Uterine Fibroids Research Articles

Intravenous iron preoperatively for woman with severe anaemia

Iron deficiency is the main cause of anaemia, especially in premenopausal due to heavy menstrual bleeding. In this case report, an asymptomatic woman presented with a haemoglobin level of 3.9 mmol/l. Due to uterine fibroids, she was scheduled for myomectomy, and she was treated with IV iron. Fourteen days post infusion her haemoglobin level was 6.3 mmol/l. This highlights the importance of screening women for heavy menstrual bleeding causing iron deficiency, and encourage at-risk women to take iron supplements. Furthermore, one should be aware of IV iron therapy as an alternative to blood transfusion in treating iron deficiency anaemia.

Clinical and anamnestic factors affecting the progression of uterine fibroids

Background. Uterine fibroids (UF) is the most common tumor of the female reproductive system. In UF progression environmental factors are of great importance, which, without changing the genome, affect the activity of processes of hereditary information realization, the so-called epigenetic factors.Objective. To identify the most significant factors enhancing uterine myoma growth and the factors having protective effect.Material and methods of research. The study is a cohort retrospective non-randomized study in which 48 women took part: group 1–28 women with large-sized UF, group 2–20 women with small-sized UF. Retrospective analysis of medical records, questionnaire with the help of a questionnaire including 50 questions about the nature of lifestyle was carried out.Results of the study. The studied groups were comparable in age, marital status, education and living conditions. The average age of the patients in the first group was 48,21±5,24 years, in the second group 46,20±3,75 years. Based on the data obtained, the factors influencing the growth of uterine fibroids were identified and ranked. The main factors accelerating the progression of UF are high obesity (OR7.34 95% CL 1,035–178.2, p<0.05), a history of cesarean section (OR4.85 95% CL 1,006–36.51, p<0.05), the presence of UF in the mother (OR4.12 95% CL 1,022–21.21, p<0.05), eating pork more than 3 times a week (OR4.12 95% CL 1,134–17.51, p<0.05), short courses of using oral contraceptives (OR4.12 95% CL 1,02–21.21, p<0.05), rare consumption of fish and seafood (OR3.88 95% CL 1,06–16.57, p<0.05), low physical activity (OR4.12 95% CL 1,134–17.51, p<0.05), duration of dynamic observation for more than 5 years (OR3.506 95% CL 1,042–12.75, p<0.05). Protective factors that slow down the growth of uterine fibroids can be called taking nonsteroidal anti-inflammatory drugs to relieve dysmenorrhea (OR0.28 95% CL 0.075–0.989, p<0.05), limiting sugar intake (OR0.187 95% CL 0.035–0.814, p<0.05), no pork consumption (OR0 95% CL 0.0–0.5097 p<0.05), consumption of fish and seafood 3 or more times a week (OR0.149 95% CL 0.0189–0.7756, p<0.05), the presence of 3 or more births in the anamnesis through the natural birth canal (OR0 95% CL 0.0–0.563, p<0.05), regular sexual activity (OR0.280 95% CL 0.0745–0.989, p<0.05), alcohol exclusion (OR0.495 95% CL 0.01893–0.7756, p<0.05), underweight (OR0.95% CL 0.0–0.3809, p<0.05).Conclusion. It is necessary to encourage women not to postpone motherhood, to popularize having many children, family values, to modify the lifestyle of women with already detected uterine fibroids by increasing motor activity, limiting the consumption of pork and sugar, increasing the consumption of fish and seafood.

Association between urinary cotinine level and hypertensive disorders of pregnancy in women with uterine myoma: findings from the Japan Environment and Children's Study.

