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PubMed2005

Uterine artery embolization for pedunculated subserosal fibroids.

OBJECTIVE: The objective of our study was to assess the outcomes of uterine artery embolization as a treatment for pedunculated subserosal fibroids, which we defined as those in which the diameter of the stalk was 50% narrower than the diameter of the fibroid. MATERIALS AND METHODS: During a 72-month period, 196 consecutive women underwent embolization for treatment of symptomatic uterine fibroids that were confirmed on baseline sagittal and axial MR images. We identified those women with pedunculated subserosal fibroids treated with embolization and retrospectively assessed complications and out-comes of embolization using a serial questionnaire and MRI. RESULTS: Of the 196 women, 12 (age range, 34-48 years; mean age, 42.3 years) had one or more pedunculated subserosal fibroids. Fifteen pedunculated subserosal fibroids were identified on baseline MR images in the 12 patients. The mean tumor diameter was 8.3 cm (range, 4.0-15.5 cm; 95% confidence interval [CI], 6.7-9.9 cm). The mean stalk diameter was 3.1 cm (range, 2.0-5.5 cm; 95% CI, 2.5-3.7 cm). The follow-up period ranged from 5 to 51 months (mean, 18.1 months). No serious complications such as separation of the tumors from the uterus, torsion of the tumors, or infection occurred after embolization. Enhanced MR images obtained 1 week after embolization showed that complete devascularization of the tumors had been achieved in 73% (11/15) of the tumors. The rates of mean tumor volume reduction were 41% (range, 12-73%) 4 months and 53% (range, 31-85%) 1 year after embolization. The mean stalk diameter was 3.2 cm (range, 1.7-5.4 cm; 95% CI, 2.5-3.9 cm) 4 months and 2.9 cm (range, 1.1-4.2 cm; 95% CI, 1.8-3.9 cm) 1 year after embolization. No significant difference in stalk diameters was noted 4 months (p=0.617) or 1 year (p=0.963) after embolization compared with the diameters before the treatment. The rates of mean uterus volume reduction were 35% (range, 15-47%) 4 months and 47% (range, 35-60%) 1 year after embolization. Marked or moderate improvement in bulk-related symptoms was achieved in 100% (10/10) of the women at 4-month follow-up, 100% (5/5) at 1-year follow-up, and 100% (2/2) at 2-year follow-up. CONCLUSION: We found no serious complications after embolization for pedunculated subserosal fibroids with stalk diameters of 2 cm or larger. Successful outcomes can be obtained in such tumors.

Adult↗
PubMedDate not supplied

Complementary medicine treatment of uterine fibroids: a pilot study.

CONTEXT: Women are seeking alternatives to medications and surgeryfor the treatment of uterine fibroids; therefore, it is important to know whether these therapies work and are cost-effective. OBJECTIVE: To report on the treatment of women with uterine fibroids using a suite of nonpharmacological and nonsurgical therapies and to compare this alternative treatment to a matched sample of similar women using standard medical approaches. DESIGN: Matched comparison to standard-of-care control group. SETTING: Academic family practice department and clinic, including a center for complementary and alternative medicine. PARTICIPANTS: Thirty-seven menstruating women, aged 24 to 45 years, with palpable uterine fibroids, and their matched controls, who were enrolled in conventional treatment. INTERVENTION: The treatment program consisted of weekly traditional Chinese medicine, body therapy (somatic therapy, bodywork), and guided imagery. Treatment lasted as long as 6 months. MAIN OUTCOME MEASURES: Changes in fibroid size, changes in bothersome symptoms, and patient satisfaction. RESULTS: Fibroids shrank or stopped growing in 22 patients among the treatment group and 3 among the comparison group (P <.01). Cost of care averaged $3800 per patient in the treatment group and was significantly greater than costs for the comparison group for the study period. Bothersome symptoms of fibroids responded equally well to pharmacological or nonpharmacological therapies. All measures of patient satisfaction were significantly higher among the treatment group compared to those receiving conventional care. CONCLUSIONS: As reported previously in the Chinese medical literature, alternatives exist to pharmacological and surgical methods for treating uterine fibroids, though they are not inexpensive.

