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Objective Fibroids are hormonally dependent uterine tumors. The literature on adiposity and fibroid prevalence is inconsistent. Previous work usually combined all those with a body mass index (BMI) ≥30 kg/m2 into a single category and relied on clinically diagnosed fibroids, which misclassifies the many women with undiagnosed fibroids. We used a prospective cohort design with periodic ultrasound screening to investigate associations between repeated measures of BMI and fibroid incidence and growth assessed at each follow-up ultrasound. Methods The Study of Environment, Lifestyle & Fibroids followed 1693 Black/African American women, ages 23 to 35 years from Detroit, Michigan, with ultrasound every 20 months for 5 years. Measured height and repeated weight measures were used to calculate BMI. Fibroid incidence was modeled using Cox models among those who were fibroid free at the enrollment ultrasound. Fibroid growth was estimated for individual fibroids matched across visits as the difference in log-volume between visits and was modeled using linear mixed models. All models used time-varying BMI and adjusted for time-varying covariates. Results Compared with BMI <25 kg/m2, those with BMI 30 to <35 kg/m2 had increased fibroid incidence (adjusted hazard ratio, 1.37; 95% CI, 0.96-1.94), those with BMI ≥40 kg/m2 had reduced incidence (adjusted hazard ratio, 0.61; 95% CI, 0.41-0.90). Fibroid growth had mostly small magnitude associations with BMI. Conclusion BMI has a nonlinear association with fibroid incidence, which could be driven by effects of BMI on inflammation and reproductive hormones. More detailed measures of visceral and subcutaneous adiposity and their effects on hormones, DNA damage, and cell death are needed. [ABSTRACT FROM AUTHOR]

Background: Endometriosis and uterine fibroids are benign conditions frequently linked to subfertility/infertility. Recent research has highlighted the importance of epithelial–mesenchymal transition between embryonic and endometrial cells in the context of embryo implantation. Additionally, the adverse endometrial environment during implantation has been proposed as a mechanism contributing to infertility in endometriosis. Nevertheless, the role of cadherin molecule alterations in relation to endometrial receptivity and embryo invasion remains a subject of controversy. Methods: We investigated the expression patterns of E-cadherin and N-cadherin in the endometria of women with ovarian endometrioma or uterine fibroids and assessed whether they differed from those of healthy women. We enrolled 17 women with ovarian endometrioma, 16 with uterine fibroids, and 6 healthy women. Endometrial tissues were obtained at the mid-secretory phase on days 19–24 of the menstrual cycle. The E-cadherin and N-cadherin mRNA and protein expression levels were measured using quantitative reverse transcriptase polymerase chain reaction and Western blot analysis, respectively. Results: The E-cadherin and N-cadherin mRNA expression levels were higher and lower, respectively, in the endometrium of women with ovarian endometrioma than in those of the controls. In the endometrium of women with uterine fibroids, similar patterns with higher E-cadherin and lower N-cadherin levels were observed compared with that of the controls. Protein expression showed similar patterns. Conclusions: Our findings revealed higher E-cadherin expression and lower N-cadherin expression in the endometria of women with infertility-related diseases than in those of healthy women in the mid-secretory phase. This suggests a resistance to endometrial receptivity, potentially reflecting mesenchymal–epithelial transition properties. [ABSTRACT FROM AUTHOR]

INTRODUCTION : Mifepristone (RU 486) is a progesterone receptor modulator with antagonistic properties. It binds strongly to endometrial progesterone receptors, minimally to estrogen receptors, and upregulates androgen receptors. In a placebo-controlled trial low dose mifepristone (RU 486) has been shown to decrease myoma size as well as symptoms. An increase in androgen receptors also contributes to antiproliferative effects. Mifepristone also delays or inhibits ovulation, which may produce amenorrhoea. Direct suppressive effects on endometrial vasculature as well as on reducing stromal vascular endothelial growth factor (VEGF) have also been suggested for reducing menstrual blood loss. OBJECTIVES : To determine the efficacy and safety of mifepristone for the management of uterine fibroids in premenopausal women. MATERIAL AND METHODS : The study was conducted in the tertiary care center. This hospital-based study was conducted between September 2023 and February 2024 for 6 months. 30 consecutive cases were studied based on inclusion criteria. All patients were treated with mifepristone 25mg once daily for 3 months. A pictorial blood loss assessment chart (PBAC) score was used to assess menstrual blood loss. A haemogram, liver function test, and ultrasound were performed. RESULTS: In this study, we observed there was a significant improvement in the hemoglobin (Hb)level, a significant reduction in uterine volume, fibroid size, and heavy menstrual bleeding. CONCLUSION : Mifepristone was able to significantly improve the patient outcome by reducing the amount of blood flow during menstruation increasing the Hb levels and significantly reducing the size of myoma. [ABSTRACT FROM AUTHOR]

Background: Many risk factors in uterine fibroid development have been identified, but women and their physicians are less aware of the influence of lifestyle on uterine fibroid development. The objective of this systematic review is to investigate and summarize modifiable prognostic factors associated with uterine fibroid development. Methods: Pubmed and Embase were searched for relevant articles according to PRISMA guidelines. References from included articles were screened and when relevant also included. Human in vivo studies on modifiable factors in fibroid development were included. Studies on non-modifiable factors and treatment, in vitro studies and animal studies were excluded. 607 articles were screened and 33 articles were included. Two independent investigators collected data from the report. Results: The strongest risk factor for fibroid development was a high BMI, while the strongest protective factors were a high fruit and vegetable intake and high vitamin D intake. Conclusion: More high-quality studies are necessary to better understand the impact of the above-mentioned factors as well as the role they play in the growth of already existing fibroids. [ABSTRACT FROM AUTHOR]

Abstract Background We aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids. Methods In this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed. Results Data from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75–87.50), 57 (44.75–80.00), and 52 (40.75–69.00) points, respectively (p 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16–3.28) ng/ml, 1.12 (0.18–2.52) ng/ml, 1.15 (0.19–2.08) ng/ml and 1.18 (0.36–2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels. Conclusions USgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.

Background. Uterine fibroid (UF) is a benign tumor of the myometrium and is considered as one of the criteria for the state of women’s reproductive health. Objective information about the incidence of UF in a modern megalopolis allows us to assess the level of health of the female population, characterize the availability and quality of medical care, and plan its development.Aim. To analyze the incidence and prevalence of UF according to the data of medical organizations in Yekaterinburg in 2016–2022.Materials and methods. An epidemiological study of the incidence and prevalence of the adult female population of the city of Yekaterinburg in 2016–2022 was conducted. For the analysis, we used Form No. 12 of the Federal Statistical Observation of Medical Organizations located in the city. The incidence rates were calculated for the average annual female population aged 18 years and over, expressed in 0/0000. Absolute growth (decrease), growth rate (decrease), growth rate (decrease), average growth rate (decrease) were studied. The long-term dynamics of the indicators was determined using the average growth rate.Results. The incidence of UF was 130.890/0000, and the prevalence was 735.800/0000 in 2016. During the pre-pandemic period, the indicators increased significantly in 2019 compared to the baseline year 2016 (р < 0.001). The incidence increased by 1.96 times, the prevalence – by 1.39 times. The indicators decreased to the level of 2016 during the pandemic of new coronavirus infection (2020–2022) (р >0.05).Conclusion. The obtained dynamics of incidence and prevalence of UF in the population of women in a modern megalopolis is considered as a criterion for the state of women’s health, accessibility and quality of preventive and planned medical care for gynecological patients. The results of the study are recommended for planning medical care for women and can form the basis for continuing epidemiological studies.

