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1
Barbosa, Lígia Flávia da Silva. "Epidemiological factors associated with uterine fibroids." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1066.
Full textAbstract:
Introduction: The uterine fibroids are the most common benign neoplasm in the female
genital tract. However, the prevalence of this disease in the general population is unknown,
which justifies this investigation.
Objective: To evaluate epidemiological factors associated with uterine myomas, in a setting
of a private medical clinic.
Methodology: It is presented as a cross-sectional research, drafted with a descriptive and an
analytical component.
To collect data a routine demographic computerized file was kept
for every patient and a pelvic transvaginal or transrectal ultrasonography was performed. We
retrieved from each patient their age at the time of consultation, weight, height, age of
menarche, number of pregnancies, pregnancy outcome, marital status, level of education,
menstrual cycle and contraceptive method used.
Through the ultrasound examination, we recorded the presence of uterine myomas,
their number and the largest dimension of the biggest myoma.
Results: From the total women studied by ultrasonography (n = 624), uterine myomas were
documented in 161 (25,8%) cases. Single myomas were presented in 49,7% (n = 80) and the
majority of women had small fibroids, between 10 mm to 19 mm (41,6%, n = 67).
Ages between 40 and 59 years, married marital status, overweight, menopause,
previous pregnancy and delivery and complaints of menorrhagia were associated with a higher
risk for uterine fibroids. The use of combined hormonal contraceptives was found to be a
protective factor. Since these variables, after conducting a multivariate analysis, were all age
dependent, we can suggest that aging is the only factor associated with the presence of
uterine fibroids. Menorrhagia, metrorrhagia and pelvic pain were associated with a higher risk
for multiple uterine fibroids. The use of combined hormonal contraceptives was associated
with a higher risk for single fibroids. Ages between 40 and 59 years and a history of pregnancy
and delivery were associated with a smaller dimension of the leiomyomas.
Conclusion: Uterine myoma is a very common pathology among the female population. In our
study, the only risk factor related with uterine fibroids was aging. Pregnacy and delivery seem
to be associated with myomas of a smaller dimension. Single myoma is more common in
patients using combined hormonal contraception.
2
Quinn, Stephen. "Uterine fibroids : response to novel treatment modalities." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/24737.
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Magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive, thermal ablation treatment for uterine fibroids. There is currently limited data regarding the long-term efficacy of this method and the effect of this treatment on circulating cytokine and growth factors. In this thesis I have: 1. Presented the most accurate method of measuring fibroid volumes, and propose a new classification system for describing fibroid uteri. 2. Reviewed the characteristics of a cohort of uterine fibroid subjects and perform a longitudinal analysis of MRgFUS results. 3. Assessed the fibroid volume treated, pain scores and cytokine levels and growth factor levels following MRgFUS and UAE. Results The Parallel Plannimetric method is an accurate and reliable method of measuring uterine, fibroid and non-perfused volumes. Classifying fibroid uteri by numbers of fibroids and the presence of dominant fibroids is useful for distinguishing between those cases to be treated by MRgFUS or UAE. Since the introduction of MRgFUS to our unit the percentage non-perfused volumes (NPV) achieved have increased from 41.22 to 50.49 (p=0.038), however the re-intervention rate at 5 years remains high at 50%. MRgFUS has an excellent safety record, and the introduction of the new ExAblate 2100 system also appears to be safe and well tolerated, with encouraging initial NPVs achieved. Following both MRgFUS and UAE circulating interleukin-6 (IL-6) is significantly raised, although this is not affected by the degree of pain experienced or the volume of fibroid treated. Following UAE there is rise in circulating vascular endothelial growth factor (VEGF) seen at one week, however no significant change in VEGF levels is seen following MRgFUS. These changes in VEGF are not related to fibroid volume. Discussion MRgFUS is a safe, well tolerated treatment for uterine fibroids, although re-intervention rate is high. Further developments in this treatment modality may continue to improve outcomes, however at present its routine use cannot be recommended.
3
Harrison-Woolrych, Mira. "Studies of peptide growth factors in uterine fibroids." Thesis, University of Southampton, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295533.
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4
Tosti, Claudia. "NEUROGENESIS IN UTERINE DISORDERS." Doctoral thesis, Università di Siena, 2019. http://hdl.handle.net/11365/1095599.
Full textAbstract:
Endometriosis, adenomyosis and uterine fibroids represent benign gynecologic diseases, affecting women of reproductive age associated with chronic pelvic pain, dysmenorrhea, dyspareunia and infertility.
The present knowledge indicates that hormonal function (estrogen and progesterone receptors), immunological and neuroinflammatory factors are critically altered in every of uterine disorders.
The aggressive behaviour of deep infiltrating endometriosis may be explained by the highly decreased apoptosis, by the increased proliferation activity related to oxidative stress and by invasive neurogenic mechanisms and inflammatory patterns that explain its correlation with chronic pelvic pain. Adenomyotic nodules are novel site of protein expression of inflammatory and neurogenic factors, probably involved in the pathogenesis of adenomyosis: endometrial cells invade and proliferate within myometrium, and inflammatory mediators participate to the intense painful symptoms.
The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli; in addition, NGF hyperexpression, in both fibroids and endometrium, may be associated with infertility. Accordingly, in the future, these neurogenic factors may represent potential therapeutic avenues to treat the fibroid-related symptoms.
In conclusion, our results give new insights into the neurogenic characteristics of uterine disorders showing that endometriosis, adenomyosis and fibroids has distinct molecular patterns.
With further advances in our understanding of uterine disorders, preventive strategies, novel non-surgical diagnostic modalities, and targeted therapeutics hold great promise of becoming realities and help to treat our patients.
The future research may contribute to a better phenotyping of these benign gynaecological diseases in order to give a specific efficient management to each disorder. Basic science approach is necessary to increase pathogenesis knowledge of endometriosis, adenomyosis and uterine fibroids, and new medical treatment, and the clinical and diagnostic approach is necessary for planning an accurate surgical or medical treatment.
5
Soucie, Jennifer Elizabeth. "Embolization therapy for uterine fibroids, a multivariate analysis of the predictive factors of fibroid response." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ62934.pdf.
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Doernte, Amy Lynn. "Spontaneously occurring fibroid tumors of the laying hen oviduct." Auburn, Ala., 2006. http://repo.lib.auburn.edu/2006%20Summer/Theses/DOERNTE_AMY_2.pdf.
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Burroughs, Kevin Dale. "The role of ovarian hormones in the development and growth of uterine leiomyoma /." Digital version accessible at:, 1998. http://wwwlib.umi.com/cr/utexas/main.
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8
Zaher, Summia S. "Magnetic resonance guided focused ultrasound surgery : a novel treatment for uterine fibroids." Thesis, Imperial College London, 2010. http://hdl.handle.net/10044/1/5948.
