The modern management of uterine fibroids-related abnormal uterine bleeding

'Ovariostasis' as the main preventive and therapeutic strategy for gynecological pathologies in women of reproductive age

Ovariostasis is a reversible and temporary suspension of the cyclic ovarian activity, characterized by anovulation and hypogonadotropinemia (low serum concentrations of FSH and LH), which can be observed in case of pregnancy or hypothalamic amenorrhea or medically obtained through the administration of combined hormonal contraceptives, progestin-only pills, or GnRH analogues. Ovariostasis effectively prevents undesired pregnancies, ovarian torsion, and hemorrhagic corpus luteum. Moreover, ovariostasis can be useful for the treatment of primary dysmenorrhea, polycystic ovary syndrome, endometriosis, adenomyosis, uterine fibroids, and abnormal uterine bleeding. Ovariostasis also offers long-term benefits; for example, a significant risk reduction for ovarian, colorectal, and endometrial cancer, despite a slightly increased breast cancer risk. According to limited data, ovariostasis may have an influence on the age of onset of natural menopause. Experimental studies on mice hypothesize positive effects of ovariostasis on the ovarian reserve, thereby contributing to preservation of fertility. Ovariostasis can be considered as a practical, effective tool to prevent and treat gynecological pathologies in women of reproductive age and needs further studies on humans to evaluate its influence on the reproductive lifespan and ovarian reserve.

Long-term outcomes and re-intervention rates in women undergoing mri-guided focused ultrasound (mrgfus) for uterine fibroids: a 7-year follow-up study

PURPOSE

To assess the long-term outcomes of MR-guided focused ultrasound (MRgFUS) for treating uterine fibroids, focusing on re-intervention rates, pregnancy outcomes, and the onset of menopause over a 7-year follow-up period.

MATERIALS AND METHODS

We conducted a historical cohort study of 99 women with symptomatic uterine fibroids who underwent MRgFUS between 2013 and 2020 at a single tertiary medical center. Data collection included patient demographics, treatment details, and follow-up interviews. Re-intervention rates were evaluated using Kaplan-Meier curves and Cox regression analysis to identify predictors of further treatments, with a specific focus on age-related differences.

RESULTS

Over a median follow-up of 6.1 years, 33.1% of women required re-intervention for persistent fibroid symptoms. The median patient's age was 43 years old. Women aged ≤ 43 years had significantly higher re-intervention rates than those aged 44 + years (47.5% vs. 16.7%, p = 0.005). Multivariable Cox regression identified age as the sole significant predictor of re-intervention (HR44+vs. <43 0.303 95% CI 0.128-0.714, p = 0.006). Sixteen women conceived after MRgFUS, resulting in 21 pregnancies, with 72.2% live births and a spontaneous miscarriage rate of 22.2%. The mean age of menopause was 51.4 years, similar to global averages.

CONCLUSIONS

MRgFUS is a practical, noninvasive option for treating symptomatic uterine fibroids. Older women show lower re-intervention rates. Pregnancies post-MRgFUS are possible, and the procedure does not appear to affect the onset of menopause. Age remains a crucial predictor for further re-intervention.

A Rare Case of Giant Uterine Leiomyomata: A Difficult Diagnosis Accompanied by Surgical Difficulties

Leiomyomas, also known as fibroids, are a group of benign smooth muscle tumors commonly present in premenopausal women. Giant uterine leiomyomas are rare. It is described as giant when it weighs 11.4 kg. This report concerns a 45-year-old, asymptomatic woman of reproductive age who presented for her first gynecological consultation at the clinic of Trikala General Hospital, Greece, for a routine smear and gynecological examination. A large, painless abdominal mass was palpated during the clinical exam, reaching the level of the xiphoid process. Imaging confirmed the clinical diagnosis of a myomatous uterus, and surgical intervention via laparotomy was decided. Intraoperatively, a giant uterine leiomyoma was identified, leading to an abdominal total hysterectomy with bilateral salpingectomy and oophorectomy. A histological examination confirmed the diagnosis. After a five-day hospitalization with an uneventful postoperative recovery, the patient was discharged. This rare case emphasizes the uncommon presentation of a giant uterine leiomyoma in an asymptomatic reproductive-age patient, highlighting the diagnostic and surgical challenges associated with managing such cases.

Evaluating pregnancy outcomes in women with uterine fibroids treated with high-intensity focused ultrasound: insights from a single-institution study

OBJECTIVE

This study aims to assess the safety and effectiveness of High-Intensity Focused Ultrasound (HIFU) ablation on pregnancy outcomes among women with uterine fibroids wishing to conceive, focusing specifically on short-term pregnancy outcomes immediately following HIFU treatment.

METHODS

A retrospective analysis was conducted on 210 women who underwent HIFU treatment (Group I) at our institution between January 2018 and December 2022 and subsequently conceived. Pregnancy outcomes were compared with two control groups: 510 patients who delivered vaginally (Group II) and 278 who underwent cesarean sections (Group III) during the same period. Statistical analyses included multivariable logistic regression to adjust for confounding factors. The study only considered outcomes related to the immediate pregnancy following HIFU treatment and did not include data on subsequent pregnancies or long-term effects.