Background: We aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids. Methods: In this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed. Results: Data from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75–87.50), 57 (44.75–80.00), and 52 (40.75–69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16–3.28) ng/ml, 1.12 (0.18–2.52) ng/ml, 1.15 (0.19–2.08) ng/ml and 1.18 (0.36–2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels. Conclusions: USgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The diagnosis of chronic uterine inversion occurs after birth or secondary to pathologies of the pelvic region organs. Especially, the diagnosis and treatment of isolated chronic inversion rapidly under appropriate conditions seem to reduce maternal morbidity and mortality. Chronic uterine inversion is a rare clinical diagnosis and difficult to diagnose and treat. This is a 22‐year‐old patient with no particular history known for a month for uterine fibroid with a polyp, who gave birth through the cervix in the context of subfertility for a year. Non puerperal uterine inversion is a rare clinical condition, and it should be kept in mind that this may be uterine inversion when mass lesions causing clinical complaints are detected, especially in the vulva, vagina, and cervix uteri region. The quality of life of the patients is increased by reducing the morbidity and mortality rates by making a diagnosis with a good clinical and ultrasonographic evaluation. [ABSTRACT FROM AUTHOR]

• Fibroid necrosis appears to be linked to (extreme) preterm birth. • Fibroid necrosis presents with heavy pain and necrosis on ultrasound in 2nd trimester. • Myometrial assessment in pregnant women with abdominal pain is highly recommended. • Structural myometrial analysis is key to assess fibroid necrosis impact on pregnancy. Uterine fibroids increase the risk of preterm birth. The current study highlights uterine fibroid necrosis as a possible cause of (extreme) preterm birth. Retrospective cohort study in one Dutch academic hospital. Cases were selected from the 526 participants of the MyoFert study (Netherlands Trial Register, NL7990), which included patients who presented between 2004 and 2018 and were between the age of 18 and 45 years at the time of diagnosis of uterine fibroids. Of these participants, 414 women became pregnant. A retrospective chart review of the first pregnancies was performed. The main outcomes were (imminent) preterm birth and signs of fibroid necrosis on ultrasound. In women with signs of fibroid necrosis, the following data were collected systematically: fibroid characteristics, clinical presentation, pregnancy outcome, and postpartum period. In total, 66 women had a preterm birth (16 %, 66/414), of which 25 pregnancies ended between 16 and <24 weeks (38 %, 25/66) and 41 pregnancies ended between 24 and <37 weeks of gestation (62 %, 41/66). Of all women with preterm birth and available ultrasound images, 15 % (7/48) had fibroid necrosis at the time of labour. These seven patients, supplemented with three patients with fibroid necrosis during their first pregnancy and at least one episode of imminent preterm birth, are described in more detail. In these ten patients, the fibroids increased substantially in size during the first and second trimester, leading to severe abdominal pain in all patients and hospital admission in seven patients. Ultrasound examination of the fibroids showed heterogenic changes and focal transonic areas in the fibroid, which are characteristics that indicate fibroid necrosis. In four patients, myomectomy was performed and necrosis was confirmed histologically. Fibroid necrosis during pregnancy is likely associated with (imminent) preterm birth. Clinicians are advised to structurally evaluate the myometrium in pregnancy, specifically in women presenting with abdominal pain in the second trimester. [ABSTRACT FROM AUTHOR]

Purpose: Uterine fibroids (UF) are the most frequent tumors in ladies and can pose an enormous threat to complications, such as miscarriage. The accuracy of prognosis may also be affected by way of doctor inexperience and fatigue, underscoring the want for automatic classification fashions that can analyze UF from a giant wide variety of images. Methods: A hybrid model has been proposed that combines the MobileNetV2 community and deep convolutional generative adversarial networks (DCGAN) into useful resources for medical practitioners in figuring out UF and evaluating its characteristics. Real‐time automated classification of UF can aid in diagnosing the circumstance and minimizing subjective errors. The DCGAN science is utilized for superior statistics augmentation to create first‐rate UF images, which are labeled into UF and non‐uterine‐fibroid (NUF) classes. The MobileNetV2 model then precisely classifies the photos based totally on this data. Results: The overall performance of the hybrid model contrasts with different models. The hybrid model achieves a real‐time classification velocity of 40 frames per second (FPS), an accuracy of 97.45%, and an F1 rating of 0.9741. Conclusion: By using this deep learning hybrid approach, we address the shortcomings of the current classification methods of uterine fibroid. [ABSTRACT FROM AUTHOR]

Background: Uterine fibroids, which are non-cancerous tumors found in the pelvic region, are prevalent among women of reproductive age. The incidence of uterine fibroids varies between 5.4% and 77%. These tumors develop within the muscular walls of the uterus in women who have not yet reached menopause. Symptomless or causing abnormal bleeding, pelvic pressure symptoms, infertility, and growth or regress throughout life, leiomyomas are more common in people of African descent, those who have never given birth, those who are overweight, and those with a positive family history of fibroids. Millions of women suffer with leiomyoma, and it is one of the most common reasons for hysterectomy. Aim of the Work: to determine whether or not vitamin D supplementation reduces the size of uterine fibroids in patients who are deficient in the nutrient. Patients and Methods: This RCT was a single-blind randomized study at tertiary care hospital at Beni-Suef university hospital from January 2022 till June 2022 and performed on a total of 100 women in childbearing period diagnosed with uterine fibroid who had vitamin-D deficiency. Results: As regards the fibroid size after Vitamin D supplementation for 6 months, according to the findings of this study, there is no statistically significant distinction in fibroid size amongst Vitamin D group and control group over the first three months whereas, fibroid size was substantially less in the Vitamin D group. At the fourth, fifth month and sixth months. Consequently, the size of the tumor decreased significantly over the six months in the group of Vitamin D supplementation with no significant improvement in the size of the fibroid over the 6 months in the control group. Conclusion: According to the results of the current research, vitamin D supplementation is an effective, low-risk method of preventing leiomyoma growth and stabilizing fibroids, therefore avoiding the onset of more serious and symptomatic disorders. Vitamin D supplementation seems to prevent fibroid growth. [ABSTRACT FROM AUTHOR]

Uterine leiomyomas (ULs) are non‐cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a "paradoxical disease" where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification "subserosal, intramural and submucosal", facilitating a detailed examination of individual ULs impact on the female reproductive system. The "type 3 UL" is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique "hybrid" between a submucous and an intramural UL, that may exert a detrimental "double hit" mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid. Synopsis: A comprehensive review of the physiopathological mechanisms by which type 3 uterine leiomyomas may affect fertility and new perspectives on their management. [ABSTRACT FROM AUTHOR]