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Uterine fibroids are the most common tumour of the reproductive tract in women of reproductive age. Although they are benign tumours that are often asymptomatic, they may cause debilitating symptoms in many women, such as abnormal uterine bleeding, abdominal pain, increased abdominal girth, urinary frequency, constipation, pregnancy loss, dyspareunia, and in some cases infertility. Several approaches are available for the treatment of uterine fibroids. These include pharmacologic options, such as hormonal therapies and gonadotropinreleasing hormone agonists; surgical approaches, such as hysterectomy, myomectomy; myolysis, laparoscopic uterine artery occlusion, uterine artery embolisation and magnetic resonance imaging-guided focused ultrasound surgery. The choice of approach may be dictated by factors such as the patient’s desire to become pregnant in the future, the importance of uterine preservation, symptom severity, and tumour characteristics. There is however, no widely agreed therapeutic strategy. There is a widespread view that hysterectomy is overused in the UK; the Chief Medical Officer in his annual report ‘On the state of public health’ in 2005, highlighted that hysterectomy in younger women is associated with complications, hospital stays, procedure-related interference with normal life and is costly. In addition he outlined the need to reduce the number of hysterectomies. This, along with the change in cultural attitudes amongst patients, who are becoming increasingly reluctant to undergo these conventional invasive procedures, has increased the need for new treatment options. Ideally new treatment options for uterine fibroids would be minimally invasive, have long-term data demonstrating efficacy and safety, have minimal or no incidence of fibroid recurrence, be easy to perform, preserve fertility, and be cost effective. New treatment approaches are under investigation, with the goals of being effective, safe, and less invasive. MRgFUS is a non-invasive thermo-ablative hybrid technique which uses both MR and ultrasound to destroy tumours. It is an outpatient procedure, which avoids the need for an anaesthetic, has a short recovery period, and is uterine sparing. The main objective of this work was to set out the rationale for using Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) for the treatment of uterine fibroids. In order to achieve this aim, four main bodies of work are necessary; 1) Identifying patient selection criteria and investigating mitigating techniques to increase the pool of women for whom this treatment can be offered. 2) Investigating a method designed to overcome the problem of safely treating women with abdominal scars for whom this treatment can cause potential morbidity. 3) Investigating the potentiality of using MRgFUS to prolong the tumour shrinkage effect of GnRH analogue injections. 4) Investigating the safety of MRgFUS in treating symptomatic women who wish to preserve fertility. Results: the first aim of this project was to identify patient selection criteria and to investigate methods to widen the selection criteria. In our retrospective review it was found that 74% of women presenting were deemed technically suitable to proceed with treatment and several mitigating techniques that solved current technical difficulties were identified and allowed for less restrictive MRgFUS selection criteria for treatment of symptomatic uterine fibroids. These less restrictive criteria are expected to expand the pool of patients for whom MRgFUS is a viable treatment option for uterine fibroid symptoms. The second aim was to identify a method of overcoming the problem of treating women with previous abdominal scars safely. We identified a unique method of highlighting the scar by painting it with a paramagnetic iron oxide material which clearly outlined the scar on MR scanning allowing complete avoidance of the scar using MR guidance. In this small pilot study, all women were treated safely with no skin burns. The third aim of this project looked at the potentiality of prolonging the shrinkage effect of GnRH analogues by following a course of 3 injections with MRgFUS treatment. In this prospective study of fifty women, there was a 50% reduction in the mean symptoms severity score at 6 months which was maintained for 24 months post treatment. There was an average reduction in target fibroid volume which was maintained for 24 months. The final aim of the project was to investigate the safety of using MRgFUS as a treatment option for those women who wished to preserve their fertility. In this multicentre international study, One hundred and sixteen women were recruited from five centres. There were sixty four reported pregnancies in Sixty one women, with 30 completed deliveries. There were no reported cases of uterine rupture, premature labour, abnormal placentation or placental abruption. Conclusion: There is a growing body of data from clinical trials and more than four years of clinical experience to validate the safety and efficacy of MRgFUS for the treatment of uterine fibroids. MRgFUS is a totally non-invasive outpatient procedure that is not associated with the typical surgical risks of bleeding, infection and has minimal recovery time. Additionally, the procedure allows women to address their symptoms whilst preserving the uterus. Consequently, MRgFUS is an alternative treatment option for suitable patients who have refused other interventions due to concerns about lost productivity, risks of surgical complications or future fertility.
9
Wang, Lu. "Studies of factors affecting recurrence of myoma after myomectomy." unrestricted, 2007. http://etd.gsu.edu/theses/available/etd-08052007-212426/.
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Thesis (M.S.)--Georgia State University, 2007.Title from title page. Yu-sheng Hsu, committee chair; Xu Zhang, Jia-wei Liu, committee members. Electronic text (44 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed Oct. 10, 2007. Includes bibliographical references (p. 35-36).
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Кузьоменська, Марина Леонідівна, Марина Леонидовна Куземенская, and Maryna Leonidivna Kuzomenska. "Оптимізація лікування хворих на міому матки." Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/14926.
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Сміян, Світлана Анатоліївна, Светлана Анатольевна Смиян, Svitlana Anatoliivna Smiian, Анатолій Борисович Сухарєв, Анатолий Борисович Сухарев, and Anatolii Borysovych Sukhariev. "Аналіз факторів ризику розвитку міоми матки у міських мешканок." Thesis, Сумський державний університет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/41422.
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Міома матки є одним з найбільш поширених захворювань жіночої репродуктивної
системи, що вимагає оперативних втручань, що призводять до зниження якості життя жінок і
втрати репродукції. Частота даної патології серед сучасної жіночої популяції коливається від
20 до 80%, досягаючи 20-25% у пацієнток репродуктивного віку і 40-45% після 40 років.
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Chaves, Francisco Nogueira. "Technical ligation of ascending branches of the arteries uterna vaginal and its effect in the treatment of symptomatic uterine fibroids." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=4792.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorA miomatose uterina à um problema de saÃde pÃblica em todo o mundo, sendo responsÃvel por 30 a 40% das indicaÃÃes de histerectomia. Necessita-se de alternativas terapÃuticas eficazes, seguras, minimamente invasivas e de baixo custo. Alguns pesquisadores observaram resultados satisfatÃrios ao promover a diminuiÃÃo do fluxo sanguineo para o Ãtero, atravÃs da oclusÃo dos vasos uterinos por via laparoscÃpica. Neste estudo, com 16 pacientes com volume uterino aumentado, sangramento uterino anormal e dor de origem miomatosa; afastando outras causas concomitantes como cÃncer de colo ou endomÃtrio, adenomiose, e pÃlipos uterinos. Realizou-se uma tÃcnica simplificada de ligadura das artÃrias uterinas ascendentes, por via vaginal (LAUAV), e avaliou-se suas repercussÃes sobre sinais e sintomas mencionados, como tambÃm, sobre as alteraÃÃes do FSH, das imagens uterinas e o grau de satisfaÃÃo geral com o procedimento. A oclusÃo destes vasos foi executada pelo fundo de saco anterior, atravÃs de incisÃo da mucosa vaginal ao nÃvel da prega vÃsico cervical, das 10h Ãs 14h, seguida de secÃÃo dos ligamentos supra-cervical e vÃsico uterino para afastar a bexiga e o ureter. A LAUAV foi realizada sob visÃo direta com material especÃfico para trabalhar neste espaÃo exÃguo. As pacientes foram acompanhadas por 6 meses e reavaliadas em relaÃÃo aos parÃmetros comentados. O sangramento, a dor, o volume uterino, o diÃmetro do maior mioma apresentaram diminuiÃÃo significante e o FSH nÃo apresentou diferenÃas significantes, refletindo preservaÃÃo da funÃÃo ovariana. NÃo ocorreram complicaÃÃes. O grau de satisfaÃÃo das pacientes atingiu 90%. A LAUAV apresentou-se como uma opÃÃo segura, barata e eficaz no tratamento da miomatose sintomÃtica.