The effect of smoking on hypertensive disorders of pregnancy is a public concern. Recent evidence suggests that the risk of hypertensive disorders of pregnancy is influenced by the presence of uterine fibroids. We explored the association between maternal smoking exposure and the risk of hypertensive disorders of pregnancy in relation to the presence of uterine fibroids using data from Japan's largest birth cohort study. This study focused on first-time mothers, and the study population comprised 2752 and 35,294 first-time mothers with and without uterine fibroids, respectively. Hypertensive disorders of pregnancy was categorized as early-onset (before 34 weeks) and late-onset (after 34 weeks). Maternal smoking exposure was assessed by measuring the urinary cotinine concentration during the mid-trimester. Participants were classified into four quartiles based on their urinary cotinine levels as follows: Q1 (low concentration) to Q4 (high concentration). Multivariate analysis adjusted for potential confounders revealed that in women without uterine fibroids, the Q3 urinary cotinine level was associated with a modified risk of early-onset hypertensive disorders of pregnancy (adjusted odds ratio: 0.63, 95% confidence interval: 0.44-0.89). Conversely, for women with uterine fibroids, Q4 urinary cotinine level was associated with an increased risk of hypertensive disorders of pregnancy (adjusted odds ratio: 1.68, 95% confidence interval: 1.05-2.72). In conclusion, this study indicated that the impact of maternal smoking exposure varied based on the presence of uterine fibroids, underscoring the importance of personalized preconception care.

11963 Comparing Fibroid Mapping Reviewer Application (FMRA) & MRI: Mapping & Measurement Correlations in Uterine Fibroids.

11963 Comparing Fibroid Mapping Reviewer Application (FMRA) & MRI: Mapping & Measurement Correlations in Uterine Fibroids.

Role of Vitamin D in Gynecological Cancer: State of the Art

: Vitamin D and Vitamin D Receptors have gained more importance beyond their roles in bone metabolism and calcium homeostasis. Several epidemiological studies have confirmed that vitamin D has a specific function in a wide variety of gynecological cancers, such as ovarian cancer, endometrial cancer, cervical cancer, uterine fibroid, and vulvar cancer. The different anti-cancer mechanisms exerted by vitamin D on tumor cells are cell proliferation, cancer progression, angiogenesis, cell cycle arrest, and inflammation. The role of vitamin D is well emphasized in ovarian cancer and uterine fibroids, with limited studies available on cervical cancer and other types of gynecological cancers. Overall, most epidemiological data support that inadequate or low levels of vitamin D in the circulation are associated with risk and poor prognosis in several types of gynecological cancer. It is evident that vitamin D plays a prominent role as an anticancer agent against numerous types of cancer. This review focuses on the etiology and role of vitamin D and the Vitamin D Receptor in various types of gynecological cancer, as well as the mechanism of Vitamin D and its metabolites in the management of gynecological cancer.

12395 Knowledge and Perspectives of Non-Surgical Management Options Among Patients With Uterine Fibroids: A Preliminary Analysis

12395 Knowledge and Perspectives of Non-Surgical Management Options Among Patients With Uterine Fibroids: A Preliminary Analysis

Evidence of Browning and Inflammation Features in Visceral Adipose Tissue of Women with Endometriosis

Patients with endometriosis tend to have a low body mass index, suggesting an inverse relationship between body fat and risk of disease. This is supported by evidence that miRNAs differentially expressed in endometriosis induce browning of pre-adipocytes in vitro. Thus, we hypothesize that endometriosis may underlie adipose tissue (AT) dysfunction and browning. Identify inflammation and browning processes in AT collected from endometriosis patients. Visceral and subcutaneous AT samples were obtained during endometriosis (n = 32) or uterine myoma (n = 14; controls) surgery. Blood catecholamines were determined by high-performance liquid chromatography while IL-6 and TGF-β levels were quantified by ELISA. Adipocyte cross-sectional areas were analyzed in H&E-stained sections by computer-assisted morphometry. Macrophages (F4/80; Galectin-3) and browning activation (UCP-1; PGC-1α) in tissues were identified by dual label immunofluorescence. Expression of inflammatory (IL-6; MCP-1; Galectin-3; CD206; TIMP1; TGF-β) and browning-related (UCP-1; PGC-1α; DIO2; CITED1; CIDEA; TMEM26; TBX1; PRDM16; PPAR-γ) molecules in AT were assessed by RT-PCR and Western blotting. Compared to controls, patients presented smaller adipocytes, especially in VAT, and lower norepinephrine levels. Serum IL-6, but not TGF-β, was increased in patients. UCP-1, PGC-1α, IL-6, and MCP-1 were upregulated in VAT from endometriosis women, which also evidenced a reduction of CD206, relative to controls. However, no differences were found in mRNA expression of IL-6, TIMP1, and TGF-β nor Galectin-3 protein levels. In SAT, protein expression remained unchanged between patients and controls. Our findings support an endometriosis' role as a pro-catabolic state along with local signals of VAT browning and inflammation.