Introduction: Uterine fibroids (UFs) are benign tumors of the female reproductive system originating from the smooth muscle of the uterus. Currently, progesterone is known to play a key role in the differentiation of the myometrial tissue to form UFs and their abnormal growth. The mechanism of action of progesterone in UF tumorigenesis involves its effect on increasing the concentrations and dysregulation of selected growth factors. Material and methods: A retrospective cohort study was performed to evaluate and compare tumor necrosis factor a (TNF-α), insulin-like growth factor 1 (IGF-1), plasminogen activator inhibitor-1 (PAI-1) serum concentrations in patients with UFs without prior hormonal treatment, patients with UFs treated with a 3-month standard ulipristal acetate (UPA - a type of selective progesterone receptor modulator) scheme (5 mg/day) and in control patients without UFs. A total of 120 patients were divided into 3 groups (controls, UFs with UPA treatment, UFs without UPA treatment). Results: There were no significant differences in TNF-α serum concentrations between patients with UFs who underwent UPA treatment and patients who did not. Serum concentrations of IGF-1 and PAI-1 did not show significant intergroup differences. Conclusions: No significant differences were found between TNF-α concentrations in the serum of patients with UFs treated with UPA, and patients without UPA treatment. In addition, our data analysis did not show significant differences in the concentrations of IGF-1 and PAI-1 between patients with UFs and the control group. Further studies on the dependence of specific symptoms on selected growth factors are mandatory. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency is a widespread global health issue, notably prevalent in the Middle East and more severe in women. Vitamin D deficiency increases the incidence of uterine fibroids in black and white women, the most frequent benign gynecologic malignancies. This study examined health-care providers' understanding of the relationship between vitamin D insufficiency and uterine fibroid at Sulaimani Hospitals in Kurdistan, Iraq. A quantitative design, cross-sectional-descriptive study (non-probability purposive sample) of 113 female nurses and gynecologists. Data were collected using a checklist through Google Forms. The results showed that the majority of the participants were nurses (88.5%), and the remaining (11.5%) were gynecologist. Two-thirds of them work in maternity teaching hospital while others work in smart hospitals and Faroq medical cities. The results revealed that the level of knowledge was significantly associated with the position of participants and level of education (P < 0.05). As well, the study demonstrated that the majority of the participants were not trained regarding uterine fibroid and vitamin D deficiency. The study concluded that nearly a quarter of the health-care professionals had a medium level of knowledge, while nearly a quarter (24.8%) of them had a high level of knowledge. The study recommended to the Ministry of Health giving opportunities to health-care professionals, especially nurses, to participate in training courses, workshops, and conferences regarding the relationship between vitamin D deficiency and uterine fibroid. [ABSTRACT FROM AUTHOR]

AbstractObjectives To quantify the reintervention rate and analyze the risk factors for reintervention after high-intensity focused ultrasound (HIFU) ablation of uterine fibroids.Methods Eighteen studies were selected from the seven databases. A meta-analysis was applied to synthesize the reintervention rates for fibroids across various follow-up durations. Subgroup-analysis was conducted based on the year of surgery, sample size, guide methods, and non-perfusion volume ratio (NPVR). Signal intensity of T2-weighted imaging (T2WI) was independently evaluated for reintervention risk.Results The study enrolled 5216 patients with fibroids treated with HIFU. There were 3247, 1239, 1762, and 2535 women reaching reintervention rates of 1% (95% confidence interval (CI): 1-1), 7% (95% CI: 4-11), 19% (95% CI: 11-27), and 29% (95% CI: 14-44) at 12, 24, 36, and 60-month after HIFU. The reintervention rates of patients treated with US-guided HIFU (USgHIFU) were significantly lower than those of patients treated with MR-guided focused ultrasound surgery (MRgFUS). When the NPVR of fibroids was over 50%, the reintervention rates at 12, 36 and 60-month after HIFU were 1% (95% CI: 0.3–2), 5% (95% CI: 3–8), and 15% (95% CI: 9–20). The reintervention risk for hyper-intensity fibroids on T2WI was 3.45 times higher (95% CI: 2.7–4.39) for hypo-/iso-intensity fibroids.Conclusion This meta-analysis showed that the overall reintervention rates after HIFU were acceptable and provided consultative suggestions regarding treatment alternatives for patients with fibroids. Subgroup-analysis revealed that USgHIFU, NPVR ≥ 50%, and hypo-/iso-intensity of fibroids on T2WI were significant factors in reducing reintervention.Systematic Review Registration PROSPERO, CRD42023456094

AbstractObjective To investigate the factors which may cause thermal injury of abdominal skin in patients with uterine fibroids (UFs) who underwent ultrasound-guided focused ultrasound ablation surgery (FUAS).Method A total of 123 patients were enrolled in the injury group. In contrast, 246 patients without thermal injury were assigned to the non-injury group. The relationship between patient and treatment parameters and injury were explored using univariate analysis and multiple logistic regression analyses. In addition, the factors influencing the degree of thermal injury were analyzed using Kruskal–Wallis H.Results (1) Abdominal scars (p = .007, OR = 2.187, 95% CI: 1.242–3.849), abdominal wall thickness (p

Background Many risk factors in uterine fibroid development have been identified, but women and their physicians are less aware of the influence of lifestyle on uterine fibroid development. The objective of this systematic review is to investigate and summarize modifiable prognostic factors associated with uterine fibroid development.Methods Pubmed and Embase were searched for relevant articles according to PRISMA guidelines. References from included articles were screened and when relevant also included. Human in vivo studies on modifiable factors in fibroid development were included. Studies on non-modifiable factors and treatment, in vitro studies and animal studies were excluded. 607 articles were screened and 33 articles were included. Two independent investigators collected data from the report.Results The strongest risk factor for fibroid development was a high BMI, while the strongest protective factors were a high fruit and vegetable intake and high vitamin D intake.Conclusion More high-quality studies are necessary to better understand the impact of the abovementioned factors as well as the role they play in the growth of already existing fibroids.

Background/Objectives: Transcervical fibroid ablation (TFA) is an incisionless method to treat symptomatic uterine fibroids. While safety regarding future pregnancy remains to be established, TFA does not preclude the possibility of pregnancy, and a previous 36-patient case series of post-TFA pregnancies reported normal outcomes. That prior series did not include postmarket cases in the United States, as the Sonata® System was initially cleared and used in Europe. This is a substantive update of known pregnancies with the Sonata System since June 2011, and includes pregnancies in Europe, Mexico, and the US. Methods: TFA was carried out under both clinical trial and postmarket use to treat symptomatic uterine fibroids. All post-TFA pregnancies reported by physicians with their patient's consent were included. Results: 89 pregnancies and 55 deliveries have occurred among 72 women treated with the Sonata System. This includes 8 women who conceived more than once after TFA. Completed pregnancies (n = 62 women) include 19 vaginal deliveries, 35 Cesarean sections, 5 therapeutic abortions, 1 ectopic pregnancy, and 1 delivery by an unknown route. Ten pregnancies are ongoing. Mean birthweight was 3276.7 ± 587.3 g. Ten women experienced 18 first-trimester spontaneous abortions (SAbs), with 10 of the 18 SAbs (55.6%) occurring between two patients with a history of recurrent abortion. The SAb rate was 22.8%, inclusive of these two patients, and 10.1% if they were excluded as outliers. There were no instances of uterine rupture, placenta accreta spectrum, or stillbirth. Conclusions: This case series, the largest to date for any hyperthermic ablation modality, suggests that TFA with the Sonata System could be a feasible, safe treatment option regarding eventual pregnancy in women with symptomatic uterine fibroids. [ABSTRACT FROM AUTHOR]

Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UFs) and experience more severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than the common alternative, open hysterectomy. To determine whether demographic disparities persist in UF treatment utilization, we reviewed patient characteristics associated with UAE versus hysterectomy for UF among studies of US clinical practices. A systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051), yielding 1,350 articles (January 1, 1995, to July 15, 2023) that outlined demographic characteristics of UAE compared with hysterectomy. Two readers screened for inclusion criteria, yielding 13 full-text US-based comparative studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed on the data (STATA v18.0). Egger's regression test was used to quantify publication bias. Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio = 3.35, P <.01) and young age (P <.05) were associated with UAE, whereas private insurance (relative to Medicare and/or Medicaid) was not (odds ratio = 1.06, P =.52). Between-study heterogeneity (I 2 > 50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. Knowledge of demographic characteristics of patients with UFs receiving UAE versus hysterectomy is sparse (n = 13 studies). Among these studies, which seem to be racially well distributed, Black and younger women are more likely to receive UAE than their counterparts. [Display omitted] [ABSTRACT FROM AUTHOR]