Uterine Myomatosis is a worldwide Public Health problem, responsible for 30 to 40% of indications for hysterectomy. Efficient, safe, minimally invasive alternative and low costs therapeutics are needed. Some researchers have observed satisfactory results at promoting the reduction of blood flow to uterus, through the occlusion of uterus blood vessels via laparoscopy. 16 patients who presented uterine increased volume, uterine abnormal bleeding and pain, originated by myomatosis participated in this study. Patients who presented other concurrent causes such as uterine bleeding, pain or uterine volume increase such as cervix cancer or uterus endometrial cancer, adenomyosis and uterine polyps were excluded from this study. It was carried out a ligature technique of ascendant branches of uterine arteries via vaginal (LAUAV) and the repercussion on signals and symptoms above mentioned, as well as alterations of follicle stimulating hormone (FSH), of uterine images, and the level of general satisfaction with such medical proceeding have been evaluated. Occlusion of such vessels was carried out by the bottom of the anterior saccus, through incision of vaginal mucosa, at the level of vesico-cervical plica, from 10a.m. to 2 p.m., followed by section of supra-cervical and vesicouterine ligaments to deviate the bladder and the ureter. LAUAV was carried out under direct vision with specific material to work in such a small space. Patients have been accompanied during 6 months and the re-evaluated in relation to the commented parameters. Bleeding, pain and uterine volume, and the diameter of the dominant myoma has presented significant reduction and FSH has not presented statistically considerable difference, reflecting the preservation of ovarian reserve. No Complications have occurred. Patientsâ satisfaction level attained 90%. LAUAV represents a secure, low-cost and efficient treatment of symptomatic myomatosis.
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Kennedy, Whitney. "Association Between Age of Women when Diagnosed with Endometriosis and Infertility." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5487.
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Abstract
Because endometriosis is considered to be the primary cause of infertility in women and
the diagnosis is known to be delayed by many years, it is important to understand the
association between endometriosis and infertility. The purpose of this cross-sectional,
secondary data analysis study was to determine whether there was an association between
the age of women when diagnosed with endometriosis and infertility. Using the general
model of total patient delay (i.e., the Andersen model) as a theoretical foundation, data
for this study was collected by assessing patient medical records of women with
endometriosis at multiple OB-GYN clinics in Eastern North Carolina. Multiple logistic
regression was conducted to determine potential association between variables. The
results presented that diagnosis at an older age and presence of uterine fibroids are
significant risk factors for infertility among women with endometriosis. From the results,
it can be concluded that infertility may be preventable in women diagnosed with
endometriosis and uterine fibroids in younger age. This study presents positive social
change by preventing infertility amongst women who suffer from both endometriosis and
uterine fibroids; potentially creating preventative programs aimed at better educating
women on the risks of endometriosis and uterine fibroids (especially when presented
together).
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Whitaker, Lucy Harriet Ravenscroft. "Effect of administration of selective progesterone receptor modulators (SPRMs) on uterine and endometrial morphology." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/28974.
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Introduction: The human menstrual cycle is regulated by sex-steroid hormones, including oestrogen (E), progesterone (P4) and androgens which act by ligand binding to their cognate receptors. Perturbation of the complex series of events governing the menstrual cycle may lead to heavy menstrual bleeding (HMB). This is a common debilitating condition and often associated with uterine fibroids. There remains an unmet need for effective, long-term medical treatment so women avoid surgery and preserve their fertility. Selective progesterone receptor modulators (SPRMs, e.g. ulipristal acetate, UPA) are synthetic ligands that bind the progesterone receptor (PR). Many SPRMs have been developed but only mifepristone (for the management of unwanted pregnancy) and UPA are in current clinical use. UPA is licensed for the intermittent treatment of symptomatic fibroids. SPRMs have potential utility for treatment of HMB as administration rapidly induces amenorrhoea but the mechanisms by which this is achieved are unknown. SPRM administration results in unique endometrial morphological changes (progesterone receptor modulator-associated endometrial changes; PAEC). Despite endometrial unopposed estradiol exposure these morphological changes do not appear to be associated with malignancy or pre-malignancy risk. Indeed endometrial cell proliferation appears reduced despite relative progesterone-antagonism. Based upon findings with other SPRMs it was hypothesised that: (i) administration of UPA would have an endometrial specific effect upon the reproductive tract, with regard to alteration in morphology, localisation of sex steroid receptors (SSR) and cell proliferation.; (ii) administration of UPA would impact upon progesterone-regulated (Pregulated) genes in the endometrium. Methods: The data presented within this thesis are derived from biopsies obtained at hysterectomy from the endometrium, fallopian tubes and cervices of women with symptomatic fibroids administered UPA for 8-15 weeks. Samples were obtained for histological assessment, immunohistochemistry and RNA extraction for subsequent quantitative RT-qPCR of sex-steroid receptors (SSR) and proliferation markers. In addition key P-regulated genes within the endometrium were investigated by RT-qPCR and selected protein expression. To further interrogate the anti-proliferative effect, RNA was extracted from “paired” endometrial biopsies from the same woman in the proliferative phase of the menstrual cycle and following subsequent treatment with UPA for at least eight weeks and microarray gene analyses undertaken. Results: Morphological alteration of the endometrium with UPA administration was consistent with previously published data, but with a higher prevalence than previously described. There was a striking alteration in expression and localization of SSRs, particularly PR and androgen receptor (AR), and alteration of many P-regulated genes, consistent with UPA acting with low progesteroneagonism within the endometrium. There was no alteration of SSR expression within the cervix and proliferation was unchanged. Fallopian tube morphology and SSR expression was consistent with proliferative phase but cell proliferation was reduced following UPA administration, consistent with secretory phase levels. Microarray analyses identified multiple transcripts altered relative to proliferative phase, with GREM2 the most significantly down-regulated gene and MUC1 one of the most significantly upregulated genes. Consistent with low levels of mitotic figures and cell proliferation, the most down regulated KEGG pathway was the cell cycle. Multiple elements within this were subsequently validated (RT-qPCR) and included key regulators of all elements of the mitotic cell cycle, many of which were novel to those previously described following administration of another SPRM, mifepristone. In summary the novel data presented in this thesis considerably extend the data available to date concerning the actions of the SPRM, UPA, on the female reproductive tract, and increases knowledge regarding a compound with promising utility for the management of the debilitating complaint of HMB.
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Ford, Ilisher. "Uterine Fibroid Symptom Severity and Impact on Health-Related Quality of Life Among African American Women." ScholarWorks, 2015. http://scholarworks.waldenu.edu/dissertations/1678.
