Fracture risk and bone density of peri- and early postmenopausal women with uterine leiomyomas

Relationship between myomectomy and risk of osteoporosis or fracture: A population-based cohort study

Myomectomy, a surgery to remove multiple leiomyomas from the uterus, is a treatment option for uterine fibroids (UF) in premenopausal patients. Osteoporosis and bone fractures are known to be strongly associated with menopausal status or hormonal changes. However, no studies have discussed the association between myomectomy and osteoporosis or fractures. This study investigated the risk of osteoporosis or fractures (vertebrae, hip, and others) in Korean patients who had undergone myomectomy without bilateral oophorectomy. We used data from the 10-year claims database of the Korean National Health Insurance from January 2009 to December 2020. Data for patients who had undergone myomectomy without oophorectomy (n = 211,969) and the control group (n = 450,124) who were randomly selected from the database were extracted. The incidence and hazard ratios (HRs) of osteoporosis or fracture between the myomectomy patients and the control group were calculated. A Cox proportional hazards model was used to analyze hazard ratios and 95% confidence intervals (CI). Subgroup analyses were performed based on age. The adjusted hazard ratios for osteoporosis and total fractures were 0.934 (95% CI: 0.916-0.954, P<0.001) and 0.919 (95% CI: 0.896-0.941, P<0.001), respectively, in the myomectomy group. The adjusted hazard ratios according to fracture site were 0.857 (95% CI: 0.799-0.92, P<0.001) for vertebral fractures, 0.706 (95% CI: 0.48-1.037, P = 0.076) for hip fractures, and 0.919 (95% CI: 0.896-0.943, P<0.001) for other fractures. In conclusion, patients who have undergone myomectomy might have a decreased risk of osteoporosis or fractures.

Uterine Leiomyoma Is Associated with Female Sexual Dysfunction in Postmenopausal Women

PURPOSE

To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausal and postmenopausal women.

MATERIALS AND METHODS

The study population consisted of consecutive women who underwent gynecologic screening tests, including transvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January 2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyoma and FSD were compared according to menopausal status.

RESULTS

In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and total FSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD than those without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequency of FSD in postmenopausal women remained significant after adjusting for confounding variables.

CONCLUSION

The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.

Effect of hysterectomy with ovarian preservation on ovarian function

OBJECTIVE

To prospectively estimate the risk for earlier ovarian failure among women undergoing hysterectomy with ovarian preservation, as compared with women of similar age without hysterectomy.

METHODS

A prospective cohort study was conducted among women aged 30 to 47 years undergoing hysterectomy without bilateral oophorectomy (n=406) and women with intact uteri (n=465). Blood samples and questionnaire data were obtained at baseline and annually for up to 5 years. Hazard ratios (HR) for ovarian failure, defined as follicle-stimulating hormone levels 40 international units/L or higher, were calculated using Cox proportional hazards models.

RESULTS

Ovarian failure occurred among 60 of the women with hysterectomy and 46 of the women in the control group. Women undergoing hysterectomy were at nearly a twofold increased risk for ovarian failure as compared with women with intact uteri (HR 1.92, 95% confidence interval [CI] 1.29-2.86). The proportional hazards model further estimated that 14.8% of women with hysterectomies experienced ovarian failure after 4 years of follow-up compared with 8.0% of the women in the control group. Risk for ovarian failure was greater for women who had a unilateral oophorectomy along with their hysterectomy (HR 2.93, 95% CI 1.57-5.49), but also it was significantly increased for women who retained both ovaries (HR 1.74, 95% CI 1.14-2.65).

CONCLUSION

Increased risk of earlier ovarian failure is a possible consequence of premenopausal hysterectomy. Although it is unresolved whether it is the surgery itself or the underlying condition leading to hysterectomy that is the cause of earlier ovarian failure, physicians and patients should take into account this possible sequela when considering options for treatment of benign conditions of the uterus.

LEVEL OF EVIDENCE

II.

Bone mineral density in African&#x2013;American women with symptomatic uterine leiomyoma

OBJECTIVE

Uterine leiomyoma is associated with increased BMD in Caucasian women and is largely attributed to the state of hyperestrogenemia associated with disease. This relationship, however, has not been previously described in African-American women. We aim to assess BMD in African-American women with symptomatic uterine leiomyoma.

DESIGN

Case-control study.

MATERIALS & METHODS

29 African-American women with uterine leiomyoma signed an Institutional Review Board (IRB) approved consent form at a reproductive clinic of an inner city hospital in Brooklyn, NY, USA. BMD and T-score of lumbar spine was compared with a controlled group matched for age, race and BMI. BMD of lumbar spine was measured using Hologic QDR 4200 in both groups. Data are presented as mean ± SEM.

RESULTS

For the entire study population the mean age (years) was 42.07 ± 1.15, and the BMI (kg/m²) was 29.37 ± 0.93 in patients with uterine leiomyoma and 30.07 ± 1.06 for the control group (p = 0.07). There was a significant difference in the mean BMD (cm²) between the uterine leiomyoma group (1.17 ± 0.03) compared with control (1.05 ± 0.02 p < 0.01). The T-score for the uterine leiomyoma group was significantly higher compared with the control group (0.31 ± 0.25 and -0.74 ± 0.21 with p < 0.01). The prevalence of osteopenia (T-score <-1) was lower for the leiomyoma group when compared with controls, (p < 0.02).

CONCLUSION

Consistent with data from the white population with uterine leiomyoma, our data showed a significantly higher BMD in African-American women with uterine leiomyoma, compared with an age- and race-matched cohort. The implications of these findings remain to be investigated and further confirmed in future longitudinal studies.