Aim: This study examined the levels of VitD, VitD binding protein (DBP), and free VitD in leiomyomas patients and their association with the quantity, dimensions, and site of fibroid growths. Additionally, we evaluated the potentiality of employing these factors as a biomarker tool for the diagnosis and assessment of uterine fibroid progression. Methods: This study involved the participation of 55 women with leiomyomas and 50 healthy women. We utilized commercial ELISA kits to measure the levels of total VitD and DBP in their serum. Additionally, we calculated the levels of free VitD and the ratio of VitD to DBP. Moreover, we determined the number, size, and location of the leiomyomas in the patients. Results: There were no significant differences in the levels of total VitD between the groups. However, patients had significantly lower levels of free VitD and higher levels of DBP compared to the control group. The size of the largest leiomyomas showed a negative relationship with free VitD and a positive relationship with DBP. Receiver operating characteristic analyses, showed that the cut‐off value for free VitD was 4.47 pg/mL, with a sensitivity of 75.6% and a specificity of 74.4%. The cut‐off value for DBP was 256.2 μg/mL, with a sensitivity of 86% and a specificity of 70.3%. Conclusions: Free VitD and DBP potentially contribute to the development of leiomyomas and are linked to the size of these tumors. The measurement of serum levels of these factors could serve as additional biomarkers for the diagnosis of leiomyomas. [ABSTRACT FROM AUTHOR]

Purpose: A prospective investigation to assess the impact of 3 months of treatment with epigallocatechin gallate (EGCG), vitamin D and D-chiro-inositol (DCI) in the treatment of uterine fibroids (UF) with laparoscopic myomectomy as evidenced by surgical outcomes and effect on liver function. Methods: Non-pregnant or lactating women aged between 30 and 40 years were scheduled for laparoscopic myomectomy to treat symptoms or looking to conceive. After enrollment, patients were assigned to either (1) intervention group, assuming a total of 300 mg EGCG, 50 μg vitamin D, and 50 mg DCI divided in 2 pills per day for 3 months, or (2) control group, including untreated women scheduled to undergo laparoscopic myomectomy after 3 months. Results: 91 patients completed the study. The comparison of the surgical outcomes between the intervention (n = 44) and the control (n = 47) groups revealed that the treatment significantly reduces the duration of surgery (41.93 ± 7.56 min vs 56.32 ± 10.63 min, p < 0.001). Moreover, the treatment also reduced blood loss during surgery (149.09 ± 25.40 mL vs 168.41 ± 21.34 mL, p < 0.001), resulting in treated patients having higher Hb levels at discharge 11.27 ± 0.82 mL vs 10.56 ± 0.82 mL, p < 0.01). The surgery induced an increase in AST and in total bilirubin regardless of the assigned group, and the treatment induced no change in liver function. Conclusions: Our data suggest that EGCG plus vitamin D, and DCI could represent a safe option for women with UF scheduled for laparoscopic myomectomy, improving surgical outcomes without affecting liver functionality. [ABSTRACT FROM AUTHOR]

Most women experience uterine fibroids (UFs), a common benign gynecological tumor, at some point in their reproductive age. There are several pharmacological treatments available to shrink fibroids and lessen the UF symptoms. These medications cost a lot of money, though, and frequently have serious side effects. Therefore, due to their low cost, comparable and powerful therapeutic efficiency and lower side effects, phytochemical-based medications are gaining popularity in these days. This review's goal is to provide a summary of the knowledge that is currently unavailable regarding the mechanisms of the action of various phytochemical-based medications with anti-uterine fibroid efficacy. The present results showed that dietary phytocompounds (dehydroxyelephantopin, butein, capsaicin, fisetin, kaempferol, resveratrol, silibinin and curcumin) could probably be effective as therapeutic compounds for uterine leiomyoma. These phytochemicals indicated their capability to regulate main fibroid promoting and initiating events for instance, proliferation, inflammation, angiogenesis and fibrosis in various experimental setups through modulating various signaling pathways, such as Smad 2/3, PI3K/AKT/mTOR, ERK 1/2 and β-catenin indicating that they could serve as targets for prevention and/or treatment of UFs. This review provides key molecular insights for the development of phytochemical-based novel personalized therapy for non-surgical management of UFs which may help to avoid hysterectomy. [ABSTRACT FROM AUTHOR]

Key Clinical Message The diagnosis of chronic uterine inversion occurs after birth or secondary to pathologies of the pelvic region organs. Especially, the diagnosis and treatment of isolated chronic inversion rapidly under appropriate conditions seem to reduce maternal morbidity and mortality. Abstract Chronic uterine inversion is a rare clinical diagnosis and difficult to diagnose and treat. This is a 22‐year‐old patient with no particular history known for a month for uterine fibroid with a polyp, who gave birth through the cervix in the context of subfertility for a year. Non puerperal uterine inversion is a rare clinical condition, and it should be kept in mind that this may be uterine inversion when mass lesions causing clinical complaints are detected, especially in the vulva, vagina, and cervix uteri region. The quality of life of the patients is increased by reducing the morbidity and mortality rates by making a diagnosis with a good clinical and ultrasonographic evaluation.

Background The incidence of uterine leiomyomas, or fibroids, affecting pregnant individuals is estimated to be 10%, but there are no guidelines or recommendations for fetal or maternal surveillance in pregnancies affected by them. Risks associated with fibroids during pregnancy include potential for pain, preterm birth, fetal growth restriction, higher cesarean delivery rate, fetal malpresentation, placenta abruption, and postpartum hemorrhage.

Abstract Background Uterine fibroids are common gynecological conditions that affect a significant number of women of reproductive age and may necessitate surgical intervention for their removal. However, there is a rising trend toward minimally invasive procedures, such as magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) ablation. This report provides the first experience in Egypt and North Africa on the use of MRgHIFU ablation as a therapeutic option for uterine fibroids. Results This study demonstrates a correlation between post-operative NPV% and symptom improvement. Following a three-month follow-up period, a significant reduction in pain scores and excessive bleeding was observed. Importantly, there was no significant elevation in hemoglobin levels (11.23 ± 2.23 to 11.25 ± 1.71 g/dL) after treatment. Furthermore, the mean non-perfused volume ratio in the treated fibroids was 46 ± 27.3% (SD) among the 20 participants. These findings suggest a favorable therapeutic outcome of MRgHIFU, with no serious adverse effects reported. Conclusion MRgHIFU is a noninvasive therapeutic approach for the treatment of uterine myomas, offering significant benefits in terms of pain reduction and improved quality of life. This particular study represents the pioneering clinical experience of this innovative therapy in Egypt.