11228 Practical Considerations for Minimally Invasive Large Uterine Fibroid Removal

11228 Practical Considerations for Minimally Invasive Large Uterine Fibroid Removal

11645 The Association Between Age and Postoperative Outcomes Following Laparoscopic Hysterectomy for Uterine Fibroids

11645 The Association Between Age and Postoperative Outcomes Following Laparoscopic Hysterectomy for Uterine Fibroids

11688 The Impact of Body Mass Index on Surgical Complications in Minimally Invasive Hysterectomy for Uterine Fibroids

11688 The Impact of Body Mass Index on Surgical Complications in Minimally Invasive Hysterectomy for Uterine Fibroids

Use of Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Comparative Review of Major National Guidelines.

Fibroids cause significant morbidity, including anemia, pelvic pain, and infertility. It is imperative that healthcare providers are well-versed on the varying treatments available for fibroids. Specifically, uterine artery embolization (UAE) is a treatment that improves anemia, pelvic pain, and quality of life. The purpose of this article is to compare international guidelines on UAE to offer best practices to healthcare providers. Guidelines from the American College of Obstetrics and Gynecology (ACOG), The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists, National College of French Gynecologists and Obstetricians (CNGOF), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the National Institute for Health and Care Excellence (NICE) were reviewed alongside peer-reviewed PubMed articles. A comparative review of major international guidelines was conducted to encompass potential geographical, cultural, and societal variances with UAE. Review of data revealed guidelines agree with many constituents surrounding treatment of fibroids with UAE. Guidelines diverge regarding offering UAE for small fibroids, intracavitary/submucosal fibroids, and pedunculated serosal fibroids with variations on suggested imaging. Most agree that an experienced care team including a gynecologist and interventional radiologist should be included. Preoperative antibiotics and IUD removal may be recommended. UAE for patients who desire fertility remains an option after counseling within most guidelines. UAE is a safe, efficacious, and cost-effective alternative to hysterectomy and myomectomy. Including UAE as a treatment option during the patient counseling process is critical. Guidelines vary based on data interpretation and are based on clinical research and expert opinion. Due to mixed data and lack of randomized controlled trials, organizations differ when offering UAE to patients who wish to preserve fertility. It is vital to note emerging studies supporting the safety of UAE for subsequent pregnancy.

12075 A Pilot Study to Explore the Benefits of 3D Visualization of MRI-Segmented Uterine Fibroids During a Minimally Invasive Myomectomy

12075 A Pilot Study to Explore the Benefits of 3D Visualization of MRI-Segmented Uterine Fibroids During a Minimally Invasive Myomectomy

Evaluation of Transcervical Ultrasound Guided Radiofrequency Ablation of Symptomatic Uterine Fibroids in a Single Center

Evaluation of Transcervical Ultrasound Guided Radiofrequency Ablation of Symptomatic Uterine Fibroids in a Single Center

12382 Knowledge Assessment for Uterine Fibroids in Black Women

12382 Knowledge Assessment for Uterine Fibroids in Black Women

Are uterine fibroids associated with delay in diagnosis of endometrial cancer?

