scholarly journals Innovative Oral Treatments of Uterine Leiomyoma

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Mohamed Sabry ◽  
Ayman Al-Hendy
Keyword(s):  
Uterine Fibroids ◽  
The United States ◽  
Uterine Wall ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Medical Treatments ◽  
Major Health ◽  
Future Fertility ◽  
Medicinal Treatment

Uterine fibroids (leiomyoma), the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail.

Current and Emerging Medical Treatments for Uterine Fibroids

2017 ◽  
Vol 35 (06) ◽  
pp. 510-522 ◽  
Author(s):  
Kristof Chwalisz ◽  
Hugh Taylor
Keyword(s):  
United States ◽  
Randomized Clinical Trials ◽  
Uterine Fibroids ◽  
The United States ◽  
Uterine Neoplasms ◽  
Medical Treatments ◽  
Gonadotropin Releasing Hormone Antagonists ◽  
Medical Therapies ◽  
Hormone Antagonists

AbstractUterine fibroids (leiomyomata) are common uterine neoplasms that are often associated with detrimental symptoms, such as heavy menstrual bleeding, dysmenorrhea, and pressure-related symptoms, which often lead to surgical intervention, including hysterectomy. Although our understanding of the pathophysiology of uterine fibroids, particularly their dependency on progesterone and the role of growth factors, has increased during the past two decades, the medical options currently approved by the United States Food and Drug Administration are limited and are only used for short-term symptom management. A long-term, safe, and effective treatment is not yet available in the United States. However, emerging medical treatments that are currently under clinical development, including progesterone receptor modulators and oral gonadotropin-releasing hormone antagonists, offer hope of new long-term medical therapies for symptomatic uterine fibroids as an alternative to surgery. Herein, we discuss the current and emerging medical therapies for fibroids based on evidence from randomized clinical trials.

scholarly journals Spontaneous Pregnancy following Treatment of Symptomatic Uterine Myomatosis with Ulipristal Acetate without Surgery

2021 ◽  
Vol 5 (3) ◽  
pp. 01-05
Author(s):  
Vicente Spinoso Cruz ◽  
Marta Colechá Morales ◽  
Ligia Gil Melgosa ◽  
Aida Revuelta Lopez
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Benign Tumors ◽  
Women Of Reproductive Age ◽  
Ulipristal Acetate ◽  
Uterine Myomas ◽  
Spontaneous Pregnancy ◽  
Future Fertility ◽  
Effective Option

Uterine fibroids are the most frequent gynaecological benign tumors in women of reproductive age and can cause infertility. Their treatment may be medical, surgical or a combination of both, but they may compromise future fertility in patients in which their wish to conceive has not yet been fulfilled. In this report we present two patients with symptomatic uterine myomas and who wanted to preserve their fertility. Treatment with one or two 12-week courses of 5 mg of ulipristal acetate was prescribed. A decrease in the size of the fibroids was observed, along with adequate control of the symptoms. Spontaneous pregnancies led to two live births without significant complications. Treatment with Ulipristal Acetate may be an effective option to take into account in the management of patients with symptomatic uterine fibroids who refuse surgery or in those in which it is contraindicated and who wish to preserve their fertility.

Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences

2021 ◽  
Author(s):  
Carrie Riestenberg ◽  
Anika Jagasia ◽  
Daniela Markovic ◽  
Richard P Buyalos ◽  
Ricardo Azziz
Keyword(s):  
United States ◽  
Polycystic Ovary Syndrome ◽  
Economic Burden ◽  
Polycystic Ovary ◽  
The United States ◽  
Reproductive Age ◽  
Cochrane Library ◽  
Control Group ◽  
Ovary Syndrome