The aim of this study was to investigate whether initial fibroid volume, FIGO classifi cation, signal intensity ratio (SIR) on T2-weighted magnetic resonance images (MRI) and the number of fi broids aff ect the outcome of Uterine Artery Embolization (UAE) as well as report of 6-year single-center experience with UAE procedures. Medical history, UAE and MRI examinations from 75 patients from the Sestre milosrdnice University Hospital Centre who underwent UAE between 2017 and 2023 were reviewed retrospectively. Results showed a negative correlation between baseline fi broid volume and volume reduction of the fi broid, with larger fi broids showing smaller volume reduction (p < 0.001). There was a statistically significant diff erence between FIGO classification groups and volume reduction of the fibroids. Submucosal fi broids showed the best volume reduction compared to hybrid fi broids and subserosal fibroids. There was no signifi cant diff erence between hybrid and subserosal fi broids in volume reduction. We found no correlation between MRI SIR and the number of fibroids on UAE procedure outcomes. The present study suggests that submucosal fibroids and smaller baseline fibroid volume could be related to greater volume reduction and may be a useful prognostic factor for UAE procedure success. In conclusion, this study confi rms that UAE is a safe and effective procedure for the treatment of uterine fibroids

Abnormal uterine bleeding (AUB) is the most common gynecological problem and is often accompanied with uterine fibroid. Very limited options are available in biomedicine for the AUB. In this reported case, AUB associated with stasis dermatitis was managed on the line of treatment of Vataja Yonivyapada with satisfactory results. This is a case of AUB in uterine fibroid associated with stasis dermatitis in the left lower limb of a 39-year-old female. Gokshuradi Guggulu 750 mg, Shatavari Churna - 2 g, Gairika - 500 mg, and Mukta Shukti Pishti - 500 mg were given twice a day for 18 months, Pushyanuga Churna - 2 g, Chandraprabha Vati - 250 mg, and Arsha Kuthara Rasa 250 mg twice a day for 8 months, and Gokshura churna - 2 g twice a day for 14 months were given to her as oral medication. Jatyadi taila was applied locally twice a day on affected area for 17 months. Four sets of Anuvasana Basti (medicated oil enema), one set of Raktamokshana (therapeutic bloodletting) with Alabu, and three sets of Raktamokshana with Shringa were also adopted in 14 months of treatment duration. After 14 months of treatment, the size of the bulky uterus was reduced from 108 mm × 76 mm × 70 mm in May 2018 to 102 mm × 64 mm × 55 mm in May 2019 and from 7.0 to 6.6 mm in endometrium thickness. The fibroid was resolved, and abnormal bleeding was arrested. This case demonstrates that Ayurveda oral medication and Panchakarma based on the management of Vataja Yonivyapada may be useful in AUB associated with stasis dermatitis.

Incidental findings in the post-treatment whole body iodine scan (WBIS) sometimes have a broad list of differentials. We present a case of differentiated thyroid carcinoma (DTC), pT3aN1b, with family history of DTC. She was treated with adjuvant 131I therapy (5.55 GBq). The patient's post-treatment WBIS revealed a large, round iodine-avid area above the bladder, which was attributed to a massive uterine fibroid. Physical examination as well as radiologic correlation with SPECT/CT were also concordant. Fibroids can trap the radioiodine by various mechanisms. This case serves as a reminder of an uncommon pitfall in WBIS, particularly in women of reproductive age. [ABSTRACT FROM AUTHOR]

Synopsis: A 73‐year‐old woman with a history of hysterectomy presented with pelvic calcified lesions. Imaging led to laparoscopic surgery, revealing a calcified fibroid after subtotal hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract Background Prediction of non-perfusion volume ratio (NPVR) is critical in selecting patients with uterine fibroids who will potentially benefit from ultrasound-guided high-intensity focused ultrasound (HIFU) treatment, as it reduces the risk of treatment failure. The purpose of this study is to construct an optimal model for predicting NPVR based on T2-weighted magnetic resonance imaging (T2MRI) radiomics features combined with clinical parameters by machine learning. Materials and methods This retrospective study was conducted among 223 patients diagnosed with uterine fibroids from two centers. The patients from one center were allocated to a training cohort (n = 122) and an internal test cohort (n = 46), and the data from the other center (n = 55) was used as an external test cohort. The least absolute shrinkage and selection operator (LASSO) algorithm was employed for feature selection in the training cohort. The support vector machine (SVM) was adopted to construct a radiomics model, a clinical model, and a radiomics–clinical model for NPVR prediction, respectively. The area under the curve (AUC) and the decision curve analysis (DCA) were performed to evaluate the predictive validity and the clinical usefulness of the model, respectively. Results A total of 851 radiomic features were extracted from T2MRI, of which seven radiomics features were screened for NPVR prediction-related radiomics features. The radiomics–clinical model combining radiomics features and clinical parameters showed the best predictive performance in both the internal (AUC = 0.824, 95% CI 0.693–0.954) and external (AUC = 0.773, 95% CI 0.647–0.902) test cohorts, and the DCA also suggested the radiomics–clinical model had the highest net benefit. Conclusions The radiomics–clinical model could be applied to the NPVR prediction of patients with uterine fibroids treated by HIFU to provide an objective and effective method for selecting potential patients who would benefit from the treatment mostly.

Background: Uterine fibroids are common gynecological conditions that affect a significant number of women of reproductive age and may necessitate surgical intervention for their removal. However, there is a rising trend toward minimally invasive procedures, such as magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) ablation. This report provides the first experience in Egypt and North Africa on the use of MRgHIFU ablation as a therapeutic option for uterine fibroids. Results: This study demonstrates a correlation between post-operative NPV% and symptom improvement. Following a three-month follow-up period, a significant reduction in pain scores and excessive bleeding was observed. Importantly, there was no significant elevation in hemoglobin levels (11.23 ± 2.23 to 11.25 ± 1.71 g/dL) after treatment. Furthermore, the mean non-perfused volume ratio in the treated fibroids was 46 ± 27.3% (SD) among the 20 participants. These findings suggest a favorable therapeutic outcome of MRgHIFU, with no serious adverse effects reported. Conclusion: MRgHIFU is a noninvasive therapeutic approach for the treatment of uterine myomas, offering significant benefits in terms of pain reduction and improved quality of life. This particular study represents the pioneering clinical experience of this innovative therapy in Egypt. [ABSTRACT FROM AUTHOR]

Three-dimensional surface rendering of 2-D ultrasound images of the uterus in mapping uterine fibroids is a fast-evolving imaging technique that holds great potential for gynecology. The purpose of this study was to assess the accuracy of 3-D surface rendering of 2-D ultrasound images of the uterus using a new Fibroid Mapping Reviewer Application (FMRA) software for mapping uterine fibroids as compared with the pathological evaluation of uterine fibroids in pre-menopausal women undergoing hysterectomy. We enrolled women aged 35–55 y scheduled for hysterectomy for symptomatic fibroids at a tertiary care hospital from 2019 to 2021. Per pre-set guidelines, we recorded 2-D images and videos of the uterus with fibroids during the transvaginal ultrasound. The recordings were transferred through USB, loaded in the FMRA software and post-processed to generate a 3-D rendered uterus model. An experienced pathologist assessed and documented the gross examination details per a set protocol. We compared the pre-specified dimensions related to the size (L1, L2) and location (X, Y) of fibroids between the 3-D model and the pathologist's assessment of the hysterectomy specimen. A total of 25 fibroids in 25 women, the single largest per woman, were considered for analysis. The two methods had good correlation with respect to size (for L1, R ² = 0.9723, and for L2, R ² = 0.9784) and location (for X, R ² = 0.9618, and for Y, R ² = 0.9753). Inter-observer analysis revealed that measurements from two sonologists were reproducible (Cronbach's α = 0.9 for the L1, L2 and L3 dimensions of fibroids from the 3-D model). The FMRA is a novel tool for mapping fibroids. With its proven accuracy, it will be helpful in planning surgeries and during guided procedures for managing uterine fibroids. [ABSTRACT FROM AUTHOR]