Adult↗
PubMedDate not supplied

MR-guided transvaginal cryotherapy of uterine fibroids with a horizontal open MRI system: initial experience.

PURPOSE: We evaluated the feasibility of MR-guided transvaginal cryotherapy for treating intramural, submucosal, and sub-serosal uterine fibroids with a horizontal open MRI system. MATERIALS AND METHODS: Using an MR-compatible cryotherapy system and a horizontal magnetic open-configuration MR scanner, we performed transvaginal cryotherapies using a Cusco speculum on eight uterine fibroids whose longest diameter ranged from 2.9 to 10.0 cm. We assessed the ratio of pre-treatment to post-treatment volume of the uterine fibroids as well as the patients' symptoms (anemia, abdominal pain, dysfunctional uterine bleeding, etc.). RESULTS: All procedures were carried out safely and accurately without any complications that required surgical treatment. MRI enabled clear visualization of the cryoneedle and freezing area as band-like and ellipsoid-like signal losses, respectively. The mean ratio of reduction in uterine fibroid volume was 31.0% at 9-12 months (0-75.0%). Symptoms caused by uterine fibroids improved in seven cases. CONCLUSION: This is the first report on a transvaginal approach to cryotherapy for uterine fibroids. MR-guided transvaginal cryotherapy appears to be feasible and promising as a minimally invasive therapy for symptomatic uterine fibroids.

Abdominal Pain↗
PubMed1999

Use of oral contraceptives and uterine fibroids: results from a case-control study.

OBJECTIVE: To analyse the association between oral contraceptive use and the risk of uterine fibroids. DESIGN: We considered data collected in a case-control study on risk factors for uterine fibroids. PARTICIPANTS: We studied 843 women with uterine fibroids, whose clinical diagnosis dated back no more than two years. Controls were 1557 non-hysterectomised patients younger than 55 years admitted for acute, non-gynecological, non-hormonal, non-neoplastic conditions. RESULTS: A total of 254 cases (30.1%) and 360 controls (23.1%) reported ever using oral contraceptives: the odds ratio (OR) for ever vs never users was 1.1 (95% CI 0.8-1.3). The risk in current users was below unity when compared with never users (OR 0.3, 95% CI 0.2-0.6), while ex-users had a risk of fibroids comparable with never users (OR 1.1, 95% CI 0.9-1.4). The risk of uterine fibroids decreased with duration of oral contraceptive use: compared with never users, the estimated OR was 0.8 (95% CI 0.5-1.2) in ever users for four to six years and 0.5 (95% CI 0.3-0.9) for seven years or more (chi2 trend = 4.6, P = 0.03). CONCLUSIONS: Although the role of selection bias should be carefully evaluated, the present data suggest that uterine fibroids should not be considered a contra-indication for oral contraceptive use.

Adult↗
PubMed2006

Uterine artery embolization for symptomatic uterine fibroids.

