conclusions, since only 24 women became pregnant in these studies, resulting in three live births. The miscarriage rate was highest in the UAE group (19.2%). USgHIFU was associated with a higher rate of placental abnormalities compared to UAE (2.8% vs. 1.6%). The pooled estimate of pregnancies was 17.31% to 44.52% after UAE, 18.69% to 78.53% after HIFU, and 2.09% to 7.63% after TFA. The available evidence confirmed that these minimally invasive uterine-sparing treatment options for uterine fibroids are a good approach for patients wishing to preserve their fertility, with comparable reproductive and obstetric outcomes among the different techniques.

Development of relugolix combination therapy as a medical treatment option for women with uterine fibroids or endometriosis

Treatment of uterine fibroids (UF) and endometriosis (EM) has relied on the surgical skills of gynecologists to improve symptoms and potentially alter the course of these debilitating diseases. Medical management of symptoms for both diseases leverages combined hormonal contraceptives used off label as a first-line treatment, with nonsteroid anti-inflammatory drugs and opioids to manage pain as needed. Gonadotropin-releasing hormone (GnRH) receptor agonists (peptide analogs) have been used as short-term therapy to manage severe symptoms of UF or EM, treat anemia, and reduce fibroid size before surgery. The introduction of oral GnRH receptor antagonists opened the door for the development of new treatment options for UF, EM, and other estrogen-driven diseases. Relugolix is an orally active, nonpeptide, GnRH receptor antagonist that competitively binds to GnRH receptors, preventing the release of follicle-stimulating hormone and luteinizing hormone (LH) into the systemic circulation. In women, the reduction in follicle-stimulating hormone concentrations prevents natural follicular development, suppressing ovarian production of estrogen, and together with reductions in LH concentrations, prevent ovulation, corpus luteum formation, and, thereby, the production of progesterone (P). By reducing circulating concentrations of estradiol (E2) and P, relugolix improves heavy menstrual bleeding and other symptoms associated with UF and moderate to severe pain associated with EM, including dysmenorrhea, nonmenstrual pelvic pain (NMPP) and dyspareunia. However, as monotherapy, the use of relugolix is associated with signs and symptoms of a hypoestrogenic state, including bone mineral density loss and vasomotor symptoms. The clinical development of relugolix incorporated the addition of a 1 mg dose of E2 and a 0.5-mg dose of norethindrone acetate (NETA) to achieve systemic E2 concentrations that remain in a therapeutic range while mitigating the risk for bone mineral density loss and vasomotor symptoms, enabling the longer-term treatment and reducing the impact of symptoms on quality of life, and potentially delaying or preventing the need for surgery. Relugolix 40 mg in combination with estradiol (E2) 1 mg and NETA 0.5 mg as a single fixed-dose combination tablet (relugolix combination therapy [relugolix-CT]) approved in the United States as MYFEMBREE is the first and only once daily oral GnRH antagonist combination therapy indicated for the management of heavy menstrual bleeding associated with UF and moderate to severe pain associated with EM. In the European Union (EU) and the United Kingdom (UK), relugolix-CT is approved as RYEQO for the management of symptoms associated with UF. In Japan, relugolix 40 mg, as monotherapy, was the first GnRH receptor antagonist approved to improve symptoms associated with UF or pain associated with EM under the brand name RELUMINA. In men, relugolix suppresses testosterone production. Relugolix 120 mg (ORGOVYX) was developed by Myovant Sciences and is approved in the United States, EU, and UK as the first and only oral androgen-deprivation therapy for the treatment of advanced prostate cancer. This review is focused on the development of relugolix and relugolix-CT in women's health indications.

Assessment of Post Therapeutic Response of Uterine Artery Embolization for Treatment of Uterine Fibroids

Background: Uterine fibroids are the most common benign gynecological tumors with an incidence rate reaching approximately 70% of women in their reproductive age and may cause serious complications in more than 50% of the patients, including vaginal bleeding, anemia, chronic pelvic pain, dyspareunia, infertility as well as secondary pressure manifestations. Uterine artery embolization (UAE) is an effective and widely used modality in managing uterine fibroids given that it is minimally invasive in managing the condition and its associated serious complications. Methods: A retrospective assessment of 41 patients who underwent UAE in a 4-year period (2016- 2020) was performed. The study evaluated the value of this new technique in the Kingdom of Bahrain, King Hamad University Hospital and included a follow up of its therapeutic response by monitoring the symptomatic status and confirmation by quantitative volumetric measurement by pre and post procedure multi parametric MRI. Results: Post-embolization MRI fibroid findings revealed an overall volume reduction rate (VRR) of 19.3% with statistically significant reduction in all outcome variables. Complete resolution of symptoms was reported by 80% of the patients. Conclusion: Uterine artery embolization is an effective treatment option for uterine fibroids. Keywords: Interventional radiology; MRI; Uterine artery embolization; Uterine fibroids; Uterine bleeding.

