Burden of anemia in women with uterine fibroid-associated heavy menstrual bleeding.

Over the last few decades, genomics has become integral to understanding disease pathophysiology, improving diagnostics, and refining treatment strategies. Endometriosis, uterine fibroids, and adenomyosis are highly prevalent benign gynecologic disorders characterized by estrogen responsiveness, aberrant tissue growth, and overlapping clinical manifestations. The purpose of this review is to highlight the current genomic understanding of these conditions and their shared and distinct molecular features. Genome-wide association studies and sequencing efforts have identified multiple susceptibility risk loci and somatic mutations associated with uterine fibroids, adenomyosis, and endometriosis. These genetic variants provide insight into the pathogenesis of these conditions. Furthermore, while some genetic overlap between these conditions has been discovered, there are also important molecular distinctions between these diseases. Current genomic evidence supports a model in which these diseases share hormonally driven and genetically influenced mechanisms of abnormal tissue growth, but diverge in key somatic events and cellular contexts. Although clinical applications remain limited, continued multiomics research will enable molecular subtyping, targeted therapies, and improved risk stratification.

Navigating benign gynecological care in a pandemic: A qualitative exploration of patient experiences during COVID-19.

Perimenopause is a clinically distinct stage in which abnormal uterine bleeding, fibroids, adenomyosis, endometriosis, and adnexal pathology may require surgical evaluation. Management is complex because symptom burden and structural disease must be balanced against proximity to menopause, potential spontaneous improvement and the risks of undertreatment or overtreatment. This review summarizes evidence on complex benign gynecology in perimenopausal women, focusing on surgical timing, uterus-sparing and definitive procedures, and adnexal management. Recent data emphasize careful preoperative assessment of abnormal uterine bleeding because hormonal disturbance, structural pathology, and premalignant or malignant endometrial lesions may coexist. Evidence also supports individualized timing of definitive surgery, as earlier loss of ovarian function, particularly before age 45-50 years, may be associated with less favorable long-term cardiovascular outcomes. Opportunistic salpingectomy during indicated benign surgery is supported as an ovarian cancer prevention strategy that preserves ovarian hormonal function, whereas oophorectomy remains individualized. Management should be tailored to symptoms, pathology, malignancy risk, proximity to menopause and patient preference. Perimenopause-specific prospective studies are needed.

Objective: To investigate the correlation between ATRX expression and alternative lengthening of telomeres (ALT) activation status in uterine smooth muscle tumors, and to evaluate the values of the two indicators in diagnosing uterine leiomyosarcoma (uLMS). Methods: Cases of uLMS and its mimickers diagnosed at the Department of Pathology, Peking University Third Hospital, Beijing, China from January 2024 to October 2025 were retrospectively identified and analyzed. Immunohistochemistry was used to detect ATRX protein expression, while telomere-specific fluorescence in situ hybridization was applied to determine ALT activation status. Next-generation sequencing (NGS) was conducted to detect ATRX gene variations in some cases. Fisher's exact test was used to analyze the correlation between ATRX expression and ALT status, as well as the differences in ATRX expression and ALT activation among different tumor types. Kappa test was applied to evaluate the agreement between ATRX expression and ALT status. Results: There were 60 cases of uLMS, 36 cases of smooth muscle tumors of uncertain malignant potential (STUMP), 77 cases of uterine leiomyoma (uLM), and 6 cases of high-grade endometrial stromal sarcoma. NGS revealed that ATRX gene mutations were mostly accompanied by complete loss of protein expression, while copy number reduction was mostly associated with decreased protein expression. The concordant rate between ATRX expression and ALT activation status was 86.4%, with a significant correlation (P<0.001) and substantial consistency (Kappa=0.68). The rates of complete ATRX loss (35/59, 59.3%) and ALT activation (49/60, 81.7%) in uLMS were significantly higher than those in the other groups: 14.3% (5/35) and 17.1% (6/35) in STUMP, 0 (0/72) and 2.6% (2/77) in uLM, and 0 (0/6) for both markers in high-grade endometrial stromal sarcoma. All intergroup differences were statistically significant (all P<0.001). Conclusions: ATRX loss is highly correlated with ALT activation status. Combined detection of ATRX expression and ALT activation status can effectively assist in the differential diagnosis of uLMS from its mimickers. In addition, the presence of ATRX loss and/or ALT activation in STUMP and uLM suggests a malignant potential and seems to warrant close clinical follow-up and individualized diagnosis and treatment decisions.