BACKGROUND: Uterine fibroids cause heavy and prolonged bleeding, pain, pressure symptoms and subfertility but are mostly benign. The traditional method of treatment has been surgery as long term medical therapies have not shown to be effective. Uterine artery embolization (UAE - complete occlusion of both the uterine arteries with particulate emboli) has been reported to be an effective and safe alternative in the treatment of menorrhagia and other fibroid-related symptoms in women not desiring future fertility, but thus far this evidence is based on case controlled studies and case reports. OBJECTIVES: To review the benefits and/or harms from randomised controlled trials (RCTs) of uterine artery embolization (UAE) versus other interventions for symptomatic uterine fibroids. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group Trials register (searched 10 August 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, Issue 3, 2004), MEDLINE (January 1966 to November 2005) and EMBASE (January 1980 to November 2005). We also contacted authors of potential ongoing studies. SELECTION CRITERIA: RCTs of UAE versus any medical or surgical therapy for symptomatic uterine fibroids. DATA COLLECTION AND ANALYSIS: Two of the authors (AS and JKG) assessed the trials and extracted the data independently. They also contacted the investigators of eligible RCTs for unpublished data. MAIN RESULTS: Three trials were included in this review. Two RCTs compared UAE with abdominal hysterectomy in 234 women. Although the follow-up period was intended for two years, the available published results was only for six months follow-up. The second trial included 63 women comparing UAE with myomectomy in women who wished to preserve their fertility. The minimum follow-up reported was six months with a mean of 17 (+/- 9.3) months. The clinical success rate measured by improvement in fibroid-related symptoms e.g. menstrual loss was at least 85% in the UAE group from both trials. The mean dominant fibroid volume decreased by 30 to 46% in two trials. UAE significantly reduces length of hospital stay compared to surgery for either hysterectomy or myomectomy. Women undergoing UAE resumed routine activities sooner than those undergoing surgery. UAE was associated with a higher rate of minor post procedural complications such as vaginal discharge, post puncture haematoma and post embolization syndrome (pain, fever, nausea, vomiting), as well as higher unscheduled visits and readmission rates after discharge, compared with hysterectomy. There were no major complication differences between the two groups. Three women in the myomectomy trial had elevated FSH levels post UAE indicating possible ovarian dysfunction. AUTHORS' CONCLUSIONS: UAE offers an advantage over hysterectomy with regards to a shorter hospital stay and a quicker return to routine activities. There is no evidence of benefit of UAE compared to surgery (hysterectomy / myomectomy) for satisfaction. The higher minor complications rate after discharge in the UAE group as well as the unscheduled visits and readmission rates require more longer term follow-up trials to comment on its effectiveness and safety profile. There is currently an ongoing trial (REST, U. K.) and EMMY trial yet to report on the long term follow up, the results of which are awaited with interest.

Arteries↗
PubMed2001

Microscopic and calorimetric assessment of freezing processes in uterine fibroid tumor tissue.

The use of cryosurgery in the treatment of uterine fibroids is emerging as a possible treatment modality. The two known mechanisms of direct cell injury during the tissue freezing process are linked to intracellular ice formation and cellular dehydration. These processes have not been quantified within uterine fibroid tumor tissue. This study reports the use of a combination of freeze-substitution microscopy and differential scanning calorimetry (DSC) to quantify freeze-induced dehydration within uterine fibroid tumor tissue. Stereological analysis of histological tumor sections was used to obtain the initial cellular volume (V(o)) or the Krogh model dimensions (deltaX, the distance between the microvascular channels = 15.5 microm, r(vo), the initial radius of the extracellular space = 4.8 micro m, and L, the axial length of the Krogh cylinder = 19.1 microm), the interstitial volume ( approximately 23%), and the vascular volume ( approximately 7%) of the fibroid tumor tissue. A Boyle-van't Hoff plot was then constructed by examining freeze-substituted micrographs of "equilibrium"-cooled tissue slices to obtain the osmotically inactive cell volume, V(b) = 0.47V(o). The high interstitial volume precludes the use of freeze-substitution microscopy data to quantify freeze-induced dehydration. Therefore, a DSC technique, which does not suffer from this artifact, was used to obtain the water transport data. A model of water transport was fit to the calorimetric data at 5 and 20 degrees C/min to obtain the "combined best fit" membrane permeability parameters of the embedded fibroid tumor cells, assuming either a Krogh cylinder geometry, L(pg) = 0.92 x 10(-13) m(3)/Ns (0.55 microm/min atm) and E(Lp) = 129.3 kJ/mol (30.9 kcal/mol), or a spherical cell geometry (cell diameter = 18.3 microm), L(pg) = 0.45 x 10(-13) m(3)/Ns (0.27 microm/min atm) and E(Lp) = 110.5 kJ/mol (26.4 kcal/mol). In addition, numerical simulations were performed to generate conservative estimates, in the absence of ice nucleation between -5 and -30 degrees C, of intracellular ice volume in the tumor tissue at various cooling rates typical of those experienced during cryosurgery (< or =100 degrees C/min). With this assumption, the Krogh model simulations showed that the fibroid tumor tissue cells cooled at rates < or = 50 degrees C/min are essentially dehydrated; however, at rates >50 degrees C/min the amount of water trapped within the tissue cells increases rapidly with increasing cooling rate, suggesting the formation of intracellular ice.