Endovascular Embolization of the Uterine Arteries in Giant Uterine Fibroids

Choosing a treatment option for uterine fibroids is today one of the most relevant problems in gynecological practice. Thanks to the success of modern medicine and the increased level of the population’s culture, female patients seek medical help without waiting for the tumor to acquire significant sizes. However, in practice, there are cases when fibroids reach gigantic sizes. Hysterectomy is a traditional approach to treating uterine fibroids of these sizes according to the current clinical guidelines. The introduction of new high-tech treatments, such as uterine artery embolization, has led to a revision of radical surgery, by giving preference to alternative approaches especially in cases where the patient desires to preserve the reproductive organ. The paper describes a clinical case that confirms an individual approach to choosing a treatment option towards organ-sparing surgery for giant uterine fibroids. The use of endovascular embolization of the uterine arteries as a treatment for giant uterine fibroids is shown to be justified as an organ-sparing surgery if the patient desires to preserve reproductive function.

Mediator Kinase Substrates in Human Myometrial Stem Cells Revealed by Using Chemical Inhibitors and Quantitative Phosphoproteomics

Uterine fibroids are benign tumors that occur in the myometrium of the uterus. Although they are benign, they represent a significant health problem as they affect approximately 70% of women and cause pregnancy complications, infertility and menstrual disorders. These health issues are especially concerning as uterine fibroids affect women of reproductive age. To date, non-invasive, long-term treatment options for uterine fibroids are not available. Thus, a significant need remains to develop non-invasive long-term treatment options for uterine fibroids. Strikingly, 70% of uterine fibroids have mutations in a protein called MED12. MED12 is one of 3 proteins that constitute the Mediator kinase complex. Together, these proteins (MED12, MED13, CYCLIN C and CDK8/19) function as a complex to integrate and transduce signals to RNA polymerase II, and thereby regulate transcription in response to numerous signaling pathways. Interestingly, our lab has previously demonstrated that these MED12 mutations lead to a loss of Mediator kinase activity. Thus, we hypothesize that this loss of Mediator kinase activity promotes uterine fibroid formation by dysregulating cellular processes. The goal of this work was to identify substrates that are phosphorylated by Mediator kinase in uterine fibroid progenitor cells, myometrium side population (MyoSP) cells, in order to understand how loss of Mediator kinase activity might promote the development of uterine fibroids. In order to identify proteins that are phosphorylated by Mediator kinase, MyoSP cells were metabolically labeled with either heavy or light stable isotopes and treated with vehicle or a specific inhibitor of Mediator kinase. Mass spectrometry was used to identify and quantify phosphoproteins from each condition (inhibitor treated vs. vehicle treated). An Empirical Bayes analysis was used to identify 307 phosphoproteins that significantly decreased upon treatment with the Mediator kinase inhibitor. Of these proteins, 4 (STAT1, TP53BP1, FOXK1, and NELFB) were further validated as direct targets of Mediator kinase by in-vitro kinase assay. In conclusion, this work identifies direct substrates of Mediator kinase that can be investigated for their roles in promoting uterine fibroid formation and represent potential targets for novel therapies to treat uterine fibroids.

Awareness of Uterine Artery Embolization as a Treatment for Fibroids among Saudi Women

Context: No study has investigated the awareness of uterine artery embolization (UAE) as a treatment option for uterine fibroids among Saudi women. Aims: The aim of this study was to investigate Saudi women's awareness of UAE as a therapeutic modality for uterine fibroids Settings and Design: This was a cross-sectional study conducted in Hail and Riyadh. Subjects and Methods: In 2019, an anonymous online questionnaire was sent via social media to women residing in Hail and Riyadh. The questionnaire contained 11 multiple-choice questions divided into two parts. The first part contained questions about demographic characteristics and one question about their history of fibroids. The second part contained items pertaining to awareness of treatment options for uterine fibroids and whether they were aware of UAE. Statistical Analysis Used: The Chi-square test was used for statistical analysis. Results: Eight hundred and forty-five responses have been received. Overall, 76.1% of the respondents had never heard of UAE. Awareness of treatment options for uterine fibroids was significantly associated with education level and participants' involvement in a medical field (P < 0.05; Chi-squared test). 9.2% were from respondents who reported a history of fibroids. Among them, 71.7% had never heard of UAE; 9% had heard about it from an obstetrician or gynecologist. Only 6.4% of the participants were aware of all the treatment options for uterine fibroids; 28.2% believed that hysterectomy was the only treatment for uterine fibroids. Conclusions: This study highlights the need for public awareness of the treatment options for uterine fibroids to appropriate candidates.