Are uterine fibroids associated with delay in diagnosis of endometrial cancer?

Preoperative Evaluation of Parasitic Blood Supply in the Massive Uterine Myoma: An Essential Step before Laparoscopic Myomectomy

Preoperative Evaluation of Parasitic Blood Supply in the Massive Uterine Myoma: An Essential Step before Laparoscopic Myomectomy

Consensus Guidelines for Delineation of Clinical Target Volumes for Intensity-Modulated Radiotherapy for Intact Cervical Cancer: An Update.

Accurate target delineation is essential when using intensity-modulated radiotherapy (IMRT) for intact cervical cancer. In 2011, the Radiation Therapy Oncology Group (RTOG) published a consensus guideline using magnetic resonance imaging (MRI). The current project expands on the previous atlas by including computed tomography (CT)-based contours, contours with MRI and positron- emission- tomography (PET) registrations, the addition of common and complex scenarios, and to incorporate information on simulation and treatment planning techniques. Twenty-eight experts in gynecologic radiation oncology contoured three cases, first on a non-contrast CT simulation scan, then with registered diagnostic scans. The cases included (1) FIGO IIIC1 with a bulky tumor and vaginal metastasis, (2) FIGO IIB with calcified uterine fibromas, and (3) FIGO IIIC2 with large lymph nodes. The contours on all six datasets (three CT simulations without diagnostic images and three with registered images) were analyzed for consistency of delineation using an expectation-maximization algorithm for simultaneous truth and performance level estimation (STAPLE) with kappa statistics as a measure of agreement. The contours were reviewed, discussed, and edited in a group meeting prior to finalizing. Contours showed considerable agreement between experts in each of the cases with kappa statistics of 0.67-0.72. For each case, diagnostic PET±MRI was associated with an increase in volume. The largest increase was the CTV primary for Case 2 with a 20% increase in volume and 54% increase in STAPLE estimate volume, which may be due to variance in registration priorities. For the third case, 92.9% increased their CTVs based on the addition of the diagnostic PET scan. The main areas of variance were in determining the superior extent of CTV coverage, coverage of the mesorectum, and simulation and planning protocols. This study shows the value as well as the challenges of using co-registered diagnostic imaging, with an average increase in volumes when incorporating MRI and PET.

11664 Hysteroscopic Resection: A Novel Approach to Management of an Unexpected Cervical Fibroid

11664 Hysteroscopic Resection: A Novel Approach to Management of an Unexpected Cervical Fibroid

11686 Vaginal Myomectomy for Cervical Fibroid in Pregnancy

11686 Vaginal Myomectomy for Cervical Fibroid in Pregnancy

Evaluation of Myomectomy During Cesarean Section: A Tertiary Center Experience

Aim: The study aims to investigate the outcomes of patients who underwent myomectomy during cesarean section in our tertiary center. Material and method: This study was conducted between January 1, 2015 and May 31, 2022. The patients included in the study were divided into three groups: patients with myoma uteri and pregnancy who underwent cesarean section and simultaneous myomectomy (Group 1), patients with myoma uteri and pregnancy who underwent cesarean section only (Group 2), and pregnant patients without myoma who underwent cesarean section only (Group 3). The groups were compared in terms of preoperative and postoperative results. Results: A total of 138 patients, 56 40.6% (Group 1), 31 22.5% (Group 2), 51 37% (Group 3) were included in the study. When compared according to demographic characteristics, Group 1 and Group 2 had significantly higher age and significantly lower gravida and parity (p: <0.001, p: 0.048, p: 0.005, respectively). There was no significant difference between Group 1 and Group 2 in terms of myoma size and number (p: 0.162, p: 0.228, respectively). Operative time, laboratory results, and blood transfusion requirements were similar between the groups. Conclusion: Although myomectomy can be performed during a cesarean section by an experienced surgeon in a tertiary center, it should be noted that complications may arise and that precautions must, therefore, be taken.