RESULTS

The natural conception rate post-HIFU was 93.81% (197/210), with a miscarriage rate of 19.05% (40/210). Group I had significantly lower rates of gestational diabetes mellitus (8.24%) and precipitate labor (0%) compared to Group II but higher rates of mild anemia (31.18%) and adherent placenta (10.59%). Compared to Group III, Group I had lower rates of gestational diabetes mellitus (8.24% vs. 20.86%) and moderate anemia (4.71% vs. 16.55%) but a higher incidence of premature rupture of membranes (18.82%). Neonates in Group I had lower birth weights compared to Groups II and III (p < 0.05), with no cases of low birth weight in Group I. Multivariable analysis identified fibroid location as a predictor of preterm birth, while maternal age and mode of delivery influenced the risk of incomplete uterine rupture.

CONCLUSION

HIFU ablation is a safe and effective fertility-preserving treatment for women with uterine fibroids, demonstrating favorable short-term pregnancy outcomes. It does not increase perinatal risks, but its impact on pregnancy duration and certain complications suggests that careful patient selection and management are crucial. Future studies should investigate the long-term effects of HIFU on subsequent pregnancies.

An Updated Review of Thermal Ablation Technology for Uterine Fibroids and Adenomyosis: Focusing on Protecting Fertility

There is a growing trend towards minimally invasive or noninvasive alternatives for gynecological disorders due to their rapid alleviation of symptom, expedited recovery, and minimal risks of postoperative complications. Thermal ablation technology has been commonly advocated as a minimally invasive therapeutic methods in recent years, including microwave ablation, radiofrequency ablation, and high-intensity focused ultrasound. The increasing application scenarios require updated and systematic research, and more evidence to promote their appropriate use. The objective of this review is to summarize the latest views of ablation from a prospective of fertility protection, endeavor to clarify the clinical value of thermal ablation technology in protecting fertility by assessing parameters such as ablation rates, alleviation of disease symptoms, re-intervention rates and post-treatment pregnancy rates. We review the clinical studies of ablation for uterine fibroids and adenomyosis treatment in the past 10 years, summarize the limitation and the prospects of its development in the treatment process, so as to provide clinicians with advice on the best practice. In the management of uterine fibroids and adenomyosis, thermal ablation technology offers improved fertility preservation and minimizes normal tissue injury compared to traditional surgical approaches for patients pursuing reproductive goals. In the future, thermal ablation technology will play a significantly enhanced role in preserving fertility for individuals requiring treatment for uterine fibroids and adenomyosis, guided by indications. But further research is still needed in the form of more extensive randomized prospective trials to provide stronger evidence supporting this perspective.

Tailoring the Diagnostic Pathway for Medical and Surgical Treatment of Uterine Fibroids: A Narrative Review

Uterine leiomyomas are the most common benign uterine tumors in women and are often asymptomatic, with clinical manifestation occurring in 20-25% of cases. The diagnostic pathway begins with clinical suspicion and includes an ultrasound examination, diagnostic hysteroscopy, and, when deemed necessary, magnetic resonance imaging. The decision-making process should consider the impairment of quality of life due to symptoms, reproductive desire, suspicion of malignancy, and, of course, the woman's preferences. Despite the absence of a definitive cure, the management of fibroid-related symptoms can benefit from various medical therapies, ranging from symptomatic treatments to the latest hormonal drugs aimed at reducing the clinical impact of fibroids on women's well-being. When medical therapy is not a definitive solution for a patient, it can be used as a bridge to prepare the patient for surgery. Surgical approaches continue to play a crucial role in the treatment of fibroids, as the gynecologist has the opportunity to choose from various surgical options and tailor the intervention to the patient's needs. This review aims to summarize the clinical pathway necessary for the diagnostic assessment of a patient with uterine fibromatosis, presenting all available treatment options to address the needs of different types of women.

Abnormal Uterine Bleeding With Leiomyomas: A Case Report of Its Natural Course and Therapeutic Management

Uterine fibroids (UFs), or leiomyomas, are common benign tumors affecting a significant proportion of women by the age of 50 years. While typically non-cancerous, UFs can severely impact the quality of life (QoL) through symptoms such as heavy menstrual bleeding (HMB) and pelvic pain. We report a case of a 45-year-old Hispanic female with a history of hypertension, diabetes, nephrolithiasis, and a solitary kidney, who presented with symptomatic UFs and an ovarian cyst. Despite initial pharmacological treatment with Ortho Micronor and Myfembree, the patient experienced persistent symptoms, prompting surgical intervention. A supracervical hysterectomy, bilateral salpingectomy, lysis of adhesions, and left ovarian cystectomy were performed, resulting in symptom relief and benign postoperative findings. This case report highlights the need for personalized treatment plans and comprehensive patient counseling to manage complex gynecological conditions effectively.

Solving the mysteries surrounding uterine fibroids: are we almost there?

A better understanding of uterine fibroid-related pathogenesis and symptoms like uterine bleeding and infertility is mandatory.