Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fibroids”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMed2003

[Management of uterine myomas in women of fertile age].

OBJECTIVE: Review of current knowledge about uterine fibroids management in young women. Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: Analysis of the facts in literature (texts in medical journals, monographies, textbooks, internet database Medline and Ovid) and authors' clinical experience. CONCLUSIONS: Alternatives of treatment of infertility in women with uterine fibroids have significantly enlarged in past 10 years. However none of the indicated methods is perfect. Expectation does not exclude the risk of growth of fibroids and abortion. The effect of pharmacological therapy is only temporary. Myomectomy is associated with the risk of surgical complications, fibroids' recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation (on an average) halves the fibroids volume, the long-term effect of the method on female fertility is still unknown. Nevertheless it seems convenient to advise the active approach to all women planning pregnancy and having significant (submucous or intramural) fibroid even before spontaneous or assisted conception. Most recent studies indicate significant improvement of reproduction outcomes after myomectomy, especially in young women with the absence of other factors of infertility. Only the results of randomized, controlled trials (that are still awaited) will inform us about comparison of the effects and risks of myomectomy and uterine artery embolization in management of infertility.

Adult↗
PubMedDate not supplied

Relationship between obesity and uterine leiomyomata.

Obesity is associated with many comorbid disease states including neoplasia. The increased risk of developing endometrial cancer is thought to be due to the higher level of circulating estrogens in obese women. Uterine leiomyomata (fibroids) are also thought to be influenced by estrogens. To determine whether patients presenting with symptomatic uterine fibroids were more obese than the general population, we retrospectively reviewed the hospital records of 144 women who underwent either hysterectomy or myomectomy for uterine fibroids. Obesity was defined as preoperative weight greater than 120% of desirable body weight (DBW) for the patient's height. In our investigation, 51% of the study population were obese. Moreover, 16% were severely obese (defined as greater than 150% DBW). When compared with the general population of women in the United States matched for height and age, the study population was significantly heavier. (p less than 0.0002). Patient age, parity, menopausal status, and degree of obesity did not correlate with the number of fibroids within the uterus. Fibroid size was significantly larger in nulliparous women (p less than 0.005). These results suggest that symptomatic uterine fibroids may be another comorbid disease state associated with obesity.

Adult↗
PubMed1978

[Cancer hazards in females with uterine myoma].

1. Women with uterine fibroids do not have an higher cancer risk than women without fibroids. 2. The carcinome of the breast is the most frequent cancer under autopsy cases with uterine fibroids. The carcinoma of the endometrium and of the pancreas are slightly increases, but tumours of other organs are less frequent. 3. The risk of sarcomatous degeneration of uterine fibroids is with 0,6% about fifty more less frequent then the risk of develope another cancer. 4. Hysterectomy does not diminuish the cancer risk of patients with uterine fibroids: Instead of the (not more possibles) cancers of the genital systems there develope tumours in other organs. 5. Under autopsy cases with uterins fibroids the trend to hypertonia, to adipositas, to myocardical infarction and to embollsm of the lung are slightly increased9

Bile Duct Neoplasms↗
PubMed1992

The assessment of benign uterine tumor vascularization by transvaginal color Doppler.

Transvaginal color flow Doppler was used to study uterine flow and fibroid arterial supply. These studies were carried out in 101 patients with palpable uterine fibroids and 60 women attending the clinic for annual checkups. Blood flow impedance expressed as resistance index (RI), pulsatility index (PI), and blood velocity are calculated from the 5th to the 8th day of the menstrual calendar. Increased blood velocity and decreased RI and PI in both uterine arteries occurred in patients with uterine fibroids. The same technique was also used to study blood flow in the main arteries supplying identifiable fibroid. Diastolic flow in these arteries was always present and increased in comparison with uterine artery blood flow. The difference in uterine artery blood flow between patients with fibroids and healthy volunteers is statistically significant and may have predictable value in growth rate evaluation of the benign uterine mass.

Adult↗
PubMed2005

Laparoscopic radiofrequency thermal ablation: a new approach to symptomatic uterine myomas.