Abstract Context Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting approximately 5-20% of women of reproductive age. A previous estimate noted that the economic burden of PCOS approximates $3.7 billion annually in 2020 USD when considering only the costs of the initial diagnosis and of reproductive endocrine morbidities, not considering the costs of pregnancy-related and long-term morbidities. Objective To estimate the excess prevalence and economic burden of pregnancy-related and long-term health morbidities attributable to PCOS. Data Sources PubMed, EmBase and Cochrane Library. Study Selection Studies in which the diagnosis of PCOS was consistent with the Rotterdam, National Institutes of Health (NIH), or Androgen Excess & PCOS (AE-PCOS) Society criteria, or that used electronic medical record diagnosis codes, or diagnosis based on histopathologic sampling were eligible for inclusion. Studies that included an outcome of interest and a control group of non-PCOS patients who were matched or controlled for body mass index (BMI) were included. Data Extraction Two investigators working independently extracted data on study characteristics and outcomes. Data Synthesis Data was pooled using random-effects meta-analysis. The I 2statistic was used to assess inter-study heterogeneity. The quality of selected studies was assessed using the Newcastle-Ottawa Scale. Results The additional total healthcare-related economic burden due to pregnancy-related and long-term morbidities associated with PCOS in the United States is estimated to be $4.3 billion annually in 2020 USD. Conclusions Together with our prior analysis, the economic burden of PCOS is estimated at $8 billion annually in 2020 USD.

Increased expression of neurogenic factors in uterine fibroids

2019 ◽  
Author(s):  
Alice Luddi ◽  
Camilla Marrocco ◽  
Laura Governini ◽  
Bianca Semplici ◽  
Valentina Pavone ◽  
...  
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Age ◽  
In Vivo Studies ◽  
Pcr Analysis ◽  
Benign Tumors ◽  
Endometrial Stromal Cells ◽  
Eutopic Endometrium ◽  
Qrt Pcr ◽  
Fertility Sparing

Abstract STUDY QUESTION Are selective markers for the neuronal differentiation such as microtubule-associated protein 2 (MAP-2) and synaptophysin (SYP) as well as the nerve growth factor (NGF) expressed by fibroids, myometrium and eutopic endometrium? SUMMARY ANSWER Neuronal markers NGF, MAP-2 and SYP are highly expressed in fibroids compared with matched myometrium, and this neurogenic pathway is upregulated by tumor necrosis factor (TNF) alpha in cultured smooth muscle cells (SMCs). WHAT IS KNOWN ALREADY Uterine fibroids or leiomyomas are the most common benign tumors, accounting for approximately one-third of hysterectomies. The present trend is to improve the medical treatment avoiding surgery, also for fertility sparing; hence, the pathogenic mechanisms are investigated, aiming to develop new therapeutic strategy. STUDY DESIGN, SIZE, DURATION This laboratory-based case–control study is focused on fibroids and myometrial specimens obtained between 2015 and 2017 from 15 women of reproductive age at the proliferative phase of the menstrual cycle. Leiomyomas, matched myometrium and endometrium from each woman were analyzed. Control endometrium was obtained from women undergoing surgery for ovarian cyst (n = 15). PARTICIPANTS/MATERIALS, SETTING, METHODS qRT-PCR, western blotting and immunostaining were applied to evaluate the expression of neurogenic markers; the effects of TNF on NGF, MAP-2 and SYP expression in cultured SMCs from leiomyomas and matched myometrium were analyzed. MAIN RESULTS AND THE ROLE OF CHANCE qRT-PCR analyses using tissues from clinical patients showed that the levels of NGF, MAP-2 and SYP mRNA were significantly higher in uterine leiomyomas compared with their matched myometrium (P < 0.05), whereas only NGF was significantly increased in eutopic endometrium compared with healthy endometrium. In primary SMCs, isolated from fibroids or from the adjacent myometrium, NGF, MAP-2 and SYP mRNA expression were significantly increased by TNF treatment (P < 0.05). Finally, human endometrial stromal cells prepared from the endometrium of patients affected by uterine fibroids display higher TNF expression (P < 0.001). LIMITATIONS, REASONS FOR CAUTION qRT-PCR analysis and immunofluorescence validation are robust methods demonstrating a clear upregulation of neurogenic factors in leiomyomas, even though additional studies are needed to establish a correlation between increased neuronal gene expression and degree of pain, as well as the involvement of inflammation mediators in the development of the neurogenic unhinge. Therefore, more in vivo studies are needed to confirm the results achieved from primary cultured SMCs. WIDER IMPLICATIONS OF THE FINDINGS The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli. Accordingly, these neurogenic pathways may represent potential therapeutic avenues to treat the fibroid-related disorders. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by research grants from the University of Siena. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

scholarly journals GP.05 The risk of malignancy after stereotactic radiosurgery

2018 ◽  
Vol 45 (s2) ◽  
pp. S9-S9
Author(s):  
AM Wolf ◽  
K Naylor ◽  
D Kondziolka
Keyword(s):  
Stereotactic Radiosurgery ◽  
Incidence Rate ◽  
Malignant Transformation ◽  
The United States ◽  
Benign Tumors ◽  
Long Term Follow Up ◽  
Risk Of Malignancy ◽  
Associated Malignancy