Body Water↗
PubMed2004

FEMIC (Fibromes Embolisés aux MICrosphères calibrées): uterine fibroid embolization using tris-acryl microspheres. A French multicenter study.

PURPOSE: A French multicenter registry was set up to confirm the safety and efficacy of large calibrated tris-acryl gelatin microspheres for embolization of symptomatic fibroids. METHODS: Technical recommendations included embolization using large microspheres (>500 microm) with no secondary embolization agent. Postprocedural pain, clinical improvement and adverse events were prospectively evaluated during a follow-up period of at least 6 months. RESULTS: Eighty-five women complaining of fibroid-related symptoms entered the study. In seven women, a secondary embolization agent was used in addition to microspheres. Complete resolution of menorrhagia was achieved in 84% of women at 24 months and significant uterine and fibroid volume reductions were noted after 6 months (37% and 73%, respectively). Three women experienced definitive amenorrhea (4%) and two women required hysteroscopic resection of a fibroid. Eight women were treated by hysterectomy because of treatment failure. In seven of these women, treatment failure was explained by an additional cause of symptoms including diffuse adenomyosis, endometrial hyperplasia or ovarian artery supply to the fibroids. CONCLUSION: Limited uterine artery embolization using large microspheres has good clinical success rate with low postprocedural pain and complications. Women can expect excellent midterm results with a high level of symptom control and significant fibroid volume reduction. Confidence in the end-point recommended here may require the experience of several cases.

Acrylic Resins↗
PubMedDate not supplied

Magnetic resonance-guided percutaneous cryoablation of uterine fibroids: early clinical experiences.

PURPOSE: Uterine fibroids (leiomyomas) are the most common tumors of the uterus. The present study evaluated the feasibility and effectiveness of magnetic resonance (MR)-guided percutaneous cryoablation for uterine fibroids as a minimally invasive treatment alternative. METHODS: From August 2001 to June 2002, MR-guided percutaneous cryoablation was performed on seven uterine fibroids in 6 patients who displayed clinical symptoms related to tumors. Using a horizontal-type open MR system, cryoablation probes were percutaneously placed in fibroids. Fibroids were ablated, and the site and size of ice balls were monitored on MR imaging. Postoperatively, patients completed a questionnaire to assess changes in presenting clinical symptoms, and MR images were obtained for all patients at follow-up. Changes in clinical symptoms and tumor volume were evaluated in each patient. RESULTS: All treated patients showed reductions in tumor size. Mean volume reduction rate was 40.3% at 6 weeks postoperatively, and 79.4% at 9-12 months. All patients reported fever after treatment. Surgical drainage was required for abscess in the probe channel in one patient, and transient liver damage occurred in another. Subjective symptoms improved in all patients except one who had multiple tumors, and no patient complained of new symptoms after cryoablation during follow-up. CONCLUSION: MR-guided percutaneous cryoablation represents a feasible and effective treatment for uterine fibroids.

Adult↗
PubMed2005

Uterine restoration after repeated sloughing of fibroids or vaginal expulsion following uterine artery embolization.

The aim of our study is to present our experience with uterine restoration after repeated sloughing of uterine fibroids or transvaginal expulsion following uterine artery embolization (UAE) and to determine its safety and outcome. One hundred and twenty-four women (mean age, 40.3 years; age range, 29-52 years) with symptomatic uterine fibroids were included in this retrospective study. We performed arterial embolization with poly(vinyl alcohol) particles (250-710 microm). Clinical symptoms and follow-up information for each patient were obtained through medical records. At an average of 3.5 months (range, 1-8 months) after embolization, magnetic resonance imaging examinations with T1- and T2-weighted and gadolinium-enhanced T1-weighted images were obtained for all patients. The mean follow-up duration was 120 days (90-240 days). Eight (6.5%) patients experienced uterine restoration after repeated sloughing of uterine fibroids or spontaneous transvaginal expulsion. The locations of the leiomyomas were submucosal (n=5), intramural (n=2) and transmural (n=1). The maximum diameter of the fibroids ranged from 3.5 to 18.0 cm, with a mean of 8.4 cm. The time interval from embolization to the uterine restoration was 7-150 days (mean 70.5 days). The clinical symptoms before and during vaginal sloughing or expulsion were lower abdominal pain (n=4), vaginal discharges (n=3), infection of necrotic myomas (n=2) and cramping abdominal pain (n=1). Gentle abdominal compression (n=1) and hysteroscopic assistance (n=1) were required to remove the whole fibroid. No other clinical sequelae, either early or delayed, were documented. Magnetic resonance images revealed the disappearance of leiomyomas, intracavitary rupture resulting in transformation of intramural or transmural myomas into submucosal myomas and localized uterine wall defects. Although the small size of this study precludes a strict conclusion, there appear to be few serious complications directly related to vaginal expulsion. Vaginal expulsion or fibroid sloughing is a possible course following UAE that is manageable, and the patients should be informed about this possibility.