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A disproportionate number of African American women are at increased risk for uterine fibroid tumors (UF) compared to their Caucasian, Asian, and Hispanic counterparts. Researchers have indicated that women diagnosed with UF can have a poorer health-related quality of life (HRQOL) when compared to women who do not have a diagnosis of UF. The overall aim of this study was to explore the impact of UF symptoms on the HRQOL of African American women. A quantitative, cross-sectional design was employed utilizing the revised version of Wilson and Cleary's model of HRQOL. A sample was gathered of 80 participants who were African American women between age 30 and 45 years with a current diagnosis of UF. Linear and multiple hierarchical regressions were performed to determine the relationship among UF symptom severity and HRQOL based on 6 subscales of HRQOL (as measured by the UFS-QOL). There was a statistically significant association between symptom severity, the 6 subscale variables of HRQOL, and employment. No significant associations were observed with age, family history (hx) of UF diagnosis, body mass index, general health perception, overall quality of life, and symptom severity. The social change implication for this study is to provide information that can direct health care providers in the development of health maintenance programs that are sensitive to the needs of African American women diagnosed with UF. In addition it will promote the need for public health professionals and medical organizations to increase the availability of information related to UF symptoms and the impact of UF symptoms on HRQOL among women.
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Ніколайчук, С. В. "Дослідження ефективності застосування емболізації маткових артерій для лікування міоми матки." Thesis, Сумський державний університет, 2017. http://essuir.sumdu.edu.ua/handle/123456789/58708.
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Кравец, В. П., and В. Ф. Петренко. "Эндометриоз яичников у больных фибромиомой матки." Thesis, Издательство СумГУ, 2002. http://essuir.sumdu.edu.ua/handle/123456789/23745.
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Hamoodi, Ibraheem. "Investigating the effect of uterine artery embolisation on the uterus of women with fibroids and heavy menstrual bleeding." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8114/.
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Uterine fibroids are common benign tumours in women. The effect they have can range from pressure symptoms and heavy menstrual bleeding to denying a woman a successful pregnancy. Despite the overall benign classification of fibroid, it is undeniable that the reduced quality of life these tumours cause may exceed the effect that some early stage gynecological cancers have on a suffering woman. There has been extensive research into treatments for fibroids however this has only resulted in a handful of worthy advances which are not proportionate to the impact these “benign” tumours have on a suffering woman. The mechanism for how fibroids affect the endometrium and cause heavy menstrual bleeding is understudied. Some of this research has pointed towards vascular endothelial growth factor and cyclooxygenase as potential mediators that change the perceived heaviness –amount and length- of a menstrual period in a woman with fibroids. Uterine artery embolisation (UAE) has emerged as a lesser invasive option and an alternative to surgery. The reported high technical success of the procedure independent of BMI and the short hospital stay and quick recovery has made it an attractive treatment modality. However, the mechanism of how it works is still not understood. Women with large variation in uterine size and fibroid number and size are undergoing this procedure without the full knowledge of how they will individually respond. This thesis aims to explore the mechanism of how UAE works by looking at the change in expression of VEGF, COX-2 & Ki67 and also the change in microvascular density of the endometrium post UAE. Our aim was to investigate how women with different sized fibroid uteri would respond to UAE and if DWI MRI had any advantages above standard MRI in predicting the outcome of UAE.
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Arponen, Felicia. "Mifepristonbehandling vid myom : Effekt- och säkerhetsaspekter." Thesis, Linnéuniversitetet, Institutionen för kemi och biomedicin (KOB), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-94171.
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Bakgrund: Myom är den vanligaste gynekologiska benigna tumören hos kvinnor i fertil ålder. Det finns idag läkemedelsbehandlingar, invasiva ingrepp och icke-invasiva ingrepp vid behandling av myom. Utvecklingen av läkemedel mot myom är lågprioriterat, eftersom de främst är benigna och snarare leder till sjuklighet än dödlighet. De läkemedel som idag används vid behandling av myom är ulipristal, GnRH-agonister, NSAID, tranexamsyra, p-piller eller hormonspiral. Ulipristal och GnRH-agonister har utöver förbättring av symtom som alla de senast nämnda, en effekt på reducering av myomstorlek. Icke-invasiva ingrepp innefattar idag myolys, embolisering av arteria uterina och fokuserad ultraljudskirurgi under MRI-vägledning, framtagna för att slippa operativa ingrepp. Myomektomi och hysterektomi är två operativa ingrepp som genomförs om inga andra behandlingar fungerar, eftersom de medför en längre återhämtningstid och en större risk för komplikationer. Mifepriston är en antiprogesteron, vilket innebär att den hämmar progesterons effekt. Progesteron i sin tur spelar en stor roll i utvecklingen av ett myom. Behandling med läkemedlet har i många olika studier visat goda resultat både i avseende på myomstorlek, symtom, livskvalité och biverkningar. Syfte: Syftet med examensarbetet var att undersöka om mifepriston är ett säkert och effektivt läkemedel vid behandling av myom hos kvinnor. Metod: Examensarbetet är en litteraturstudie och baseras på 6 olika randomiserade kontrollerade vetenskapliga studier som undersökte mifepristons effekt och säkerhet vid behandling av myom. Studierna hämtades från PubMed. Resultat: Samtliga studier visade en reducering i myomvolym, en förbättring av symtom och milda biverkningar med olika doseringar av mifepriston vid behandling av myom. I 2 av studierna undersöktes livskvalitén vilket ökade hos de personer som behandlades med mifepriston. Slutsats: Det är svårt att dra generella slutsatser vilken dos och behandlingstid som är optimala på grund av de olika behandlingstiderna, doseringarna och studieuppläggen som användes i samtliga studier. Dock har mifepriston en god effekt avseende på reducering i myomstorlek, symtom, biverkningar och livskvalité. Det krävs dock fler studier för att säkerställa dosering och behandlingstid samt fler jämförelser med andra behandlingsalternativ som idag finns för behandling av myom.
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Abukhnjr, Salha Ali Muamer. "The role of vascular endothelial growth factor and other cytokines in the aetiology of heavy menstrual bleeding in women with uterine fibroids." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/6501/.
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Introduction: The human endometrium undergoes cyclical changes of proliferation, differentiation and shedding. This cyclical process has been described as an inflammatory process. Menstrual abnormalities account for the morbidity of a large population of females in their reproductive age. Aberration in endometrial angiogenesis has been implicated in the mechanism of heavy menstrual bleeding (HMB). Although the precise mechanism for control the endometrial neoangionesis is not fully understood, vascular endothelial growth factor and other cytokines such as cyclooxygenases, prostaglandins, interleukin -8 and leukocytes have been implicated in both endometrial pathologies and angiogenesis dysregulation. In addition, heavy menstrual bleeding results from upregulation of the expression/synthesis of these local markers. Uterine fibroids are the most common benign tumor affecting the female reproductive tract. Heavy menstrual bleeding is the main presenting complaint of women with uterine fibroids. However, the mechanism by which uterine fibroids cause heavy menstrual bleeding has not been elicited yet. Therefore, the mechanism of action of different available treatments for this condition, including uterine artery embolisation is unclear. This thesis is based on the hypothesis that a) uterine fibroid changes the physiology of endometrium and we aimed to find out whether these markers work in a different way in heavy menstrual bleeding in those with uterine fibroids and those without., In addition I we wished to study whether uterine fibroid upregulate these local markers in heavy menstrual bleeding, whereas uterine artery emolisation down-regulates them. Methods: This thesis describes the use of endometrial samples, taken with a Pipelle sampler, collected from women with heavy menstrual bleeding both with uterine fibroids and also with normal uteri, to estimate the difference in the endometrial expression of the factors likely to be involved in the control of menstrual bleeding between the two groups. Results: The study found no differences between the expression of both either proteins or mRNA for the cytokines under investigation By using endometrium, myometrium and different types of fibroid tissue collected from women who had hysterectomies with the complaint of heavy menstrual bleeding, there was higher expression of VEGF, COX-2, PGE2 and IL8 proteins in fibroid than myometrial tissue. However, the level mRNA of expression for VEGF, COX-1, COX-2, IL8 and EP2 showed no differences between myometrial and fibroid tissue. In the same group, endometrial expression of these markers for women who had no hormonal therapy before operation compared with that for women who received gonadotropin releasing hormone agonists (GnRH), higher expression of VEGF mRNA in women who had GnRH agonists than those who had no any hormones. In fibroid tissue, GnRHdownregulated the expression of VEGF protein and other cytokines compared with those not on any hormonal therapy. In addition, the estimated serum levels of these factors, indicating a higher level of IL8 in the GnRH group than in the other group. Conclusion: It seems that theses markers play a role in HMB mechanism in both uterine fibroid and normal uteri group in same manner. In addition, they have a fundamental role in the growth of uterine fibroids as well.