Background: A major concern of patients undergoing Gamma Knife radiosurgery (GKS) for benign tumors and other conditions is the risk of a separate secondary malignancy or malignant -transformation. The incidence of radiosurgery-associated malignancy based on long-term follow-up remains unknown. Methods: We conducted a population-based cohort study to estimate the incidence rate of both malignant transformation and a separate radiation-associated malignancy in patients undergoing GKS from 1987 to 2016 at 5 centers. Results: 11 527 patients underwent radiosurgery for meningioma (n=3261), arteriovenous malformation (n=2868), trigeminal neuralgia (n=1982), vestibular schwannoma (n=1957), pituitary adenoma (n=1193), other (n=266). The follow-up time ranged from 0.3 to 23.8 years. Four cases of malignant transformation and 3 new malignant brain tumors were reported, two of which were not within the irradiated field. The incidence of malignant transformation was 6.6 per 100 000 patient-years and of new malignancy, either locally or distant, was 5 in 100 000 patient-years. These risks are not higher than the Central Brain Tumor Registry of the United States derived annual incidence rate of all primary malignant CNS tumors of 7.15 per 100 000. Conclusions: Physicians can safely counsel patients that the risk of malignancy after stereotactic radiosurgery remains extremely low, even at long-term follow-up of greater than 10 years.

scholarly journals Understanding the Impact of Uterine Fibroids on Human Endometrium Function

2021 ◽  
Vol 9 ◽  
Author(s):  
Antonia Navarro ◽  
Maria Victoria Bariani ◽  
Qiwei Yang ◽  
Ayman Al-Hendy
Keyword(s):  
Transforming Growth Factor ◽  
Vascular System ◽  
Uterine Fibroids ◽  
Transforming Growth Factor Β ◽  
Uterine Wall ◽  
Reproductive Age ◽  
Menstrual Bleeding ◽  
Women Of Reproductive Age ◽  
Myometrial Cells ◽  
The Impact

Uterine fibroids (leiomyomas) are the most common benign gynecological tumors in women of reproductive age worldwide. They cause heavy menstrual bleeding, usually leading to severe anemia, pelvic pain/pressure, infertility, and other debilitating morbidities. Fibroids are believed to be monoclonal tumors arising from the myometrium, and recent studies have demonstrated that fibroids actively influence the endometrium globally. Studies suggest a direct relationship between the number of fibroids removed and fertility problems. In this review, our objective was to provide a complete overview of the origin of uterine fibroids and the molecular pathways and processes implicated in their development and growth, which can directly affect the function of a healthy endometrium. One of the most common characteristics of fibroids is the excessive production of extracellular matrix (ECM) components, which contributes to the stiffness and expansion of fibroids. ECM may serve as a reservoir of profibrotic growth factors such as the transforming growth factor β (TGF-β) and a modulator of their availability and actions. Fibroids also elicit mechanotransduction changes that result in decreased uterine wall contractility and increased myometrium rigidity, which affect normal biological uterine functions such as menstrual bleeding, receptivity, and implantation. Changes in the microRNA (miRNA) expression in fibroids and myometrial cells appear to modulate the TGF-β pathways and the expression of regulators of ECM production. Taken together, these findings demonstrate an interaction among the ECM components, TGF-β family signaling, miRNAs, and the endometrial vascular system. Targeting these components will be fundamental to developing novel pharmacotherapies that not only treat uterine fibroids but also restore normal endometrial function.

scholarly journals Myomectomy during cesarean section

2021 ◽  
Vol 43 (3-4) ◽  
pp. 73-80
Author(s):  
Radmila Sparić ◽  
Đina Tomašević ◽  
Mladen Anđić ◽  
Miljan Pupovac ◽  
Aleksandra Pavić ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Perioperative Complications ◽  
Uterine Fibroids ◽  
Surgical Site Infections ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Uterine Torsion ◽  
Perioperative Bleeding ◽  
Increased Risk