Abnormal uterine bleeding (AUB) is the most common gynecological problem and is often accompanied with uterine fibroid. Very limited options are available in biomedicine for the AUB. In this reported case, AUB associated with stasis dermatitis was managed on the line of treatment of Vataja Yonivyapada with satisfactory results. This is a case of AUB in uterine fibroid associated with stasis dermatitis in the left lower limb of a 39-year-old female. Gokshuradi Guggulu 750 mg, Shatavari Churna - 2 g, Gairika - 500 mg, and Mukta Shukti Pishti - 500 mg were given twice a day for 18 months, Pushyanuga Churna - 2 g, Chandraprabha Vati - 250 mg, and Arsha Kuthara Rasa 250 mg twice a day for 8 months, and Gokshura churna - 2 g twice a day for 14 months were given to her as oral medication. Jatyadi taila was applied locally twice a day on affected area for 17 months. Four sets of Anuvasana Basti (medicated oil enema), one set of Raktamokshana (therapeutic bloodletting) with Alabu, and three sets of Raktamokshana with Shringa were also adopted in 14 months of treatment duration. After 14 months of treatment, the size of the bulky uterus was reduced from 108 mm × 76 mm × 70 mm in May 2018 to 102 mm × 64 mm × 55 mm in May 2019 and from 7.0 to 6.6 mm in endometrium thickness. The fibroid was resolved, and abnormal bleeding was arrested. This case demonstrates that Ayurveda oral medication and Panchakarma based on the management of Vataja Yonivyapada may be useful in AUB associated with stasis dermatitis. [ABSTRACT FROM AUTHOR]

Background: Prediction of non-perfusion volume ratio (NPVR) is critical in selecting patients with uterine fibroids who will potentially benefit from ultrasound-guided high-intensity focused ultrasound (HIFU) treatment, as it reduces the risk of treatment failure. The purpose of this study is to construct an optimal model for predicting NPVR based on T2-weighted magnetic resonance imaging (T2MRI) radiomics features combined with clinical parameters by machine learning. Materials and methods: This retrospective study was conducted among 223 patients diagnosed with uterine fibroids from two centers. The patients from one center were allocated to a training cohort (n = 122) and an internal test cohort (n = 46), and the data from the other center (n = 55) was used as an external test cohort. The least absolute shrinkage and selection operator (LASSO) algorithm was employed for feature selection in the training cohort. The support vector machine (SVM) was adopted to construct a radiomics model, a clinical model, and a radiomics–clinical model for NPVR prediction, respectively. The area under the curve (AUC) and the decision curve analysis (DCA) were performed to evaluate the predictive validity and the clinical usefulness of the model, respectively. Results: A total of 851 radiomic features were extracted from T2MRI, of which seven radiomics features were screened for NPVR prediction-related radiomics features. The radiomics–clinical model combining radiomics features and clinical parameters showed the best predictive performance in both the internal (AUC = 0.824, 95% CI 0.693–0.954) and external (AUC = 0.773, 95% CI 0.647–0.902) test cohorts, and the DCA also suggested the radiomics–clinical model had the highest net benefit. Conclusions: The radiomics–clinical model could be applied to the NPVR prediction of patients with uterine fibroids treated by HIFU to provide an objective and effective method for selecting potential patients who would benefit from the treatment mostly. [ABSTRACT FROM AUTHOR]

Uterine fibroid is a common gynecological disorder that affects women of reproductive age and has emerged as a major public health concern. The symptoms have a negative influence on both their physical health and quality of life. The cost of treatment has a significant impact on the disease's burden. Even though its origin is uncertain, estrogen is thought to be a key player in fibroid pathophysiology. Many theories, including those based on genetic and environmental factors, explain what causes hyper-estrogenic condition in fibroid patients. One such possibility that is currently being explored is the hypothesis that an altered gut microbiome can contribute to the development of diseases characterized by estrogen dominance. Gut dysbiosis is often a "hot area" in the health sciences. According to a recent study, uterine fibroid patients have altered gut microbiome. A variety of risk factors influence both fibroid development and gut homeostasis. Diet, lifestyle, physical activity, and environmental contaminants have an impact on estrogen and the gut flora. A better understanding of uterine fibroids' pathophysiology is required to develop effective preventative and treatment options. A few ways by which the gut microbiota contributes to UF include estrogen, impaired immune function, inflammation, and altered gut metabolites. Therefore, in the future, while treating fibroid patients, various strategies to deal with changes in the gut flora may be advantageous. For developing suggestions for clinical diagnosis and therapy, we reviewed the literature on the relationship between uterine fibroids and the gut microbiota. [ABSTRACT FROM AUTHOR]

A 59-year-old female was referred to our hospital for pancreatic tumor. She had undergone resection of uterine fibroids 27 years ago, and leiomyoma in the left thigh 8 years ago. Tumor markers were normal. A well-defined hypoechoic tumor measuring 26 mm × 22 mm was detected at the pancreatic tail using ultrasound. Inside the tumor, a small cystic structure was observed. High-sensitivity Doppler imaging revealed faint signals indicating blood flow from the periphery to the interior. Contrast-enhanced ultrasonography in the arterial phase revealed slow, heterogenous enhancement from the periphery to the center of the mass that occurred later than that in the pancreatic parenchyma. The tumor then exhibited homogeneous enhancement except for the periphery, with subsequent washout. Endoscopic ultrasound–fine-needle aspiration was performed. Histopathological examination diagnosed a leiomyoma. The left thigh tumor resected 8 years ago had been diagnosed as benign metastatic leiomyoma (BML). We considered that the current pancreatic tumor was also BML clinically. We report this case because pancreatic metastasis from uterine fibroids is extremely rare. Uterine fibroids are benign tumors, but there are rare cases of metastasis to various organs, which should be considered when performing ultrasound. [ABSTRACT FROM AUTHOR]

Abstract Background Accurate preoperative assessment of the efficacy of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids is essential for good treatment results. The aim of this study was to develop robust radiomics models for predicting the prognosis of HIFU-treated uterine fibroids and to explain the internal predictive process of the model using Shapley additive explanations (SHAP). Methods This retrospective study included 300 patients with uterine fibroids who received HIFU and were classified as having a favorable or unfavorable prognosis based on the postoperative nonperfusion volume ratio. Patients were divided into a training set (N = 240) and a test set (N = 60). The 1295 radiomics features were extracted from T2-weighted imaging (T2WI) and contrast-enhanced T1-weighted imaging (CE-T1WI) scans. After data preprocessing and feature filtering, radiomics models were constructed by extreme gradient boosting and light gradient boosting machine (LightGBM), and the optimal performance was obtained by Bayesian optimization. Finally, the SHAP approach was used to explain the internal prediction process. Results The models constructed using LightGBM had the best performance, and the AUCs of the T2WI and CE-T1WI models were 87.2 (95% CI = 87.1–87.5) and 84.8 (95% CI = 84.6–85.7), respectively. The use of SHAP technology can help physicians understand the impact of radiomic features on the predicted outcomes of the model from a global and individual perspective. Conclusion Multiparametric radiomic models have shown their robustness in predicting HIFU prognosis. Radiomic features can be a potential source of biomarkers to support preoperative assessment of HIFU treatment and improve the understanding of uterine fibroid heterogeneity. Clinical relevance statement An interpretable radiomics model can help clinicians to effectively predict the prognosis of HIFU treatment for uterine fibroids. The heterogeneity of fibroids can be characterized by various radiomics features and the application of SHAP can be used to visually explain the prediction process of radiomics models. Graphical Abstract