Abdominal Pain↗
PubMed2006

Health care resource use for uterine fibroid tumors in the United States.

OBJECTIVE: The purpose of this study was to quantify the total direct cost to the US health care system for the management of uterine leiomyomas. STUDY DESIGN: We used Center for Disease Control heath care databases for estimates of inpatient care, ambulatory care, and outpatient care of leiomyomas. With International Classification of Diseases-9 codes for fibroid tumors and fibroid-related conditions, all fibroid-related care was identified in each database. Inpatient and ambulatory surgical cases were stratified by surgical procedure, and outpatient clinical cases were categorized by type of visit and health care provider. With the use of Medicare's RBRVU reimbursement rates for 2000 as a proxy for the cost of physician services and Medicare diagnostic-related group reimbursement as a proxy for facility costs, the total direct cost to the US health care system for the care of fibroid tumors was estimated. RESULTS: Total direct cost to treat uterine fibroid tumors was estimated at 2,151,484,847 dollars. Most of the cost was due to inpatient care, in particular, hysterectomy. CONCLUSION: Uterine fibroid tumors consume a significant amount of health care resources in the United States.

Adolescent↗
PubMed2004

[Urodynamics and uterine fibroid. Is there a specific parameter?].

AIM OF STUDY: To search for a urodymamical parameter and/or a VBN parameter (deduced from a modelized analysis of uroflows) which could characterize the voiding dysfunctions due to a uterine fibroid. POPULATION AND METHODS: Thirty women (31-69 years) with a uterine fibroid (exclusion criteria: neurological disease, diabetes mellitus, previous pelvic surgery, grade > I prolapse) underwent one urodynamic session which included the successive tests: free uroflow, urethral profilometry, cystometry and, if possible, a second free uroflow. Twenty-eight patients complained from stress urinary incontinence. Modelized analysis of the flow curves was performed in order to determine the value of two VBN parameters: urethral parameter g and recruitment ratio rr (which quantify the ratio of firing motor neurons during detrusor contraction). RESULTS: The fibroid (known for 23 subjects) was detected during gynaecological examination in seven cases. No significant change of the value of one urodynamical parameter which could be linked to the uterine fibroid rather than the urinary disorder has been found. Some urethral constrictive obstruction exists for 18 patients (g = 0.40 +/- 0.15) but is not meaningful. In the whole population, an effective abdominal pressure is found in 78% of the analyzed micturitions. CONCLUSION: Some urinary disorders result from the presence of a uterine fibroid; they are significantly improved by simple hysterectomy. If urodynamics does not have any specificity, concomitant physical examination allows to detect fibroids with only urinary symptomatology.

Adult↗
PubMed2005

Differences between the pre-menopausal and post-menopausal uterine fibroid vasculature.

OBJECTIVES: To quantitatively examine differences in microvascular density between fibroid and myometrial tissue from fibroid uteri removed at hysterectomy, both before and after the menopause, and with hormone replacement therapy. METHODS: Factor VIII immunostaining of formalin fixed tissues was used to identify blood vessels, and the vessels counted by an investigator blinded to tissue type or menopausal status. RESULTS: The mean myometrial: fibroid MVD ratio was 2.38 higher in the post-menopausal group (95% CI: 0.12, 4.65, p=0.0474) than in the pre-menopausal group, with the hormone therapy (HT)-using post-menopausal group lying in between. An increase in microvascular density in the myometrium after the menopause was responsible for most of the change in ratios seen between the pre and post-menopausal pairs. There was a trend to increasing myometrial MVD with increasing number of years post-menopause. CONCLUSIONS: Myometrial microvascular density increases markedly after the menopause, while fibroid microvascular density does not alter. Thus, the difference between myometrial and fibroid vasculature becomes greater after the menopause. The implications of this for the treatment of fibroids in post-menopausal women is discussed.