Premenstrual syndrome (PMS) and uterine fibroids (UF) are major gynecological diseases that markedly affect the reproductive health of women of reproductive age (WRA). This study aimed to provide updated global estimates of these disorders among WRA (15-49 years) between 1990 and 2023 and to forecast future trends. Data from the GBD 2023 were used to assess the temporal trend and future projections of PMS and UF among WRA. Estimated annual percent change (EAPC), ARIMA model, and Pearson correlation analysis were used to assess temporal trends (1990-2023), forecast projections (2024-2050), and examine the association of socio-demographic index (SDI) with major gynecological disorders, respectively. In 2023, the global incidence was approximately 233,405,777 cases of PMS and 10,017,494 cases of UF. Between 1990 and 2023, the age-standardized prevalence rates of PMS and UF among WRA increased, with EAPC of 0.06% (95% CI: 0.04, 0.07) and 0.58% (95% CI: 0.53, 0.62), and the corresponding age-standardized disability-adjusted life years (DALYs) rates also increased, with EAPC of 0.05% (95% CI: 0.03, 0.07) and 1.21% (95% CI: 1.01, 1.42), respectively. Projections to 2050 indicate a slight decline in PMS prevalence rates but a mild increase in DALY rates, whereas both the prevalence and DALY rates of UF are expected to rise substantially. The burden and temporal patterns of PMS and UF varied markedly across countries, regions, and SDI levels. The prevalence rates of PMS (r = 0.351) and UF (r = 0.381) showed significant positive correlations with SDI (p < 0.0001). The PMS burden was highest among women aged 15-30 years, while women aged 35-49 years showed a greater burden of UF. The global burden of PMS and UF has increased over the last 34 years, underscoring the need for targeted public health strategies to improve reproductive health in women.

Chronic pelvic pain in women is often multifactorial and associated with amarked impairment in quality of life. Among the most common structural causes are symptomatic uterine fibroids and pelvic congestion syndrome. This review provides an overview of interventional radiological treatment options for both conditions, with afocus on pain reduction and clinical effectiveness. Current reviews, meta-analyses, and clinical studies on uterine artery embolization (UAE), magnetic resonance (MR-)high-intensity focused ultrasound (HIFU), and radiofrequency and microwave ablation for the treatment of symptomatic uterine fibroids, as well as pelvic vein embolization for pelvic congestion syndrome, were summarized. In uterine fibroids, UAE, HIFU/MR-HIFU, and thermal ablation techniques improve symptoms and quality of life. UAE is particularly well established for multiple and large fibroids, whereas HIFU and thermal ablation techniques appear especially suitable for selected, more focal lesions. In pelvic congestion syndrome, meta-analyses demonstrate amarked and sustained reduction in pain following pelvic vein embolization. Interventional radiological procedures represent effective organ-preserving treatment options for both conditions. While the analgesic effect in pelvic congestion syndrome is usually demonstrated directly by pain scales, in fibroid therapies it is generally assessed only indirectly through symptom and quality-of-life parameters. Standardized assessment of pain could help to define patient-relevant benefit more clearly in future studies.

Leiomyomas (LMs) represent the most frequent mesenchymal tumors of the urinary bladder. Despite their relative frequency, large clinicopathological studies are scarce, and their pathogenesis remains poorly understood. In this study, we performed a clinicopathological analysis of 35 bladder LMs and explored whether they share pathogenic mechanisms previously documented in uterine LMs. The tumors occurred in 18 women and 17 men, with a median age of 55 years (range: 20 to 78y). Clinical data were available for 30 cases (85%). Most tumors were incidentally discovered (16/30, 53%), while the remaining patients presented predominantly with lower urinary tract symptoms. Ten patients had a prior history of cancer, and 3 women had a history of uterine LM. Tumor size, available in 12 cases, ranged from 6 to 66mm (mean, 31mm). Histologically, most tumors showed a uniform morphology, consisting of well-circumscribed nodules composed of bland smooth muscle cells without mitotic activity. Rare findings included extensive necrosis (3/35, 8%) and a pseudohyperplastic appearance (1/20, 5%). On immunohistochemistry, a subset of tumors, predominantly in females, expressed estrogen receptors (7/28, 25%), progesterone receptors (5/24, 21%), and androgen receptors (10/23, 43%). HMGA2 expression was observed in one case (1/27, 4%). Fumarate hydratase (FH) expression was retained in all tested tumors (n=31); 2SC expression was detected in 4 tumors (4/32; 12%), all with preserved FH and lacking distinctive histomorphological features of FH-deficient LMs. DNA sequencing of 2SC-positive tumors identified a pathogenic FH variant in one of the 4 analyzed cases at a low variant allele frequency. No other known pathogenic variants, including MED12 commonly seen in uterine LMs, were detected. Altogether, this study characterizes the clinicopathological features of large cohort of bladder LMs, highlighting unrecognized morphologic features, including cases with massive necrosis. Our findings suggest that bladder LMs differ pathogenetically from their uterine counterparts, with a more limited role for hormone receptor signaling and distinct genetic alterations.