IntroductionBlack American women's health outcomes have been altered by a number of factors. Those factors include social determinants of health, lack of culturally competent healthcare providers, and generations of medical racism leading to prolonged pain, delayed care, and sometimes, untimely deaths.MethodsThis original research article centers Southern Black women's lived experiences through family storytelling. We explored generations of health narratives in regard to age, region, and at times, their own acts of silence. Building from theorizing on loud healing, two Black daughters turned the mic on for their mothers by engaging in a critical intergenerational double duoethnography to discuss decades of healing over a 3 months long conversation (in person, over the phone, and on video chat).ResultsThe analysis of the interviews/dialogue between Black mothers and daughters identified several themes connected to loud healing: (1) some healths lessons are quietly taught from intergenerational trauma; (2) the silencing of Black matriarchs occurs in generations not just spirals; (3) loud healing is a faith-filled call to action; (4) mothers and daughters help turn the mic on for each other; (5) Loud healing is affirming and produces visibility; (6) the body teaches culturally competent health lessons; (7) Trusting loud healing to leave the mic on and door open.DiscussionOur collective and individual lived experiences reveal the very real impacts of culture, identity, and power on Black women's health and storytelling. By interrogating the past with our stories, this group of Black mothers and daughters represents three generations of medical erasures, amplification of voice, and the need for loud healing for loud, tangible change.

BackgroundUterine fibroids (UFs) are the most common benign tumors in women of reproductive age. The most effective treatment is myomectomy, but there is no long-term or low-invasive treatment option exists. Acupuncture can be used to treat UFs in a variety of ways. However, there is no meta-analytic synthesis including valid data that explored the efficacy of acupuncture for UFs.ObjectiveTo assess the efficacy and safety of acupuncture for treating UFs.MethodsThe PRISMA 2020 checklist was used. We identified and extracted the trials through may 2023 from six databases. The quality of the trials was assessed using the risk of bias (2.0). Meta-analysis was performed using RevMan 5.4 software, and it was synthesized using the random-effects model if the included studies were in high heterogeneity. Subgroup and sensitivity analysis were used if necessary.ResultsA total of 1,035 trials were identified, of which 11 were included in the review and meta-analysis. In terms of acupuncture scheme design and fibroid-related symptoms, the trials are highly heterogeneous. All 11 trials have reported acupuncture types, with traditional acupuncture and electroacupuncture being the more representative subgroups. A qualitative review of existing evidence shows that acupuncture has no serious adverse reaction on UFs. Meta-analysis shows that acupuncture can effectively reduce the volume of UFs (MD – 3.89, 95% CI – 5.23 to – 2.56, P

AbstractPurpose Magnetic resonance – high-intensity focused ultrasound (MR-HIFU) is a noninvasive treatment option for symptomatic uterine leiomyomas. Currently, pretreatment MRI is used to assess tissue characteristics and predict the most likely therapeutic response for individual patients. However, these predictions still entail significant uncertainties. The impact of tissue properties on therapeutic outcomes remains poorly understood and detailed knowledge of the histological effects of ultrasound ablation is lacking. Investigating these aspects could aid in optimizing patient selection, enhancing treatment effects and improving treatment outcomes.Methods and materials We present seven patients who underwent MR-HIFU treatment for leiomyoma followed by second-line surgical treatment. Tissue samples obtained during the surgery were stained with hematoxylin and eosin, Masson’s trichrome and Herovici to evaluate general morphology, fibrosis and collagen deposition of leiomyomas. Immunohistochemical CD31, Ki-67 and MMP-2 stainings were performed to study vascularization, proliferation and matrix metalloproteinase-2 protein expression in leiomyomas, respectively.Results The clinical characteristics and radiological findings of the leiomyomas prior to treatment as well as qualitative histological findings after the treatment are presented and discussed in the context of current literature. A tentative model for volume reduction is presented.Conclusion These findings provide insights into potential factors contributing to suboptimal therapeutic outcomes and the variability in histological changes following treatment.

AbstractObjective To predict the risk of postoperative reintervention for uterine fibroids using clinical-imaging features and T2WI radiomics before high-intensity focused ultrasound (HIFU) ablation.Methods Among patients with uterine fibroids treated with HIFU from 2019 to 2021, 180 were selected per the inclusion and exclusion criteria (42 reintervention and 138 non-reintervention). All patients were randomly assigned to either the training (n = 125) or validation (n = 55) cohorts. Multivariate analysis was used to determine independent clinical-imaging features of reintervention risk. The Relief and LASSO algorithm were used to select optimal radiomics features. Random forest was used to construct the clinical-imaging model based on independent clinical-imaging features, the radiomics model based on optimal radiomics features, and the combined model incorporating the above features. An independent test cohort of 45 patients with uterine fibroids tested these models. The integrated discrimination index (IDI) was used to compare the discrimination performance of these models.Results Age (p

AbstractObjectives Our study aims at the comprehensive analysis of adverse events (AEs) in patients with symptomatic uterine fibroids (UFs) who underwent magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) in the last 6 years in one of the major Polish centers performing this type of therapy.Methods The presented retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów in cooperation with the Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw. The study enrolled 372 women with symptomatic UFs who underwent MR-HIFU and reported AEs during or after the procedure. The occurrence of particular AEs was analyzed. Statistical comparison of two cohorts (patients with and without AEs) was conducted based on epidemiological factors, UF characteristics, fat layer thickness, the presence of abdominal scars and technical parameters of the procedure.Results The overall mean occurrence rate of AEs was 8.9% (n = 33). No major AEs were reported. The only statistically significant risk factor of AEs was the treatment of type II UFs according to Funaki (OR 2.12, CI 95%, p = 0.043). Other investigated factors did not have a statistically significant influence on AE occurrence. Abdominal pain was the most common AE.Conclusion Our data showed that MR-HIFU seemed to be a safe procedure. The AE rate after the treatment is relatively low. According to the obtained data it seems that the occurrence of AEs does not depend on the technical parameters of the procedure and the volume, position and location of UFs. Further prospective, randomized studies and with long follow-up are necessary to confirm the final conclusions.

AbstractObjectives The aim of this review was to analyze and summarize the most common adverse events (AEs) and complications after magnetic resonance-guided focused ultrasound (MRgFUS) therapy in uterine fibroids (UFs) and to establish the risk factors of their occurrence.Methods We searched for original research studies evaluating MRgFUS therapy in UFs with outcomes containing AEs and/or complications in different databases (PubMed/MEDLINE, SCOPUS, COCHRANE) until March 2022. Reviews, editorials, opinions or letters, case studies, conference papers and abstracts were excluded from the analysis. The systematic literature search identified 446 articles, 43 of which were analyzed.Results According to available evidence, the overall incidence of serious complications in MRgFUS therapy is relatively low. No AEs/complications were reported in 11 out of 43 analyzed studies. The mean occurrence of all AEs in the analyzed material was 24.67%. The most commonly described AEs included pain, skin burns, urinary tract infections and sciatic neuropraxia. Major AEs, such as skin ulcerations or deep vein thrombosis, occurred in 0.41% of cases in the analyzed material.Conclusion MRgFUS seems to be safe in UF therapy. The occurrence of AEs, especially major ones, is relatively low in comparison with other methods. The new devices and more experience of their users seem to reduce AE rate. The lack of unification in AE reporting and missing data are the main issues in this area. More prospective, randomized studies with unified reporting and long follow-up are needed to determine the safety in a long-term perspective.