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

Highlights on Medical Treatment of Uterine Fibroids

2021 ◽  
Vol 26 ◽  
Author(s):  
Stefano Angioni ◽  
Maurizio N. D’Alterio ◽  
Angelos Daniilidis
Keyword(s):  
Medical Treatment ◽  
Treatment Effectiveness ◽  
Treatment Options ◽  
Uterine Fibroids ◽  
European Medicines Agency ◽  
Benign Tumors ◽  
Medical Treatments ◽  
Advantages And Disadvantages ◽  
Receptor Modulators ◽  
Progesterone Receptor Modulators

: Uterine fibroids (leiomyomas or myomas) are the most frequent benign tumors in women. Heavy menstrual bleeding with resultant anemia, dysmenorrhea, chronic pelvic pain, infertility urinary symptoms and constipation are generally associated with uterine fibroids (UFs). Although strategies mainly resort to surgical intervention, medical treatments are considered the first-line treatment to preserve fertility and avoid surgery. The aim of this review is to offer available and newest medical treatment options for symptomatic UFs. Various medical therapies are now available for women with uterine fibroids, although each therapy has its own advantages and disadvantages. Our topic specifically explores gonadotropin-releasing hormone (GnRH) analogs and selective progesterone receptor modulators (SPRMs), but also provides the reader with useful advice on the therapies for fibroids available after the recent European Medicines Agency (EMA) warning (EMA/160220/2020). The treatment options depend on the personal treatment objectives of the patients, in addition to treatment effectiveness and necessity for recurrent interventions.

scholarly journals The Rising Phoenix-Progesterone as the Main Target of the Medical Therapy for Leiomyoma

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
H. H. Chill ◽  
M. Safrai ◽  
A. Reuveni Salzman ◽  
A. Shushan
Keyword(s):  
Therapeutic Option ◽  
Treatment Options ◽  
Uterine Fibroids ◽  
Term Treatment ◽  
Reproductive Age ◽  
Surgical Approaches ◽  
Common Benign Tumor ◽  
Long Term Treatment ◽  
Suitable Treatment

Leiomyomas, also known as uterine fibroids, are a common benign tumor in women of reproductive age. These lesions disrupt the function of the uterus causing menorrhagia and pelvic pressure as well as reproductive disorders. These women pose a true challenge for clinicians in the attempt of choosing the suitable treatment for each patient. Patient’s age, interest in fertility preservation, and leiomyoma location and size are all factors to be taken into account when deciding upon the preferable therapeutic option. For the past few decades, surgical treatment was the only reliable long-term treatment available. A variety of surgical approaches have been developed over the years but these developments have come at the expense of other treatment options. The classical medical treatment includes gonadotropin-releasing hormone (GnRH) agonists and antagonists. These agents are well known for their limited clinical effect as well as their broad spectrum of side effects, inspiring a need for new pharmacological treatments. In recent years, promising results have been reported with the use of selective progesterone receptor modulators (SPRM). Long-term clinical trials have shown a reduction in bleeding and shrinkage of leiomyoma mass. These results instill hope for women suffering from symptomatic leiomyomas seeking an effective, long-term medical option for their condition.

scholarly journals THE MODERN VIEW ON THE COMPLEX TREATMENT OF PATIENTS WITH UTERINE FIBROIDS

2010 ◽  
Vol 1 (3) ◽  
pp. 15-20
Author(s):  
S A Levakov ◽  
A G Kedrova ◽  
K V Kojurina ◽  
N S Vanke
Keyword(s):  
Uterine Artery ◽  
Combined Therapy ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Long Term Results ◽  
Complex Treatment ◽  
Female Pelvis ◽  
Results Of Treatment ◽  
Risk Of Relapse

Uterine fibroids are the most common solid tumours in the female pelvis. The purpose was to examine the long term results of treatment uterine myoma through combined therapy in 54 patients. To assess the reproductive health of patients with uterine fibroids after treatment included to use ana logues of gonadotropinreleasing hormone (GnRH) with or without embolization of uterine artery(UAE) and myomectomies. . The introduction of gonadotrophinreleasing hormone agonists (GnRHa) has been found to be useful in the management of patients of reproductive age with uterine fibroids for minimization of risk of relapse.

Sign in / Sign up

Export Citation Format

Share Document