Pregnancy, delivery, and neonatal outcomes in women with uterine fibroids carrying singleton vs. multiple gestations: A retrospective population database cohort study.

Current status data are frequently encountered in many real life cross-sectional epidemiological, demographic, and medical studies, where each subject is examined only once, and the failure time of interest is never exactly observed but known to be either smaller or larger than the examination time for each subject by evaluating the failure status. Consequently, current status data are a mixture of left-censored and right-censored observations for the failure times of all subjects with or without covariates. In some real life studies, the test or diagnosis that is used to determine the failure status may be error-prone, and this leads to misclassified failure status for some or all subjects. The resulting data are referred to as misclassified current status data in the literature. In this paper, we study regression analysis of misclassified current status data and propose a novel estimation approach under the proportional odds model. Specifically, monotone splines are adopted to approximate the baseline odds function, and an efficient expectation-maximization algorithm is developed based on a data augmentation involving exponential and Poisson latent variables. An extension of the proposed method is also developed to account for the unknown test accuracy. The proposed method is shown to have excellent estimation performance in our simulation studies and is illustrated by an application to uterine fibroid data.

Percutaneous Sclerotherapy Followed by Transabdominal Microwave Ablation for Treatment of Uterine Fibroids: A Prospective Study.

Endometriosis (EMS) is a prevalent gynecological condition, and its diagnosis remains challenging. Hematological indicators such as platelet count (PLT), mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) have recently received attention for their potential diagnostic value in EMS. To assess the association of PLT, MPV, and PLR in EMS by a meta-analysis. We systematically searched Embase, PubMed, Cochrane Library, and Web of Science up to June 2025 for studies on the association of platelet-related parameters (PLT, MPV, and PLR) with EMS. Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated for PLT, MPV, and PLR using a random-effects model. All statistical analyses were performed using Stata16.0. Nineteen studies with 5675 subjects were included. Overall pooled analyses showed no statistically significant differences in PLT (SMD 0.35 [- 0.02, 0.71], I²=97.6%, P = 0.063) and PLR (SMD 0.24 [- 0.16, 0.64], I²=96.6%, P = 0.224) between EMS and non-EMS populations. However, MPV was significantly elevated in EMS compared with non-EMS populations (SMD 0.30 [0.09, 0.52], I²=82.7%, P = 0.006). Subgroup analyses by control group type revealed context-dependent associations. Compared with benign gynecological conditions (e.g., ovarian cysts, uterine fibroids), EMS showed significantly elevated PLT (SMD 0.20 [0.01, 0.38], I²=53.7%, P = 0.042) and PLR (SMD 0.33 [0.22, 0.43], I²=0.0%, P < 0.01). PLT was significantly lower in EMS than in ovarian cancer (SMD - 0.56 [- 0.81, - 0.32], I²=0.0%, P < 0.001). MPV was significantly elevated in EMS compared with healthy individuals (SMD 0.46 [0.11, 0.81], I²=84.7%, P = 0.010), whereas no significant difference was observed between EMS and other benign gynecological conditions (SMD 0.04 [- 0.10, 0.19], I²=0.0%, P = 0.547). MPV shows potential as an adjunctive marker for EMS, while PLT and PLR have limited independent diagnostic value but may be useful in specific clinical contexts.