OBJECTIVE: The purpose of this study was to evaluate the feasibility and efficacy of laparoscopic radiofrequency ablation of uterine fibroids. STUDY DESIGN: Eighteen women with symptomatic intramural uterine myomas underwent radiofrequency ablation under laparoscopic guidance. Postoperative sonographic evaluations of the fibroids size were scheduled at 1, 3, 6 ,9, and 12 months. The impact of myoma-related symptoms on quality of life (QOL) was assessed using a validated questionnaire. RESULTS: The median number of myomas treated per patient was 1 (1-3). The median baseline volume of the dominant myoma was 67.2 cm 3 (14.8-332.8). No intraoperative or postoperative complications occurred. The median reductions in myomas volume were 41.5%, 59%, and 77% at 1, 3, and 6-months, follow-up evaluation, respectively. No further change in fibroid size was observed at 9 months and 1 year. A significant improvement in the symptoms score and QOL score was observed at 3 and 6 months, follow-up. CONCLUSION: In this pilot study, laparoscopic radiofrequency ablation successfully reduced fibroid symptoms and fibroid volume in short-term follow-up. Additional studies are needed before its efficacy and safety can be confirmed.

Catheter Ablation↗
PubMed2004

Reproductive performance before and after abdominal myomectomy: a retrospective analysis.

OBJECTIVE: To evaluate the results of abdominal myomectomy for intramural and subserosal fibroids and to identify factors that influence the reproductive outcome after surgery. DESIGN: Retrospective analysis of a case series. SETTING: An academic department specializing in gynecologic surgery. PATIENT(S): A total of 72 women with intramural and subserosal fibroids submitted to abdominal myomectomy who wished to conceive after surgery. INTERVENTION(S): Data were collected on clinical characteristics, surgical features, and obstetric history before and after surgery. MAIN OUTCOME MEASURE(S): Conception rate, pregnancy loss, and live birth rate before and after surgery, as well as postoperative probability of conception according to selected clinical and fibroid characteristics. RESULT(S): Conception rate was 28% before myomectomy and 70% after surgery. The corresponding figures were 69% and 25% for pregnancy loss and 30% and 75% for live birth rate, respectively. Age <30 years and number of fibroids removed were the only significant and independent predictors of obstetric outcome by multivariate analysis. CONCLUSION(S): Our results suggest that abdominal myomectomy might improve reproductive outcome in patients with intramural and subserosal fibroids. The reproductive performance was particularly good when the patients were younger than 30 years and had a single myoma to remove.

Abortion, Spontaneous↗
PubMed2004

[Results of hysteroscopic myomectomy].

Main symptoms related to submucous fibroids are menorrhagia, infertility, and postmenopausal bleeding. First experiences of hysteroscopic transcervical resection of fibroids have been published by Neuwirth in the late seventies. Reports with long-term follow-up in patients with abnormal uterine bleeding are available. After a follow-up period of five years and more, results are satisfactory in 70-85% of the patients. Intramural class 2 and larger fibroids (> 4 cm) constitute the limits of the endoscopic technique. Prior to hysteroscopic myoma resection, pretreatment with GnRH agonists may be indicated in selected cases (large myomas, patients suffering from secondary anemia). Repeat resection is an option after failed primary hysteroscopic operation and may reduce the hysterectomy rate. In infertile women with submucosal or intracavitary fibroids, pregnancy and delivery rates are increased after hysteroscopic myomectomy. Operative hysteroscopy is also safe and effective in controlling persistent postmenopausal bleeding. To conclude, hysteroscopic resection is the gold standard for the treatment of symptomatic submucous fibroids.

Female↗
PubMed2000

Radiographic imaging techniques for the diagnosis of abnormal uterine bleeding.