Modelling fibroid pathology: development and manipulation of a myometrial smooth muscle cell macromolecular crowding model to alter extracellular matrix deposition.

Current treatment options for uterine fibroids are limited to hormonal manipulation or surgical intervention. We aimed to develop an in vitro model to mirror collagen deposition and extracellular matrix (ECM) formation, the principal features of uterine fibroids, to enable testing of novel therapeutics. Macromolecular crowding with Ficoll 400 and Ficoll 70 in cultures of human uterine myometrial smooth muscle cells containing ascorbic acid, provided the basis for this model. These culture conditions mimic the 'crowded' nature of the in vivo extracellular environment by incorporating neutral, space-filling macromolecules into conventional cell cultures. This method of culture facilitates appropriate ECM deposition, thus closely representing the in vivo fibrotic phenotype of uterine fibroids. Macromolecular crowding in Ficoll cultures containing ascorbic acid reduced myometrial smooth muscle cell proliferation and promoted collagen production. Under these conditions, collagen was processed for extracellular deposition as demonstrated by C-propeptide cleavage from secreted procollagen. The fibrosis marker activin was increased relative to its natural inhibitor, follistatin, in crowded culture conditions while addition of exogenous follistatin reduced collagen (Col1A1) gene expression. This in vitro model represents a promising development for the testing of therapeutic interventions for uterine fibroids. However, it does not recapitulate the full in vivo pathology which can include specific genetic and epigenetic alterations that have not been identified in the myometrial smooth muscle (hTERT-HM) cell line. Following screening of potential therapeutics using the model, the most promising compounds will require further assessment in the context of individual subjects including those with genetic changes implicated in fibroid pathogenesis.

Comparison between the outcome of single versus multiple uterine fibroids after uterine artery embolization

BackgroundUterine fibroids are the most common benign tumor of the reproductive tract in women. Uterine artery embolization has been approved as an alternative treatment option for uterine fibroids to reduce uterine and fibroid volumes as well as to relieve the patient symptoms. The current study included 80 patients with symptomatic uterine fibroids. All patients underwent pre-embolization MRI, uterine artery embolization, and follow-up post-embolization MRI at 6 months post procedure for a reduction in uterine and dominant fibroid volumes. The aim of the study was to assess the role of transcatheter uterine artery embolization in reducing the uterine fibroid volume.ResultsThere was a significant difference in the uterine volume reduction between a group with single fibroids and a group with multiple uterine fibroids The mean uterine volume reduction in the first group was 46.5% compared to 37.4% reduction in the second group. While there was no significant difference in the dominant fibroid volume reduction between both groups (48.8% and 44.9% respectively).ConclusionsUAE has a high efficacy in the reduction of both the uterine volume and the dominant fibroid volume, which results in improvement in patient’s quality of life.

The role of atorvastatin in suppressing tumor growth of uterine fibroids

BackgroundMedical therapeutic options remain quite limited for uterine fibroids treatment. Statins, competitive inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, have anti-tumoral effects on multiple cancer types, however, little is known about their effects on uterine fibroids.MethodsInitially, we conducted a retrospective study of 120 patients with uterine fibroids and hyperlipidemia from the Second Affiliated Hospital of Wenzhou Medical University. Then, we evaluated the effect of atorvastatin on proliferation and apoptosis both in immortalized uterine fibroids cells and primary uterine fibroids cells. Furthermore, the molecular mechanism by which atorvastatin suppressed uterine fibroids cell growth was explored.ResultsOur results showed that atorvastatin use for 1 or 2 years significantly suppressed growth of uterine fibroids. Atorvastatin inhibited the proliferation of immortalized and primary uterine fibroids cells in a dose and time-dependent manner and stimulated apoptosis of uterine fibroids cells by inducing caspase-3 activation, up-regulating Bim and down-regulating Bcl-2. Additionally, atorvastatin treatment suppressed phosphorylation of ERK1/2 and JNK. Furthermore, GGPP, a downstream lipid isoprenoid intermediate, significantly rescued the effect of atorvastatin.ConclusionsThese results suggest that atorvastatin exerts anti-tumoral effects on uterine fibroids through inhibition of cell proliferation and induction of apoptosis in HMG-CoA-dependent pathway. Our results provide the first clinical and preclinical data on the use of atorvastatin as a promising nonsurgical treatment option for uterine fibroids.