Analysis of Variance↗
PubMed2003

A randomized, placebo-controlled, dose-ranging trial comparing fulvestrant with goserelin in premenopausal patients with uterine fibroids awaiting hysterectomy.

OBJECTIVE: To compare the use of a new antiestrogen fulvestrant with goserelin in reducing uterine fibroid growth before hysterectomy. DESIGN: An international, multicenter, randomized, placebo-controlled study. SETTING: Departments of obstetrics and gynecology. PATIENT(S): Premenopausal women (n = 307) diagnosed with uterine fibroids requiring hysterectomy. INTERVENTION(S): Over a 12-week period, patients received fulvestrant (50 mg, 125 mg, or 250 mg) as an i.m. injection, goserelin (3.6 mg) as a s.c. injection, or an injection-matched placebo once every 4 weeks. Patients underwent a hysterectomy at week 13. MAIN OUTCOME MEASURES: Efficacy endpoints included changes in fibroid growth, endometrial thickness, and uterine volume. The excretion of urinary markers of bone resorption was also examined. RESULT(S): Goserelin significantly reduced fibroid growth and endometrial thickness compared with placebos. Fulvestrant did not significantly alter fibroid volume or endometrial thickness or change endpoints such as endometrial histology or vaginal bleeding. Fulvestrant was associated with fewer postmenopause-related adverse events than goserelin. Goserelin, but not fulvestrant, significantly increased markers of bone resorption. CONCLUSION(S): At doses equivalent to those used for the treatment of breast cancer in postmenopausal women, fulvestrant did not significantly inhibit fibroid growth and, of particular note, did not lead to bone resorption.

Adult↗
PubMed2003

Spontaneous expulsion of three large fibroids after uterine artery embolization.

OBJECTIVE: To report a case of uneventful expulsion of huge fibroids after uterine artery embolization. Case report. SETTING: The Department of Obstetrics and Gynaecology of a university hospital. PATIENT(S): A 45-year-old woman who underwent uterine artery embolization for fibroids. INTERVENTION(S): Transfemoral selective bilateral uterine artery catheterization and injection of 500-700 microm polyvinyl alcohol particles. RESULT(S): Recovery of the patient. The spontaneous expulsion of three fibroids on three different occasions over several months resulted in a significant reduction in menstrual loss and dysmenorrhea. CONCLUSION(S): Delivering fibroids or sections of fibroids may be a natural process after uterine artery embolization, therefore it is essential to warn women about the possible risk. Close follow-up is also essential. The size of the fibroids discharged did not require hysterectomy. Adequate antibiotic cover may be necessary to prevent sepsis.

Arteries↗
PubMed1997

Gastric inflammatory fibroid polyps: endoscopic ultrasonographic analysis in comparison with the histology.

BACKGROUND: Histologic diagnosis of inflammatory fibroid polyp is usually difficult on routine endoscopic examinations. The aim of this study was to describe endoscopic ultrasonographic features of gastric inflammatory fibroid polyps. METHODS: Endoscopic ultrasonography was performed in 10 patients with gastric inflammatory fibroid polyps before resection. All lesions were resected by either endoscopic removal or gastrectomy and then confirmed histologically as inflammatory fibroid polyps. To evaluate the diagnostic value of endosonography, endoscopic ultrasonographic images of the lesions were analyzed and compared with resected specimens retrospectively. RESULTS: All lesions were located in the second and/or third sonographic layer of the gastric wall without involvement of the fourth layer. The most frequent endoscopic ultrasonographic features were an indistinct margin (90%), and a hypoechoic (80%), homogeneous (90%) echo pattern. Histologically, inflammatory fibroid polyps developed in the deep mucosa and/or submucosa by proliferation of fibrous tissue, but did not have a capsule. CONCLUSIONS: The characteristic endoscopic ultrasonographic attributes of gastric inflammatory fibroid polyps are indistinct margin, hypoechogenicity, homogeneous appearance, and location within the second and/or third layer. These findings correlate very closely to the histologic findings.