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Uimari, O. (Outi). "Epidemiological and familial risk factors of uterine leiomyoma development." Doctoral thesis, Oulun yliopisto, 2017. http://urn.fi/urn:isbn:9789526214870.
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Abstract Uterine leiomyomas are the most common benign tumours in females. They are myometrial neoplasms, may present single or multiple, and may be located in various sites of the uterus. Leiomyomas distort the uterine cavity and the uterus itself, causing abnormal vaginal bleeding, reduced fertility and also pelvic pressure and pain symptoms. The aim of this study was to elaborate current knowledge on familial uterine leiomyomas and to explore the possible association between uterine leiomyoma and cardiovascular disease risk factors, and also the association between leiomyomas and endometriosis. The natural history of familial uterine leiomyoma study showed significant differences between familial and non-familial leiomyoma cases, familial cases having more severe clinical characteristics. They presented with multiple uterine leiomyomas and were more often symptomatic. They were also diagnosed at a younger age. The prevalence study on uterine leiomyomas and endometriosis offered confirmation of an association between the diseases. Uterine leiomyomas and endometriosis seem to decrease female fertility independently of each other. Uterine leiomyomas related to the hereditary leiomyomatosis and renal cell cancer (HLRCC) tumour syndrome were studied in regard to their clinical characteristics and immunophenotype. The study provided evidence that women with HLRCC may be identified through distinct leiomyoma clinical characteristics, and routine-use IHC of CD34 and Bcl-2. Distinguishing these leiomyoma cases from sporadic ones may identify families affected by fumarate hydratase (fumarase, FH) mutation. Uterine leiomyoma and cardiovascular disease risk factors were studied in The Northern Finland Birth Cohort 1966 (NFBC1966). The study showed an association between leiomyomas and raised cardiovascular disease risk factors, serum lipids and metabolic syndrome in particular. These findings may suggest that there are shared predisposing factors underlying both uterine leiomyomas and adverse metabolic and cardiac disease risks, or that metabolic factors have a role in biological mechanisms underlying leiomyoma development. This study provides novel information on clinical characteristics of familial uterine leiomyomas and on the immunophenotype of HLRCC-related leiomyomas. The study also offers significant confirmation of associations between uterine leiomyomas and both endometriosis and several CVD risk factorsTiivistelmä Kohdun leiomyoomat ovat naisten yleisin hyvänlaatuinen kasvain. Ne ovat myometriumin neoplastisia muutoksia ja ne ilmenevät joko yksittäisinä tai monilukuisina, ja ne voivat sijaita missä tahansa kohdun myometriumia. Leiomyoomat muuttavat kohdun ja kohtuontelon säännöllistä muotoa. Lisäksi ne aiheuttavat vuotohäiriöitä, alentunutta hedelmällisyyttä, ja lantion alueen painetta ja kipua. Tämän tutkimuksen tavoitteena oli laajentaa nykyistä tietämystä suvuittain esiintyvistä kohdun leiomyoomista ja selvittää mahdollista leiomyoomien ja kardiovaskulaaritautiriskin assosiaatiota, ja lisäksi selvittää leiomyoomien ja endometrioosin assosiaatiota. Suvuittain esiintyvien kohdun leiomyoomien taudinkulkua selvittävässä tutkimuksessa osoitettiin merkittäviä eroja suvuittain ja ei-suvuittain esiintyvien leiomyoomien välillä. Suvuittain esiintyvien leiomyoomien kliininen taudinkuva oli vaikeampi, leiomyoomia oli kohdussa useampia ja ne aiheuttivat useammin oireita ja lisäksi ne diagnosoitiin nuoremmalla iällä. Kohdun leiomyoomien ja endometrioosin yleisyyttä selvittävä tutkimus antoi lisävahvistusta sille havainnolle, että nämä taudit assosioivat keskenään. Tutkimustuloksen mukaan leiomyoomat ja endometrioosi vähentävät naisen hedelmällisyyttä toisistaan riippumatta. Perinnöllinen kohdun leiomyomatoosi ja munuaissyöpä (hereditary leiomyomatosis and renal cell cancer, HLRCC) -kasvainoireyhtymään liittyvän kohdun leiomyoomia selvittävän tutkimuksen tuloksien mukaan HLRCC-naisten kohdun leiomyoomien kliiniset ominaisuudet poikkeavat satunnaisesti esiintyvien leiomyoomien ominaisuuksista. Naisella HLRCC voitaisiinkin tunnistaa näiden poikkeavien ominaisuuksien perusteella, sekä immunohistokemiallisilla värjäyksillä CD34 ja Bcl-2. Fumaraattihydrataasi (fumaraasi, FH) -geenin mutaatiota kantava suku voitaisiin siten tunnistaa yksittäisen HLRCC leiomyoomatapauksen avulla. Pohjois-Suomen syntymäkohortti 1966 (Northern Finland Birth Cohort 1966, NFBC1966) tutkittiin kohdun leiomyoomia ja kardiovaskulaarisairauden riskitekijöitä. Tutkimustuloksien perusteella kohdun leiomyoomat assosioivat koholla olevien kardiovaskulaarisairauden riskien kanssa, erityisesti seerumin lipidien ja metabolisen syndrooman suhteen. Näiden tutkimustulosten perusteella voidaan esittää, että leiomyoomien ja terveydelle epäedullisen metabolian ja kardiovaskulaaritaudin riskien taustalla on mahdollisesti joitain yhteisiä altistavia tekijöitä, tai että metabolisilla tekijöillä on rooli kohdun leiomyoomien tautimekanismissa. Tämä tutkimus on tuottanut uutta tietoa suvuittain esiintyvien kohdun leiomyoomien kliinisestä taudinkuvasta ja HLRCC:n liittyvien leiomyoomien immunofenotyypistä. Lisäksi tämä tutkimus esittää lisävahvistusta kohdun leiomyoomien ja endometrioosin assosiaatiolle sekä useille kardiovaskulaaririskitekijöille
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Morgan, Marisa L. "Exposure to Endocrine Disrupting Compounds and Reproductive Toxicity in Women." FIU Digital Commons, 2014. http://digitalcommons.fiu.edu/etd/1586.