During magnetic resonance-guided focused ultrasound (MRgFUS) treatment of uterine fibroids, ablating tissue near the spine is challenging as unwanted far-field bone heating can cause pain and potentially injure nearby nerves. This study investigates an anti-focus (AF) scheme for minimizing bone heating when targeting fibroid tissue in proximity to the spine.&#xD;Approach: Acoustic and thermal simulations were conducted using 3D MRI-derived anatomical models from ten patients who underwent MRgFUS for uterine fibroids using a low-frequency (0.5 MHz) 6144-element flat fully-populated modular phased array during a clinical trial (NCT03323905). AF points were distributed over patient spine surfaces with varying densities, transducer array element-wise phase and amplitude controls were obtained via Tikhonov regularization, and the resulting temperature fields were compared to those obtained via both conventional focusing (CF) and a transducer module partial blocking (PB) approach developed to mitigate far-field bone heating [Goudarzi et al., Med. Phys. 51(12):8670-87 (2024)]. Optimal regularization parameter values were chosen to maximize the focal-to-bone heating ratio (ΔTratio) while maintaining focal integrity.&#xD;Results: For high point densities (0.25 AF/mm²), AF driving signals provided significant improvements in ΔTratio compared to CF (fold improvement: 13 ± 16, p = 0.0009) and the optimal PB approach (fold improvement: 11 ± 11, p = 0.0009), at the cost of more diffuse focusing (focal heating volumes increased 77% ± 23% vs. CF; 50% ± 33% vs. PB; p < 0.0001) and thus requiring higher acoustic power levels to maintain focal heating (increased 73% ± 19% vs. CF; 15 ± 20% vs. PB; p < 0.0001). Soft-tissue aberration corrections improved focal targeting accuracy and reduced acoustic power demands, complementing the AF strategy.&#xD;Significance: AF driving signals show promise for enabling MRgFUS tissue ablation close to the spine without overheating the bone or nearby nerve bundles.&#xD.

HMGA2 Mediates Uterine Fibroid Progression via MAP4-Dependent Regulation of ECM and EMT.

Uterine fibroids represent one of the most common gynecological diseases and accurate 3D reconstruction is a prerequisite for clinical diagnosis, surgical planning, and treatment evaluation. Routine clinical protocols typically involve a set of orthogonal sagittal, coronal, and transverse MRI scans to assess morphology. These images usually have anisotropic voxels with sparse 3D coverage and existing assessment schemes are often limited to different 2D views based on planar segmentation. Moreover, models trained on data from individual centers often fail to generalize to wider datasets. Accurate and consistent 3D reconstruction for quantitative uterine fibroid analysis, particularly with unsupervised domain adaptation (UDA), is an unmet clinical need. This paper proposes the Foundation Model-Guided Adaptive Segmentation (FGAS) framework for automatic annotation-free multi-planar uterine fibroid MRI segmentation. FGAS uses anatomical priors for pseudo-label optimization, and integrates multi-view consistency constraints and connected component control to reduce planar dependency and suppress false positives. Extensive experiments on clinical datasets demonstrate the superior performance of FGAS, improving the Dice similarity coefficient from 42.8% of baseline models to 70.6%, outperforming existing state-of-the-art UDA and multi-plane methods. These results indicate that FGAS can achieve robust, high-accuracy automated reconstruction for annotation-free multi-view and cross-domain image analysis.

A dual imaging pattern of hyperattenuation on non-enhanced computed tomography and hypointensity on T2-weighted imaging is frequently encountered in various lesions. In the present review, we aimed to explore this imaging combination across a spectrum of abdominal and pelvic lesions to clarify its clinical implications.This pattern is commonly observed in lesions rich in fibrous or smooth muscle components, making it more frequently encountered in benign entities, including fat-poor angiomyolipomas, uterine leiomyomas, and tumors with predominant fibrous stroma. However, similar imaging findings may also be encountered in rare high-cellularity malignancies, selected systemic diseases, and lesions containing melanin, metal deposition, or thyroid tissue. Although not specific to a single disease, this imaging pattern offers valuable diagnostic clues for lesion characterization. When contrast-enhanced imaging is unavailable or contraindicated, combining non-enhanced computed tomography and T2-weighted imaging findings may help narrow the differential diagnosis. Despite its general association with benign lesions, this imaging phenotype requires careful exclusion of important pathologic mimics. Overall, integration with clinical information and other imaging findings remains essential for accurate interpretation.

Uterine fibroids (UF) affect up to 80% of women of reproductive age, with Black women experiencing disproportionate rates and symptom severity. Despite significant UF prevalence, Black women face delayed diagnosis and treatment due to lack of awareness, menstrual stigma, and healthcare distrust. This two-phase, mixed-methods study developed and evaluated a patient-centered, community-based UF education intervention to address these challenges. In Phase 1, focus groups with Black women identified gaps in UF knowledge, preferences for educational delivery, and trust-related communication barriers with healthcare providers. Findings informed the design of educational sessions implemented in Phase 2 across community venues in a large midwestern city, engaging 110 participants. Post-session evaluations revealed significant improvements in participants' confidence in UF knowledge, with satisfaction rates exceeding 90%. This study underscores the value of community-based education facilitated by trusted Black female healthcare providers. This model demonstrates feasibility and potential for addressing other health issues that disproportionately impact Black women by integrating patient perspectives and leveraging community-based settings for health education.

