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We performed a systematic review about studies reporting data of myomectomy performed by magnetic resonance-guided focused ultrasound (MRgFUS) technique in order to define its safety, feasibility, indications, complications, and impact on uterine fibroid symptom and health-related quality of life (UFS-QOL) and fertility. Outcomes were considered according to fibroids shrinkage, nonperfused volume (NPV), NPV ratio, and uterine fibroid symptoms assessed with UFS-QOL questionnaire (baseline 3, 4, 6, and 12 months). We analyzed 38 eligible studies reporting outcomes about 2500 patients (mean age 43.67 years). The MRgFUS results a safe, efficient, and cost-effective minimal invasive technique for treatment of uterine fibroids. Increasing experience, device improvements, and availability for a larger number of patients are enhancing the outcomes, while the obstetrical ones should be more extensively explored. The MRgFUS could be considered as a minimal invasive alternative to traditional surgical or radiological procedures for the treatment of symptomatic uterine myomas improving both QOL and subsequent fertility.

The hormone dependency of endometrial cancer and the increase of its incidence seem to be generally accepted. The Authors expose the results of a four year retrospective epidemiological research aiming at verifying the possible role of menopausal estrogen assumption in the etiopathogenesis of the above mentioned disease. Two groups of post-menopausal patients were examined, who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy: 168 were endometrial cancer free, 50 were affected. The percentages of estrogen users, the exposition time and type of therapy were carefully analyzed in them. No correlation could be found between estrogen consumption, which resulted much lower than in the U.S.A., and endometrial cancer incidence. The relatively short assumption times, the different drug associations, and the hypoestrogenic origin of the most disturbing menopausal symptoms can help to explain this finding which is however, in agreement with what emerges from studies carried out in different countries by several Authors.

The authors evaluate the reliability of GnRH-Test in menopause in detecting the substratum at risk for the development of endometrial cancer. The study was carried out on 30 women affected with endometrial cancer and 30 controls; the examination of the individual curves of gonadotropin values in each patient led to observe LH preferential release in 23 out of 30 cancer patients and in 10 out of 30 controls. The difference of response between the two groups in highly statistically significant (0.0005 less than p less than 0.001). However, the predictive-value of the Test in relation to the detection of the substratum at risk, is about 70%; this apparently unsatisfactory result may be corrected by the finding that about 30% of endometrial cancers seem to develop independently from estrogens. GnRH-Test in menopause might then prove to be highly reliable in predicting the occurrence of estrogen-dependent endometrial malignancies, and may be particularly useful in detecting the substratum at risk among those women presenting no risk-factors, who otherwise might escape careful medical controls.

The Authors report the results of study carried out on ten post-menopausal patients affected with endometrial carcinoma (FIGO stage I & II) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH & BSO). Estradiol, Testosterone and Prolactin plasma levels were assayed before surgery and in the 2nd, 10th and 30th post-operative day. The evaluation of the data supports the opinion that in postmenopause Estradiol origin is mainly extraglandular and the ovaries produce Testosterone; the evaluation of Prolactin levels before and after surgery, at last, cannot rule out the hypothesis of an hypothalamo-pituitary disfunction in post-menopausal patients affected with endometrial cancer.

The Authors, after reviewing the results of their previous studies on the endocrine situation in post-menopausal endometrial carcinoma and considering what emerges from the present work, suggest GnRh-Test as a mean to better identify the subjects at risk for this neoplasia; in patients already affected with endometrial cancer, it could be an indirect index in recommending or not endocrine therapy.

After considering the postmenopausal variations in the hypothalamic-hypophyseal-ovarian feed-back system, the Authors review the medical literature about ovarian and adrenal contribution to postmenopausal steroidogenesis. Comparisons are made between postmenopausal sex-hormone levels in controls and in endometrial cancer affected patients; estradiol is given the main attention: its higher level in cancer patients seems closely related to their higher mean weight; indeed, no estradiol level difference is found between patients and controls correctly matched as to the body weight. The possible role of estradiol in the pathogenesis of endometrial cancer is then discussed basing on data obtained from women affected with diseases generally considered to be estrogen dependent.