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The overall objective of the research presented in this dissertation was to assess exposure to endocrine disrupting chemicals (EDCs), polychlorinated biphenyls (PCBs), phthalates, and bisphenol A (BPA) in the general population and evaluate their associations with adverse reproductive health effects, including cancers, in women. Given the proven contribution of unopposed estrogens to the risk for endometrial neoplasia or breast cancer, renewed health concerns have aroused about estrogen mimicking EDCs found in food, personal care products or as environmental contaminants. Our meta-analysis showed that exposure to estrogen mimicking PCBs increased summary risk of breast cancer and endometriosis. We further evaluated the relationship between endometriosis and breast cancer, and EDCs using a bioinformatics method. Our bioinformatics approach was able to identify genes with the potential to be involved in interaction with PCB, phthalates and BPA that may be important to the development of breast cancer and endometriosis. Therefore, we hypothesized that exposure to EDCs such as PCBs, phthalates, and BPA, results in adverse reproductive health effects in women. Using subject data and biomarkers available from the Center for Disease Controls National Health and Nutrition Examination Survey database we conducted a cross-sectional study of EDCs in relation to self-reported history of endometriosis, uterine leiomyomas, breast cancer, cervical cancer, ovarian cancer, and uterine cancer. Significantly higher body burdens of PCBs were found in women diagnosed with breast cancer, ovarian cancer, and uterine cancer compared to women without cancer. PCB 138 was significantly associated with breast cancer, cervical cancer, and uterine cancer, while PCBs 74 and 118 were significantly associated with ovarian cancer. The sum of dioxin-like PCBs were significantly associated with ovarian cancer (OR of 2.02, 95% CI: 1.06-3.85) and the sum of non-dioxin-like PCBs were significantly associated with uterine cancer (OR of 1.12, 95%CI: 1.03-1.23). Significantly higher body burdens of PCBs were also found in women diagnosed with endometriosis and uterine leiomyomas. Documenting the exposure to EDCs among the general U.S. population, and identifying agents associated with reproductive toxicity have the potential to fill research gaps and facilitate our understanding of the complex role environmental chemicals play in producing toxicity in reproductive organs.
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Hashemi, Nezhad Maliheh [Verfasser], Joern [Akademischer Betreuer] Bullerdiek, and Andreas [Akademischer Betreuer] Dotzauer. "Analysis of the Genome Stability of Uterine Fibroids with Different Degree of HMGA Expression / Maliheh Hashemi Nezhad. Gutachter: Joern Bullerdiek ; Andreas Dotzauer. Betreuer: Joern Bullerdiek." Bremen : Staats- und Universitätsbibliothek Bremen, 2013. http://d-nb.info/1072077078/34.
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Morris, Edward Patrick. "A placebo-controlled, randomised, double-blind study of tibolone as 'add-back therapy' in conjunction with a gonadotrophin-releasing hormone analogue in the treatment of uterine fibroids." Thesis, King's College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268665.
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Torres, Fernanda Pelegrini. "Ganho de peso na idade adulta e ocorrência de miomas uterinos em trabalhadoras de uma universidade: Estudo Pró-Saúde." Universidade do Estado do Rio de Janeiro, 2012. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=6396.
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Os miomas uterinos (MU) são considerados os tumores mais comumente encontrados no sistema reprodutor feminino. Este estudo buscou investigar associação entre o ganho de peso na idade adulta e a ocorrência de miomas. Esta relação foi explorada em estudos internacionais na maior parte americanos. No Brasil nenhum estudo havia abordado este tema até o término desta dissertação. Para investigar como a associação entre o ganho de peso na idade adulta afeta o risco de miomas, foi conduzido um estudo transversal referente aos dados da linha
de base (1999-2001) do estudo longitudinal Pró-Saúde onde 2594 servidores técnico-administrativos de uma universidade pública do Rio de Janeiro são participantes, entre eles foram selecionadas 1560 mulheres com diagnóstico médico autorrelatado de MU e que tiveram seus pesos aos vinte anos de idade autorrelatados em questionário autopreenchível cujas idades variaram entre 22 a 67 anos. Foi avaliada a mudança de peso desde os 20 anos até o momento da entrada no estudo. As prevalências de miomas encontradas neste grupo foram23.3%
(IC95% - 21,2; 25,4), situando-se em posição intermediária quando comparada as prevalências encontradas nos estudos norte-americanos. A maior prevalência de ganho de peso foi encontrada no 4 quintil cujos valores variaram entre ganho maior que 0,7 Kg/ano e menor que 1,1 Kg/ano. A faixa etária com maiores prevalências de diagnóstico médico auto-relatado de miomas ficou compreendida entre 45 a 54 anos (39,1%).Os valores de peso aos 20 anos informados pelas respondentes variaram entre 30,0 e 96,0 kg. O IMC aos 20 anos de idade se situou está dentro da categoria de normalidade entre a maior parte das participantes. Os resultados não sugerem associação entre o ganho de peso na idade adulta e miomas nesta população de estudoThe uterine fibroids (MU) are considered the most common tumors found in the female reproductive system. This study investigated the association between weight gain in adulthood and the occurrence of fibroids. This relationship was explored in international studies mostly Americans. In Brazil, no studies had addressed this issue until the end of this dissertation. To investigate how the association between weight gain in ddulthood affects the risk of fibroids, a crosssectional study was conducted for the data from the baseline (1999-2001) longitudinal study of the Pro-Saúde where2594 technical and administrative staff of a public university in Rio de Janeiro are participating, among them were selected in 1560 women with self-reported medical diagnosis of MU and had their weights at the age of twenty self-reported in self-administered questionnaire whose ages ranged from 22-67 years. Weight change since 20 years was evaluated until the entry into the study. The prevalence of fibroids found in this group were 23.3% (95% CI - 21.2, 25.4), standing at an intermediate position compared the prevalence found in American studies. The highest prevalence of weight gain was found in the 4th quintile values ranged between gain greater than 0.7 kg / year and less than 1.1 kg / year. The age group with highest prevalence of self-reported medical diagnosis of fibroids was between 45 and 54 (39.1%). The weight at age 20 reported by respondents ranged between 30.0 and 96.0 kg. The BMI at 20 years old stood in the category is normal among most participants. The results suggest no association between weight gain in adulthood and fibroids in this study population.
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Kreuzer, Johannes Verfasser], Stephan A. [Akademischer Betreuer] Sieber, and Aymelt [Akademischer Betreuer] [Itzen. "The Natural Product Acivicin as a Tool for ABPP and the Activity of Serine Hydrolases in Uterine Fibroids / Johannes Kreuzer. Gutachter: Aymelt Itzen ; Stephan A. Sieber. Betreuer: Stephan A. Sieber." München : Universitätsbibliothek der TU München, 2015. http://d-nb.info/1071651544/34.