The introduction of SIS has been a significant advance in TVUS evaluation of the endometrial cavity in the 1990s. SIS provides an unparalleled, clear, enhanced view of the endomyometrial complex that cannot be obtained with TVUS alone. Focal and global endometrial pathology can be differentiated with SIS. Saline infusion improves the sensitivity for the detection of endometrial abnormalities. The continuing challenge for gynecologists is to provide patients with cost-effective, minimally invasive evaluation and directed therapy for menstrual dysfunction. SIS targets patients needing biopsy, directs the surgical approach, and minimizes office diagnostic hysteroscopy--all with a quick office procedure. For patients, the benefits include minimal and brief discomfort and a better understanding of intrauterine pathology through viewing the ultrasound monitor. Patients also appreciate the ease of scheduling, the minimal time away from work, and that no escort is needed after the procedure. SIS provides an extension of the pelvic gynecologic examination. SIS is the most important imaging modality for evaluating endometrial pathology. Although there is no perfect test to evaluate the endometrium, overall, SIS is superior to other imaging and diagnostic procedures. It is less expensive than D&C or hysteroscopy. It is a safe, efficient, convenient, and well-tolerated procedure. In some instances, however, neither TVUS nor SIS is definitive in determining the location of fibroids or able to discern adenomyosis. In these instances, MR imaging triage is helpful. MR imaging is gaining widespread acceptance and, in many instances, is a cost-effective tool in the evaluation of abnormal uterine bleeding. It is noninvasive, differentiates uterine anatomy in response to exogenous hormones or the normal menstrual cycle, and reliably localizes pelvic pathology and size of lesions. When uterine conservation is desired in women with fibroids and TVUS or SIS is indeterminate in localizing depth of myometrial involvement of a fibroid, MR imaging should be considered as a part of the clinical algorithm. The precision of MR imaging localization of submucosal fibroids can obviate the need for hysterectomy and permit a skilled surgeon to hysteroscopically resect the fibroids. If the clinical examination is suspicious for adenomyosis and the US is nondiagnostic, the clinician should consider MR imaging strongly. When the results of the imaging study would influence surgical route and planning, MR imaging should be considered in the preoperative evaluation.

Biopsy↗
PubMed1998

Hysterectomy and myomectomy by laparotomy.

Hysterectomy provides definitive treatment for uterine fibroids. Surgery should be offered to women whose fibroids are symptomatic; it is not indicated on the basis of uterine size alone. Myomectomy is an option for those wishing to preserve uterine function. The prospects for successful pregnancy following myomectomy are encouraging, although there is a significant risk of the later recurrence of fibroids. Laparotomy remains the most appropriate surgical approach for large fibroids, although vaginal, rather than abdominal, hysterectomy may be suitable for some women whose uteri do not exceed a 12-14 week gestation size. There is some evidence that the morbidity of abdominal procedures increases with very large uteri. Uterine shrinkage with GnRH analogues may facilitate vaginal hysterectomy and be useful prior to abdominal hysterectomy or myomectomy for very large fibroids, although cost-effectiveness for its use with abdominal procedures has not been demonstrated.

Female↗
PubMed2000

Pain after uterine artery embolization for leiomyomata: can its severity be predicted and does severity predict outcome?

PURPOSE: To determine whether the severity of postprocedure pain associated with uterine artery embolization (UAE) for leiomyomata can be predicted and if its severity can predict outcome. MATERIALS AND METHODS: Eighty-one patients underwent UAE and had postprocedure pain managed with use of patient-controlled analgesia (PCA) in the form of an intravenous morphine pump. Baseline uterine and dominant fibroid volumes were calculated for each patient. Attempted doses, doses given, total morphine dose, and maximum numerical rating scale (NRS) score during postprocedure hospitalization were recorded. At 3 months postprocedure, repeat imaging was used to determine uterine and dominant fibroid volume reduction. Each patient also completed a questionnaire assessing change in menstrual bleeding, pelvic pain and pressure symptoms, and satisfaction with symptomatic outcome. Simple regression analysis was used to determine if baseline volumes predicted postprocedure pain and if the pain-related variables could be used to predict outcome. RESULTS: Neither baseline uterine volume nor dominant fibroid volume predicted the severity of postprocedure pain. Similarly, none of the pain-related variables predicted uterine or fibroid volume reduction, symptomatic improvement, or satisfaction with outcome. CONCLUSIONS: Postprocedural pain cannot be predicted based on baseline uterine or fibroid volume and the severity of pain experienced cannot be used to predict outcome.