Adult↗
PubMed2004

Uterine fibroids risk and history of selected medical conditions linked with female hormones.

To understand the role of several medical conditions on the risk of uterine fibroids, we analysed the findings of a large case-control study. Cases were 843 women aged 54 or less (median age 43 years, range 21-54) with histologically confirmed uterine fibroids, whose clinical diagnosis dated back no more than 2 years. Indications for surgery were recurrent menorrhagia or ultrasound evidence of fibroids larger than 10 cm in diameter. Controls were 1557 women aged 54 years or less of comparable quinquennia of age (median age 43 years, range 21-54) who had not undergone hysterectomy and were admitted for acute, non-gynecologic, non-hormonal, non-neoplastic conditions to a network of hospitals with a similar catchment area. Clinical history of severe overweight was inversely associated with the risk of fibroids (multivariate odds ratio (OR), OR: 0.6, 95% confidence intervals (CI): 0.5-0.8). An increase in the frequency of fibroids was seen in women with a history of benign breast disease (OR: 1.2, 95% CI: 0.9-1.6) and particularly of breast biopsies (OR: 2.0, 95% CI: 1.2-3.5). The results of this large dataset indicate that medical conditions known or likely to be related to female hormones are not important determinants of the risk of fibroids.

Adult↗
PubMed2005

7q deletion mapping and expression profiling in uterine fibroids.

Uterine fibroids are some of the most common tumours of females, but relatively little is known about their molecular basis. Several studies have suggested that deletions on chromosome 7q could have a role in fibroid formation. We analysed 165 sporadic uterine fibroids to define a small 3.2 megabase (Mb) commonly deleted region on 7q22.3-q31.1, flanked by clones AC005070 and AC007567. We also used oligonucleotide microarrays to compare the expression profiles of 10 samples of normal myometrium and 15 fibroids, nine of which displayed 7q-deletions. Activating transcription factor 3, patched homolog (Drosophila), homeo box A5, death-associated protein kinase 1, and retinoic acid receptor responder 3 were downregulated, and excision repair crosscomplementing 3, transcription factor AP-2 gamma and protein kinase C beta 1 were upregulated in fibroids. New pathways were discovered related to fibroid formation. The presence or absence of 7q-deletions did not dramatically affect the global expression pattern of the tumours; changes, however, were observed in genes related to vesicular transport and nucleic acid binding.

Chromosome Deletion↗
PubMed2002

Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids.

OBJECTIVES: To evaluate sonographic features following uterine artery embolization and to assess using ultrasound the efficacy of embolization as the primary treatment of fibroids. DESIGN: Fifty-eight women (mean age, 44.5 years; range, 33-65 years) suffering from symptoms due to fibroids (menometrorrhagia, bulk-related symptoms, pelvic pain) were followed-up after uterine artery embolization by ultrasound examination at 3 months, 6 months, 1 year and 2 years with assessment of volume and vascularization of fibroids as well as uterine vascularization. RESULTS: Fifty-eight patients were examined at 3 months, 46 at 6 months, 36 at 1 year and 19 at 2 years. Most patients were improved or free of symptoms at 3 months (90%), 6 months (92%) and 1 year (87%) and all monitored patients were free of symptoms at 2 years. Clinical failure of treatment occurred in only two cases (3%). Progressive significant reduction in fibroid size with reference to the baseline was demonstrated during follow-up from 3 months (-29%) to 24 months (-86%). Absence of intrafibroid vessels was observed in all except three cases as early as 3 months, whereas perifibroid vessels persisted in 21 cases. No changes in uterine vascularization or uterine artery resistance were noted. CONCLUSIONS: Uterine artery embolization is a valuable endovascular method for the treatment of fibroids, resulting in marked reduction in fibroid size and disappearance of intrafibroid vessels without reduction in uterine vascularization which is well depicted by sonography.

Adult↗