Uterine fibroids (UFs) are benign tumors arising from the uterus, characterized by accumulation of abundant extracellular matrix (ECM) and sex steroid-dependent growth. Women with symptomatic UFs have reduced quality of life and decreased labor productivity. Among the driver gene mutations identified in UFs, mutations in MED12, a component of the cyclin-dependent kinase (CDK) Mediator module, are the most common and observed in 50-80% of UFs. They are gain-of-function mutations and are more frequently observed in Black women and commonly observed even in small UFs. MED12 mutation-positive UFs (MED12-UFs) often develop multiple rather than solitary and have distinct gene expression profiles, DNA methylomes, transcriptomes, and proteomes. Gene expressions related to ECM organization and collagen-rich ECM components are upregulated, and impaired Mediator kinase activity and dysregulation of Wnt/ß-catenin signaling are identified in MED12-UFs. Clinically, the UF shrinking effect of gonadotropinreleasing hormone agonists and ulipristal acetate is dependent on the MED12 mutation status. Understanding of characteristics of MED12-UFs and functions of MED12 mutations for UF tumorigenesis may elucidate the pathophysiology of UFs, leading to the development of new therapeutic options in women with symptomatic UFs. [ABSTRACT FROM AUTHOR]

Uterine fibroids (UFs) are common tumors in women of reproductive age. It is imperative to comprehend UFs' associated risk factors to facilitate early detection and prevention. Simple relying on surgical/pharmacological treatment of advanced disease is not only highly expensive, but it also deprives patients of good quality of life (QOL). Unfortunately, even if the disease is discovered early, no medical intervention is traditionally initiated until the disease burden becomes high, and only then is surgical intervention performed. Furthermore, after myomectomy, the recurrence rate of UFs is extremely high with the need for additional surgeries and other interventions. This confused approach is invasive and extremely costly with an overall negative impact on women's health. Secondary prevention is the management of early disease to slow down its progression or even halt it completely. The current approach of watchful observation for early disease is considered a major missed opportunity in the literature. The aim of this article is to present an approach named the ESCAPE (Evidence-Based Approach for Secondary Prevention) of UF management. It comprises simple, inexpensive, and safe steps that can arrest the development of UFs, promote overall reproductive health, decrease the number of unnecessary surgeries, and save billions of health care systems' dollars worldwide. [ABSTRACT FROM AUTHOR]

Objective: To identify variables predictive of durable clinical success after MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids. Materials and methods: In this prospective, multicenter trial, 99 women with symptomatic uterine fibroids were treated using MRgFUS. Pelvic MRI was obtained at baseline and treatment day. The Uterine Fibroid Symptom-Quality of Life questionnaire was used to calculate a symptom severity score (SSS) at baseline and 6, 12, 24, and 36 months following treatment. Clinical, imaging, and treatment variables were correlated with symptom reduction sustained through the 12- and 24-month time points using univariable and multivariable logistic regression analyses. A novel parameter, the ratio of non-perfused volume to total fibroid load (NPV/TFL), was developed to determine association with durable outcomes. Results: Post-treatment, mean symptom severity decreased at the 6-, 12-, 24-, and 36-month follow-ups (p < 0.001, all time points). In univariable analysis, three variables predicted treatment success (defined by ≥ 30-point improvement in SSS) sustained at both the 12-month and 24-month time points: increasing ratio of NPV/TFL (p = 0.002), decreasing total fibroid load (p = 0.04), and the absence of T2-weighted Funaki type 2 fibroids (p = 0.02). In multivariable analysis, the NPV/TFL was the sole predictor of durable clinical success (p = 0.01). Patients with ratios below 30% had less improvement in SSS and lacked durable clinical response compared with those between 30–79 (p = 0.03) and ≥ 80% (p = 0.01). Conclusion: Increased non-perfused volume relative to total fibroid volume was significantly associated with durable reduction of symptoms of abnormal uterine bleeding and bulk bother. Clinical relevance statement: Patient selection for sustained clinical benefit should emphasize those with likelihood of achieving high ablation ratios, as determined by imaging (e.g., device access, Funaki type) and by considering the total fibroid load, not just the primary symptomatic fibroid. Trial registration: Clinical trial ID: NCT01285960. Key Points: • Patient selection/treatment approach associated with durable symptom relief in MRI-guided focused ultrasound ablation of uterine fibroids remains unclear. • The ablation ratio, non-perfused volume/total fibroid volume, was positively associated with sustained symptom relief in both bleeding and bulk bother at 1- and 2-year follow-ups. • Selecting patients with imaging features that favor a high ratio of ablation to total fibroid load (including non-targeted fibroids) is the main factor in predicting durability of symptom relief after uterine fibroid treatment. [ABSTRACT FROM AUTHOR]

Uterine fibroids are the most common noncancerous tumors in women of childbearing age. This review was developed to evaluate the current role of gonadotropin-releasing hormone (GnRH) agonists and antagonists in the therapy of symptomatic uterine fibroids. There is a great need for alternative methods for surgical treatment of uterine fibroids. Hormonal therapy remains the first-line treatment option for most patients. GnRH analogs (agonists and antagonists) modulate the pulsatile release of GnRH. This review summarizes the available literature concerning pharmacologic principles underlying the mechanism of action of GnRH and its analogs, as well as individual therapeutic applications to which these drugs have been applied. In many cases, it is possible to try to treat uterine fibroids pharmacologically. Both groups of GnRH analogs are used in therapy, agonists instead as a preparation for surgery, and antagonists as a drug for long-term use. It is essential to develop this path further and look for at least long-term-release systems or new methods of administering these drugs. It is also important from the patient's perspective to search for possible drugs that may have an additive effect of decreasing side effects when combined with GnRH analogs. [ABSTRACT FROM AUTHOR]

Background: The main aim of our study involves the analysis of reasons and risk factors for perioperative treatment discontinuation in patients with symptomatic uterine fibroids (UFs) who were qualified for magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) and in whom the procedure was discontinued. Methods: The presented research included 372 women who were primarily eligible for MR-HIFU, but the procedure was interrupted. The reasons and risk factors for treatment discontinuation were analyzed. A statistical comparison of two cohorts (patients in whom the treatment was discontinued and completed) was conducted based on epidemiological factors, UF characteristics and the implementation of uterotonics. Results: The mean discontinuation rate was 18.28% (n = 68). The main reason was the malposition of the intestines (52.94% of all cases). The thermoablation of subserosal UFs was a statistically significant risk factor of perioperative treatment discontinuation (OR 4.62, CI 95% 2.04–10.56), while the therapy of intramural UFs considerably decreased the risk (OR 0.21, CI 95% 0.08–0.51). The volume of the targeted UF was negatively correlated with the risk of discontinuation (OR 0.991, CI 95% 0.986–0.996). Augmentation with oxytocin, but not misoprostol, during the procedure significantly decreased the risk of potential discontinuation (OR 0.15, CI 95% 0.045–0.387, p < 0.001). Conclusion: Although the discontinuation rate seems to be relatively low, further prospective randomized trials are needed to confirm our results. The establishment of particular eligibility criteria for the treatment is a crucial issue in this area. Resigning from the procedure in cases at a high risk of discontinuation might increase patient safety and shorten the time to introduce the most appropriate therapy. [ABSTRACT FROM AUTHOR]