Adult↗
PubMed1999

Near-infrared optical properties of ex vivo human uterus determined by the Monte Carlo inversion technique.

The optical properties, absorption (mua) and reduced scattering coefficient (mu's), of ex vivo human myometrium and leiomyoma (fibroid) have been determined by the Monte Carlo inversion technique over the wavelength range 600-1000 nm. This region is currently of interest for new, minimal-access, surgical laser procedures such as photodynamic therapy (PDT) for abnormalities of the uterus, and interstitial laser photocoagulation (ILP) for the thermal ablation of fibroids. In the region 630-675 nm (corresponding to PDT), the optical coefficients of myometrium are mua = 0.041+/-0.012 mm(-1) and mu's = 1.37+/-0.19 mm(-1). For the wavelength range 800-1000 nm (associated with infrared lasers for ILP), the optical coefficients of fibroid were found to be mua = 0.020+/-0.003 mm(-1) and mu's = 0.56+/-0.03 mm(-1). Overall, the optical properties of fibroid were found to be lower than myometrium, and this was attributed to the differences in both anatomy and vascularity. The results show that PDT for ablation of the uterine endometrium is most unlikely to affect any tissues beyond the myometrium, and that the region around 800 nm is the most effective for ablation of fibroids using ILP as the penetration depth of light is greatest at this wavelength.

Adult↗
PubMed2005

A prospective study of hypertension and risk of uterine leiomyomata.

Although uterine leiomyomata (also known as fibroids or myomas) affect the reproductive health and well-being of approximately 25% of premenopausal women, risk factors are poorly understood. Elevated diastolic blood pressure may increase fibroid risk through uterine smooth muscle injury, not unlike atherosclerosis. The authors prospectively examined the relation between diastolic blood pressure and incidence of clinically detected leiomyomata. The sample included 104,233 premenopausal nurses from 14 US states enrolled in the Nurses' Health Study II. Participants, aged 25-42 years, had intact uteri and no history of cancer or fibroids at enrollment in 1989. During the 827,348 woman-years of follow-up (1989-1999), 7,466 incident diagnoses of uterine leiomyomata, confirmed by ultrasound or hysterectomy, were reported. With a multivariable Cox proportional hazards model, the relative risk of self-reported ultrasound- or hysterectomy-confirmed uterine leiomyomata according to diastolic blood pressure in 1989 and time-varying antihypertensive use was estimated. With adjustment for age, race/ethnicity, body mass index, and reproductive history covariates, for every 10-mmHg increase in diastolic blood pressure, the risk of fibroids rose 8% (5-11%) and 10% (7-13%) among nonusers and users of antihypertensive medications, respectively. Elevated blood pressure has an independent, positive association with risk for clinically detected uterine leiomyomata among premenopausal women. Investigating this association may suggest possible pathways to prevent fibroids.

Adult↗
PubMed2003

Impact of HIV infection on invasive cervical cancer in Kenyan women.

OBJECTIVES: To determine the association between invasive cervical cancer (ICC) and HIV infection in Kenyan women. STUDY DESIGN: Case-control, with ICC patients as cases, and women with uterine fibroids as controls. METHODS: Medical and socio-demographic data were collected from 367 ICC patients, and 226 women with fibroids. After informed consent, HIV testing was done. RESULTS: ICC patients were older than fibroid patients (48 versus 41 years; P < 0.001), with an HIV seroprevalence of 15% and 12% respectively (P > 0.05). However, cases younger than 35 years were 2.6-times more likely to be HIV positive than controls of similar age [35% versus 17%; odds ratio (OR), 2.6; P = 0.043]. ICC HIV-seropositive patients were, on average, 10 years younger than HIV-seronegative patients (40 versus 50 years; P < 0.001). Eighty per cent of HIV-seropositive and 77% of HIV-seronegative ICC patients were in FIGO stage IIb or above. However, the odds of having poorly differentiated tumours was three times higher for HIV-seropositive than for HIV-seronegative ICC patients (77% versus 52%; OR, 3.1; P = 0.038) after adjusting for histological cell type and clinical stage. Mean CD4 cell count was 833 x 10(6) cells/l in ICC and 1025 x 10(6) cells/l in fibroid patients (P = 0.001). CONCLUSION: Young women with ICC were more often HIV infected than women with fibroids of the same age groups. HIV infection was associated with poor histological differentiation of the tumours. These findings suggest an accelerated clinical progression of premalignant cervical lesions to ICC in HIV-infected women.