Optimizing research in symptomatic uterine fibroids with development of a computable phenotype for use with electronic health records

Women with symptomatic uterine fibroids can report a myriad of symptoms, including pain, bleeding, infertility, and psychosocial sequelae. Optimizing fibroid research requires the ability to enroll populations of women with image-confirmed symptomatic uterine fibroids. Our objective was to develop an electronic health record-based algorithm to identify women with symptomatic uterine fibroids for a comparative effectiveness study of medical or surgical treatments on quality-of-life measures. Using an iterative process and text-mining techniques, an effective computable phenotype algorithm, composed of demographics, and clinical and laboratory characteristics, was developed with reasonable performance. Such algorithms provide a feasible, efficient way to identify populations of women with symptomatic uterine fibroids for the conduct of large traditional or pragmatic trials and observational comparative effectiveness studies. Symptomatic uterine fibroids, due to menorrhagia, pelvic pain, bulk symptoms, or infertility, are a source of substantial morbidity for reproductive-age women. Comparing Treatment Options for Uterine Fibroids is a multisite registry study to compare the effectiveness of hormonal or surgical fibroid treatments on women's perceptions of their quality of life. Electronic health record-based algorithms are able to identify large numbers of women with fibroids, but additional work is needed to develop electronic health record algorithms that can identify women with symptomatic fibroids to optimize fibroid research. We sought to develop an efficient electronic health record-based algorithm that can identify women with symptomatic uterine fibroids in a large health care system for recruitment into large-scale observational and interventional research in fibroid management. We developed and assessed the accuracy of 3 algorithms to identify patients with symptomatic fibroids using an iterative approach. The data source was the Carolina Data Warehouse for Health, a repository for the health system's electronic health record data. In addition to International Classification of Diseases, Ninth Revision diagnosis and procedure codes and clinical characteristics, text data-mining software was used to derive information from imaging reports to confirm the presence of uterine fibroids. Results of each algorithm were compared with expert manual review to calculate the positive predictive values for each algorithm. Algorithm 1 was composed of the following criteria: (1) age 18-54 years; (2) either ≥1 International Classification of Diseases, Ninth Revision diagnosis codes for uterine fibroids or mention of fibroids using text-mined key words in imaging records or documents; and (3) no International Classification of Diseases, Ninth Revision or Current Procedural Terminology codes for hysterectomy and no reported history of hysterectomy. The positive predictive value was 47% (95% confidence interval 39-56%). Algorithm 2 required ≥2 International Classification of Diseases, Ninth Revision diagnosis codes for fibroids and positive text-mined key words and had a positive predictive value of 65% (95% confidence interval 50-79%). In algorithm 3, further refinements included ≥2 International Classification of Diseases, Ninth Revision diagnosis codes for fibroids on separate outpatient visit dates, the exclusion of women who had a positive pregnancy test within 3 months of their fibroid-related visit, and exclusion of incidentally detected fibroids during prenatal or emergency department visits. Algorithm 3 achieved a positive predictive value of 76% (95% confidence interval 71-81%). An electronic health record-based algorithm is capable of identifying cases of symptomatic uterine fibroids with moderate positive predictive value and may be an efficient approach for large-scale study recruitment.

Comparing Treatment Options for Uterine Fibroids: An EHR-based Algorithm for Registry Recruitment [12H

INTRODUCTION: COMPARE-UF is a national registry of women with uterine fibroids (UF) that will examine the effectiveness of different fibroid treatments on patient-centered outcomes. Electronic health records (EHR) may be used for efficient identification of eligible women within healthcare systems. An EHR-based algorithm was developed to identify women with symptomatic UF for recruitment into the PCORI-supported COMPARE-UF registry. METHODS: An iterative process was undertaken with a goal to maximize the positive predictive value (PPV) of the final algorithm. For the first algorithm, women were required to be age 18-54, have imaging confirming UFs or a diagnosis code for UF and no history of hysterectomy. The second algorithm required both imaging and at least 2 diagnoses codes for UF. The third algorithm required at least 2 diagnosis codes for UF on separate dates, and excluded patients who had UF detected during a prenatal or emergency department visits. Randomly selected charts were reviewed for each algorithm. RESULTS: The first algorithm identified 4,342 patients, with a PPV of 47% (95% CI: 39-56%) after 150 charts were reviewed with ultrasound evidence of UFs in 139 (93%). The second algorithm yielded 1,174 patients, with a PPV of 65% (95% CI: 50-79%) after reviewing 51 charts. The third algorithm yielded 465 patients, with a PPV of 76% (95% CI: 71-81%) after 300 chart reviews. CONCLUSION: An EHR algorithm can identify patients with UFs. However symptomatic UF cases can be challenging to distinguish from asymptomatic cases and require additional steps to confirm eligibility.