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Summerer-Moustaki, Margarita [Verfasser], and Uwe [Akademischer Betreuer] Hasbargen. "Conservative medical vs. surgical therapy management of high risk pregnancies, complicated by large uterine fibroids : a single German university center experience at the University Clinic Großhadern from 1996-2007 / Margarita Summerer-Moustaki ; Betreuer: Uwe Hasbargen." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2018. http://d-nb.info/1163949000/34.
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Patel, Trusher. "Uterine Arterial Embolization: Classification of Leiomyomas to Determine Predictors of Response." Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-134426/.
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The purpose of this study is to determine features of uterine leiomyoma on Magnetic Resonance Imaging (MRI) that identify predictors of response to Uterine Arterial Embolization (UAE). MRI images were obtained before and after UAE in 35 women. These images were analyzed for uterine and fibroid size changes along with fibroid border characteristics and location for a total of 73 fibroids. Fibroids were classified as either smooth or lobulated based on border appearance on MR imaging to determine any differences in mean fibroid volume reduction post-embolization. The mean decrease in fibroid volume from pre-embolization to post-embolization was 48.1% ± 28.6 % (SD) (P < 0.001). No statistical difference was detected in the mean volume reduction between lobulated and smooth fibroids, 40.6% ± 23.1% (SD) and 50.9% ± 30.2% (SD) respectively, with a confidence interval [-25.1, 4.6, SEM 7.5, Df 71], single factor ANOVA (F[1,71]=1.88, Fcrit=3.98, p=0.17). However, some difference was detected in the failure rate of lobulated versus smooth fibroids to embolization, 5% and 9.4% respectively, ANOVA (F [1, 71]= 0.37, Fcrit= 3.98, p > 0.1), albeit at low statistical power. Also no difference was detected in mean fibroid volume reduction between intramural, submucosal, and subserosal fibroids. Thus, we introduced a novel characteristic by which to classify uterine fibroids based upon border appearance on MR imaging.
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LICATA, JACQUES. "Tactiques operatoires des fibromes uterins : a propos d'une serie personnelle." Aix-Marseille 2, 1990. http://www.theses.fr/1990AIX20318.
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Pryimak, S. G. "Current approaches to treatment of fibrosis - crystostic mastopathy in patients with uterine myoma." Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/17620.
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Zapata, Vásquez Luis Alberto. "Correlación clínica anátomo patológico de las histerectomías por leiomiomatosis uterina." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2009. https://hdl.handle.net/20.500.12672/15338.
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El documento digital no refiere asesorDetermina si existe correlación entre el diagnóstico de Leiomiomatosis uterina en el pre-operatorio y el estudio anatomía patológica posterior a la Histerectomía, los objetivos específicos fueron determinar la prevalencia, grupos etáreos más afectados, morbilidad más frecuente asociada Leiomiomatosis, confirmar diagnóstico de Leiomiomatosis por anatomía patológica posterior a la histerectomía, detectar por anatomía patológica patologías que no fueron diagnosticadas antes de la histerectomía. Se realizó un estudio observacional, descriptivo, retrospectivo y transversal con el total de pacientes con diagnóstico de Leiomiomatosis Uterina de enero del 2007 a diciembre del 2008, se utilizó un cuestionario estructurado para la recolección de datos obtenidos de las Historias Clínicas y resultados de Anatomía Patológica de los pacientes con Diagnóstico pre quirúrgico de Leiomiomatosis uterina en el registro de SOP- HNDAC-CALLAO. Se encontró que el grupo mayor afectado fue de 41-45 años(39.82%), los grupos < de 25 y ˃ de 60 años tuvieron la menor prevalencia de leiomiomatosis uterina, a si mismo el 32.30% tuvo una paridad de 4, el 100.00% de pacientes tuvieron como criterio de Diagnóstico pre quirúrgico el examen clínico y la Eco TV, al 100.00% de pacientes se les realizó PAP, el 92.00% biopsia de endometrio y el 100.00% contó con resultado de Hb, el 34.07% tuvo 12 gramos de Hb, en el 65.48% se confirmó el diagnóstico de Leiomiomatosis por Anatomía Patológica, en el 15.04% se encontró adenomiosis, el 65.48% de los pacientes se les encontró correlación entre Clínica, Eco TV y hallazgo Anátomo Patológico de Leiomiomatosis uterina. La USV tiene bajo VPP para leiomiomatosis uterina, según lo confirma los resultados de anatomía patológica.
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CASTELLUCCI, CLARA FEDERICA. "Ability of omega-3 fatty acids to modulate uterine fibrotic cell structure and gene expression." Doctoral thesis, Università Politecnica delle Marche, 2018. http://hdl.handle.net/11566/256439.
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I leiomiomi uterini, anche conosciuti come fibromi, rappresentano la forma tumorale benigna più comune nelle donne fertili. Spesso si ricorre all’asportazione chirurgica dell’utero, isteroctomia, con conseguente morbilità e onere socioeconomico. La patogenesi non è del tutto conosciuta, pertanto è auspicabile una migliore comprensione della malattia per definire nuovi bersagli terapeutici.
In questo studio, abbiamo analizzato gli effetti degli acidi grassi omega-3 sul profilo lipidico, sull'architettura della membrana cellulare e sull'espressione di specifici geni nelle cellule isolate da miometrio e da leiomioma.
Le cellule primarie di miometrio e di leiomioma sono state trattate con gli acidi grassi omega-3, l’acido eicosapentaenoico (EPA) e l’acido docosaesaenoico (DHA) (50 μM) per 48 ore.
Il contenuto degli acidi grassi è stato misurato mediante gas-cromatografia con rivelatore a ionizzazione di fiamma (GC-FID). Lo stato di fluidità o rigidità delle membrane è stato individuato utilizzando la fluorescenza del Laurdan.
I livelli di espressione genica dei component della matrice extracellulare (Collagene1A1, fibronectina, versican), dei fattori pro-fibrotici (activina A), delle molecole di mechanical signaling (integrina β1, FAK and AKAP13) e di regolazione degli steroli (ABCG1, ABCA1, CAV1 and SREBF2), nonché degli enzimi mitocondriali (CYP11A1) sono stati valutati mediante PCR real-time. I risultati che abbiamo ottenuto mostrano che l’EPA e il DHA riducono il contenuto degli acidi grassi monoinsaturi e fanno incrementare gli acidi grassi polinsaturi in vitro nelle cellule isolate da entrambi i tipi di tessuto, miometrio e leiomioma.
Le membrane cellulari miometriali e di leiomioma non trattate erano nella fase liquido-cristallina. Quando trattati con EPA e DHA, entrambi i tipi di cellule hanno riportato valori di polarizzazione generalizzata di eccitazione del Laurdan più elevati, indice di una maggiore rigidità.
Sebbene non siano stati rilevati cambiamenti nell'espressione di mRNA dei componenti della matrice extracellulare, l’EPA e il DHA hanno ridotto i livelli di ABCG1, ABCA1 e AKAP13 in entrambi i tipi di cellule e hanno anche diminuito la produzione di FAK e CYP11A1 nelle cellule del miometrio.