Adult↗
PubMed1996

Value of sonohysterography in the diagnosis and management of abnormal uterine bleeding.

PURPOSE: To assess the value of sonohysterography in the diagnosis and management of abnormal uterine bleeding. MATERIALS AND METHODS: Sonohysterography was performed in 28 women (aged 29-55 years) in whom transvaginal sonography (TVS) suggested an abnormal endometrial echo (n = 14) or fibroids (n = 14). Its effect on diagnosis and treatment was studied. RESULTS: In the patients with an abnormal endometrial echo, sonohysterography depicted endometrial polyps (n = 9), intracavitary fibroids (n = 3), placental polyp (n = 1), and a normal cavity (n = 1). Hysteroscopic resection resolved the bleeding in 11 of 14 patients; surgery was obviated in one. In the group with fibroids, sonohysterography depicted small submucous fibroids amenable to hysteroscopic myomectomy (n = 5), a small mural fibroid with a normal cavity, which obviated surgical intervention (n = 4), and endometrial polyps, which altered the treatment plan (n = 1). Sonohysterography suggested the need for an abdominal myomectomy (n = 4) and alerted the surgeon to explore the uterine cavity in three patients. CONCLUSION: By helping elucidate the cause of bleeding, sonohysterography assisted in determining the therapeutic approach and often reduced the level of surgical intervention or obviated it altogether.

Adult↗
PubMed2002

[Evaluation of results in transcervical hysteroscopic myoma resection].

INTRODUCTION: The benign uterine fibroid is one of the most common cause for complains of females. The most important aim of the medicine nowadays is to treat the patient with minimally invasive methods, saving the organ. OBJECTS: Authors evaluate the efficacy of the transcervical hysteroscopic fibroid resection (TCRM) among their patients. MATERIALS AND METHODS: Authors performed 66 transcervical hysteroscopic fibroid resection (TCRM) in 61 patient in a six-year period. Based on clinical computed database and mailed questionnaires 51 patients were followed up. RESULTS: 30 out of 51 patients showed no symptoms after the procedure, in 14 cases subsequent fibroid was detected, while in 7 cases other type of complains occurred not related to the myoma. During the procedures complications appeared only in 4 cases, one perforation and three bleeding episodes occurred. CONCLUSIONS: Based on the data authors emphasize that TCRM is a safe and excellent method in treating submucosal fibroids.

Adult↗
PubMed2006

[Abdominal myomectomy as an alternative to hysterectomy: analysis of 504 cases].