Ulipristal acetate as a treatment option for uterine fibroids.

Uterine fibroids are the most common benign uterine tumours. Clinical symptoms include abnormal bleeding, pelvic pressure, pelvic pain, infertility and obstetric complications. Approximately one third of women with fibroids will require treatment. The management also depends on the number, size, and location of the fibroids. There are surgical and non-surgical treatment options. The choice of therapy depends on different factors, such as the severity of symptoms, tumour characteristics, age, and wish to preserve the uterus and fertility. There is growing evidence of the main role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators such as ulipristal acetate. The efficacy of long-term intermittent use of UPA was recently demonstrated by randomised controlled studies. There is great demand for alternatives to surgical intervention, especially in women seeking to preserve their fertility. One of these alternatives is ulipristal acetate, which is proven to treat fibroid symptoms effectively.

Review of nonsurgical/minimally invasive treatments and open myomectomy for uterine fibroids.

The main purpose of this review is to collect the most recent evidence with regards to safety and effectiveness of the nonsurgical and minimally invasive treatment options for uterine fibroids. Among the nonsurgical options, uterine artery embolization (UAE), and in eligible patients, magnetic resonance-guided high-intensity focused ultrasound (MRgFUS) are emerging as effective alternatives to surgical options for treatment of symptomatic fibroids. MRgFUS is comparable to UAE, and appears to be a cost effective treatment option, especially in older women, although long-term data are awaited. The transvaginal route for radiofrequency ablation is a promising new nonsurgical alternative, which needs to be studied in larger trials to establish its safety and efficacy.The laparoscopic myomectomy results in less postoperative pain, reduced febrile morbidity, and shorter hospital stay when compared with open laparotomy. The newer robotic approach is comparable to traditional laparoscopic technique in short surgical outcomes but is associated with higher costs. Hysteroscopic myoma resection is an effective surgical intervention for submucous fibroids and prior misoprostol use can help in reducing cervical lacerations. UAE and MRgFUS can be offered as an alternative nonsurgical option for eligible women with symptomatic fibroids. Laparoscopic myomectomy remains a safe and effective surgical option with advantage of less postoperative pain and faster recovery compared with open laparotomy for women who wish to retain their fertility options.

Non-invasive magnetic resonance-guided high intensity focused ultrasound ablation of a vascular malformation in the lower extremity: a case report.

IntroductionTherapy of choice for symptomatic vascular malformations consists of surgery, sclerotherapy, or embolization. However, these techniques are invasive with possible complications and require hospitalization. We present a novel non-invasive technique, i.e., magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation, for the treatment of a vascular malformation in a patient. This technique applies high-intensity sound waves transcutaneously to the body and is fully non-invasive. MRI guidance is the novel aspect of HIFU treatments and is used for exquisite delineation and localization of the lesion and accurate real-time temperature monitoring during tissue ablation. MR-HIFU is a well-established treatment option for uterine fibroids and is currently being investigated for, e.g., bone tumors, breast cancer, prostate cancer, and liver cancer. MR-HIFU of vascular malformations has not been a topic of research yet.Case descriptionVolumetric MR-HIFU ablation of a vascular malformation in the lower extremity of an 18-year-old male patient was performed. Temperatures of 62–80 °C were reached in the target lesion with sonications of 4 × 4 × 8 mm using powers of 200 W for <20 s. At 1-month follow-up, the patient reported qualitatively sustained reduction of pain and normal motor function. Three-month follow-up imaging indicated successful nidus destruction, which resulted in reduction of >30 % of the tumor volume. After 13 months, pain score was reduced to <2 after extreme exertion for several hours and to 0 for daily activities.Discussion and evaluationRadiofrequency ablation and cryoablation are minimally invasive techniques that have been tried on low-flow vascular malformations with inconsistent results. Furthermore, both techniques require probe insertion, which is associated with risks of wound infection and hospitalization. Since MR-HIFU is truly non-invasive, these risks are negligible.ConclusionsIn conclusion, we reported a successful non-invasive treatment of a vascular malformation with MR-HIFU in a clinical patient including long-term follow-up data for the first time. The patient reported qualitatively sustained pain reduction up to 13 months post treatment.