Pathological and microbiological surveillance of wildlife can reveal clinically silent but biologically important reproductive disorders. This case report describes a middle-aged (6–7 years) fallow deer hind ( Dama dama ) in good body condition, legally culled in Hungary, in which post-mortem examination identified a uterine leiomyoma in the left uterine horn and retained fetal cranial bones in the cranial vagina. To the best of our knowledge, this is the first published description of uterine leiomyoma in this species. Gross pathology, histopathology, and desmin immunohistochemistry supported the diagnosis of leiomyoma, and 16S rRNA amplicon sequencing was used to compare the microbiomes of the unaffected uterine horn, affected uterine tissue, and feces. The affected uterine sample showed a microbial profile more similar to that of feces than the unaffected uterine sample, with an increased relative abundance of genera, including Bacteroides , Escherichia–Shigella , and Turicibacter . As this was a single post-mortem case, no treatment was administered. These findings suggest a possible association between chronic mechanical obstruction, retained fetal material, and marked local microbial alteration, while also illustrating the limitations of causal inference from single-animal microbiome data. This case expands the differential diagnosis of reproductive tract lesions in wild ruminants and highlights the value of integrating pathology with careful microbiome interpretation in wildlife case reports.

Interstitial thermal ablation represents a uterine-sparing alternative for symptomatic fibroid management. Transvaginal ultrasound-guided myolysis enables precise targeting and real-time monitoring of the ablation zone. To illustrate the feasibility and immediate intraoperative response of transvaginal ultrasound-guided interstitial myolysis for the treatment of uterine fibroids. A 36-year-old multiparous woman with persistent abnormal uterine bleeding and pelvic pain related to a known uterine fibroid seeking a uterus-preserving treatment. Previous treatments, including levonorgestrel-releasing intrauterine system and oral therapy with relugolix, estradiol, and norethisterone had failed. Transvaginal ultrasound revealed a retroverted, enlarged uterus with a posterior type 2-5 fibroid measuring 45×37×49 mm (volume: 42.4 cm³). Under conscious sedation, a 16G-27 cm microwave antenna was transvaginally inserted and repositioned within the fibroid under continuous ultrasound guidance. Ablation was delivered in four cycles at 20 W for a total duration of 194 seconds, with a cumulative net energy delivered of 3.3 kJ calculated by the device, while continuously assessing safety margins and tissue response. Immediate ultrasound evaluation showed a 42.7% volume reduction (from 42.4 to 24.3 cm³), loss of fibroid definition, and partial collapse, consistent with effective devascularisation. No complications occurred, and the patient was discharged the same day. At 4-month follow-up, fibroid volume reduction was sustained (41.7%), with complete symptom control under the previously ineffective hormonal therapy. Transvaginal interstitial myolysis offers a minimally invasive, uterine-sparing treatment option for selected patients with symptomatic fibroids. Real-time ultrasound monitoring enables precise ablation and immediate confirmation of treatment efficacy. This video documents the immediate volumetric response of a uterine fibroid following transvaginal ultrasound-guided myolysis.

Uterine fibroids are common among reproductive-aged women, with notable racial disparities in disease burden and outcomes. Myomectomy is a fertility-sparing surgical treatment associated with variable transfusion risk. To evaluate racial disparities and identify risk factors for blood transfusion in patients undergoing myomectomy, and to develop a predictive model for high-risk patients. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Project (2018-2022) to identify women aged 18-55 years who underwent myomectomy. Patients with malignancy or bleeding disorders were excluded. Multivariable logistic regression was used to assess transfusion predictors and racial disparities. Incidence and predictors of perioperative blood transfusion; model performance for transfusion prediction. Among 6,154 patients, 604 (9.8%) required transfusion. Non-Hispanic Black patients accounted for 74.3% of transfusion cases (vs. 52.0%, P<0.001) and had over twice the adjusted odds of transfusion compared to Non-Hispanic White patients [adjusted odds ratio (aOR): 2.1, 95% confidence interval: 1.6-2.7]. Preoperative anaemia (aOR: 8.5), abdominal approach (aOR: 4.7), and fibroid burden (>250 grams) (aOR: 2.0) were also significant. The predictive model demonstrated excellent discrimination (area under the receiver operating characteristic curve: 0.79). Non-Hispanic Black patients face higher transfusion risks during myomectomy, even after adjusting for clinical factors. Interventions targeting anaemia and prioritising minimally invasive approaches may reduce these disparities. This study explores recent racial disparities in blood transfusion among myomectomy patients and assesses how these patterns have evolved in recent years using a nationally representative surgical dataset.