UNLABELLED: Surgical management of symptomatic uterine fibroids by abdominal myomectomy. MATERIAL AND METHODS: Authors review their experiences and surgical methods for 504 abdominal myomectomies performed over the last 15 years. They retrospectively analyze the annual number of myomectomies, the age distribution, the most frequent indications, the location, size, and number of leiomyomas, the number of cases in which the uterine cavity was opened, the frequency of post-operative complications, and the number and outcome of post-myomectomy pregnancies. RESULTS: The annual number of myomectomies increased 26 times over the 15 year period, the average age at myomectomy was 33 years, 1.8% of post-fertile patients desired surgery which allowed for conservation of the uterus. The three most frequent indications for myomectomy were abdominal pain, infertility and menorrhagia. Regarding location, size and number; 82.7% of fibroids were submucosal/intramural and/or larger than 7 cm and/or greater than three in number. The uterine cavity was opened in 112 cases (22.2%). Post-operative complications occurred in 67 cases (13.3%): 7.7% required transfusions, 2.2% needed repeat laparotomy, two of which resulted in hysterectomy, and fever occurred in 13 cases (3.0%). There were 122 (24.2%) pregnancies in 105 patients following myomectomy. Eighty-nine patients conceived once, 15 patients conceived twice and 1 patient conceived three times post-myomectomy. There were 26 spontaneous abortions representing 5.2% of the post-myomectomy patients and 21.3% of the conceived pregnancies. There were 96 deliveries in 19.0% of the patients who had myomectomy and 78.7% of the total conceived pregnancies. CONCLUSION: Authors suggest that abdominal myomectomy for the therapy of symptomatic uterine fibroids is an effective surgical alternative to hysterectomy one, which preserves fertility and femininity. In cases where the fibroids have well-defined borders, the success of surgery does not depend on the location, size or number of fibroids. In cases with adenomyosis, myomectomy alone is not sufficient to alleviate the symptoms. When the uterine cavity is opened during surgery, post-operative transcervical drainage is suggested to prevent hematometra, post-operative adhesions inside the uterus, infection, fever and wound dehiscence.

Abdominal Pain↗
PubMed1990

[GnRH-analogs in the therapy of uterine myomatosis].

Uterine fibroids are the commonest tumors of the female genital tract. Hysterectomy is the typical therapy in patients whose families are complete. In women desirous of children GnRH-analogues can effect a shrinkage of leiomyomata before a myomectomy. Furthermore, GnRH-A treatment can be an alternative to hysterectomy in inoperable patients or in premenopausal women with symptoms of uterine fibroids. In this study eleven patients were treated with 3.2 mg triptorelin monthly and ten patients with 900 micrograms buserelin daily for 6 months. With triptorelin, a 50% reduction of the uterus volume can be observed after 3 months. A further treatment has no benefit. With buserelin, a regression in the same range as with triptorelin can be reached only after 6 months. In contrast, fibroid volumes revealed a regression of 28% with triptorelin and 21% with buserelin in the same time. In this period all fibroid-associated symptoms disappeared. Less bleeding resulted in an increase of hemoglobin. Therefore, treatment with GnRH analogues can be an important factor in the management of uterine fibroids patients in at-risk.

Adult↗
PubMed1994

Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Gruppo italiano per lo studio dell'endometriosi.

We have evaluated the prevalence of endometriosis in selected gynaecological conditions requiring surgery. Eligible for the study were women with primary or secondary sterility, chronic pelvic pain, fibroids or benign ovarian cysts requiring laparoscopy or laparotomy consecutively observed during the study period in 23 obstetrics and gynaecology departments in Italy between May 1991 and July 1992. Women with a previous diagnosis of endometriosis were specifically excluded. A total of 3684 subjects entered the study. Of these, 660 (mean age 31 years) were included for sterility, 409 (mean age 32) for chronic pelvic pain, 1880 (mean age 42) for fibroids and 735 (mean age 33) for benign ovarian cysts. During the surgical procedure surgeons were asked to examine the pelvis carefully to identify endometriosis. Out of the 660 women included for sterility, 195 [30%, 95% confidence interval (CI) 26-35] had endometriosis; the corresponding figures were 185 out of 409 (45%, 95% CI 39-52) for pelvic pain, 219 out of 1880 (12%, 95% CI 10-14) for fibroids and 257 out of 735 (35%, 95% CI 31-40) for ovarian cysts; these differences were significant (chi2(3) heterogeneity, absence versus presence = 323.9, P < 0.001). Among women with endometriosis who entered the study for sterility, 51% were at stage 1, 22% at stage 2, 20% at stage 3 and 7% at stage 4. The corresponding figures for pelvic pain and fibroids were largely similar: 37%, 24%, 30%, 10% for women with pelvic pain, 36%, 11%, 45% and 8% for those with fibroids, but among cases with ovarian cysts stage 3 was over-represented (62% of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