In conclusione, gli acidi grassi omega-3 sono in grado di modificare il profilo degli acidi grassi, di modificare l'architettura della membrana cellulare, di ridurre l'espressione dei geni necessari per il mechanical signaling e per l'accumulo intracellulare di lipidi nelle cellule di miometrio e di leiomioma.Uterine leiomyomas, also known as fibroids, represent the most common form of benign tumors in premenopausal women. Treatment often results in hysterectomy, which correlates with a high morbidity and socio-economic burden. Also, as knowledge on the pathogenesis is limited, it is important to gain a better understanding of the disease and define new therapeutic targets. In this study, we analyzed the effects of omega-3 fatty acids on the lipid profile, membrane architecture and specific gene expression in myometrial and leiomyoma cells. Primary myometrial and leiomyoma cells were treated with omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (50 μM) for 48 hours. Gaschromatography with flame ionization detector (GC-FID) was used to measure fatty acid content and by applying the method of Laurdan fluorescence we assessed membrane fluidity or rigidity. Real-time PCR was used for measurement of gene expression of extracellular matrix components (Collagen1A1, fibronectin, versican), pro-fibrotic factor (activin A), mechanical signaling (integrin β1, FAK and AKAP13) and sterol regulatory molecules (ABCG1, ABCA1, CAV1 and SREBF2) as well as mitochondrial enzyme (CYP11A1). Our results show that EPA and DHA reduce the monounsaturated fatty acid content and lead to an increase of polyunsaturated fatty acids in both, myometrial and leiomyoma cells in vitro. Untreated myometrial and leiomyoma cell membranes were in the liquid-crystalline phase. When treated with EPA and DHA, both cell types had higher Laurdan excitation generalized polarization values indicating an increased rigidity. Though there was no change in the mRNA expression of EMC components detectable, EPA and DHA lead to reduced levels of ABCG1, ABCA1 and AKAP13 in both cell types and also decreased FAK and CYP11A1 production in myometrial cells. In conclusion, omega-3 fatty acids are able to modify the fatty acid profile, restructuring the cell membrane architecture and downregulating the expression of genes required for mechanical signaling and cellular lipid accumulation in myometrial and leiomyoma cells.
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Martins, Mauricio de Sena. "Embolização das arterias uterinas como tratamento de miomas sintomaticos." [s.n.], 2001. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313235.
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Orientadores: Gustavo Antonio de Souza, Cecilia Maria Roteli MartinsTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-07-31T14:57:07Z (GMT). No. of bitstreams: 1 Martins_MauriciodeSena_D.pdf: 1215934 bytes, checksum: 1b03cb75f02b54915711c5e4394ba117 (MD5) Previous issue date: 2001
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ISLAM, MD SORIFUL. "Involvement of activin-A and myostatin in myometrial patho-physiology and their relation with therapeutic effects of CDB-2914 on uterine fibroid." Doctoral thesis, Università Politecnica delle Marche, 2013. http://hdl.handle.net/11566/242538.
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Beltrán, Zevallos Martín José. "Complicaciones maternas de la miomatosis uterina durante la gestación y parto en pacientes atendidas en el Hospital Docente Madre-Niño San Bartolomé : año 2012-2013." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2014. https://hdl.handle.net/20.500.12672/13109.
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Objetivo: Determinar las complicaciones maternas de la miomatosis uterina durante la gestación y parto en pacientes atendidas en el Hospital Docente Madre –Niño San Bartolomé. Año 2012-2013.
Metodología: Estudio observacional, descriptivo – comparativo, retrospectivo de corte transversal, realizado en una muestra de 100 pacientes con el diagnóstico de miomatosis uterina durante el embarazo cuyas gestaciones y partos fueron atendidos en el Hospital Docente Madre – Niño San Bartolomé. Año 2012 – 2013.
Resultados: Las características maternas más importantes de las pacientes con miomatosis uterina respecto a aquellas sin miomatosis, fueron en mayor porcentaje una edad de 20 a 34 años (52.9% vs 80.0%), educación secundaria (64.7% vs 20.0%), partos a término (82.4% vs 60.0%), antecedente de cirugía pélvica (29.4% vs 40.0%), antecedente de amenaza de aborto (17.6% vs 0.0%) e IMC adecuado (41.2% vs 40.0%), el resto de gestantes fueron catalogadas con sobrepeso u obesidad pregestacional, para ambos grupos. La frecuencia de miomatosis uterina durante el periodo de estudio fue de 51 casos. Entre las principales complicaciones maternas de la miomatosis uterina respecto a gestantes sin esta patología se encontró: anemia (47.1% vs 20.0%), dolor pélvico (5.9% vs 0.0%), Placenta previa (5.9% vs 0.0%) y parto prematuro (5.9% vs 0.0%); encontrándose a la cesárea en mayor porcentaje como medio de culminación del embarazo en gestantes con miomatosis (52.9%), respecto a aquellas gestantes sin miomatosis (20.0%). Asimismo, la mala presentación fetal (17.6%) y el trabajo de parto disfuncional (5.9%) fueron las principales complicaciones maternas durante el parto en gestantes con miomatosis, aunque no se presentaron en mayor porcentaje en este grupo respecto a aquellas sin miomatosis uterina. Por último, los resultados perinatales más importantes de los recién nacidos de gestantes con miomatosis fueron: sexo masculino (58.8%), peso adecuado al nacer (88.2%), APGAR al minuto ≤5 (5.9%), 6 – 7 (35.3%) y ≥8 (58.8), mientras que las puntuaciones del APGAR a los 5 minutos fueron en el 100% de casos ≥8 puntos.
Conclusiones: Las principales complicaciones maternas de la miomatosis uterina durante la gestación y parto fueron: anemia (47.1%), dolor pélvico (5.9%), placenta previa (5.9%), parto prematuro (5.9%), mala presentación fetal (17.6%) y trabajo de parto disfuncional (5.9%).Trabajo académico
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Myles, Ranell L. "Unbearable Fruit: Black Women's Experiences with Uterine Fibroids." 2013. http://scholarworks.gsu.edu/sociology_diss/72.
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Uterine Fibroids, medically termed uterine leiomyoma, are benign tumors of smooth muscle cells that grow in the uterus. While they are the most common pelvic neoplasm in women and fewer than 1 percent of fibroids develop into cancer, uterine fibroids can cause infertility, adverse pregnancy outcomes, and greatly affect one’s quality of life. Black women have been disproportionately affected by fibroids; when compared to white women, Black women are: 2-3 times more likely to have fibroids, diagnosed at a younger age, more likely to have 7 or more fibroids, more likely to have more severe and more troublesome symptoms (anemia, severe pelvic pain, constipation, and stomach aches), and have twice as many hysterectomies due to fibroids. Black women’s disproportionate affliction with uterine fibroids is particularly concerning given the historical medical injustices associated with Black women’s bodies and reproductive rights from slavery to present day. By placing Black women at the center of analysis and using a Black feminist epistemological framework, this study aims to make a unique contribution to medical sociology as well as literature on the theoretical and practical management of sickness and wellness among Black women in the United States. Using qualitative interviews and grounded theory methodology, the study examined how Black women frame the condition of having uterine fibroids. Specifically, the study investigated a) how Black women conceptualize having fibroids, b) how Black women’s conceptualizations of fibroids affect their feelings about selves or their lifestyles, c) the mechanisms, if any, by which Black women deal with uterine fibroids, d) how their multiple race, class, and gender identities affect their illness experiences and types of treatment that they seek, and e) how conventional and complementary/alternative medicine shapes Black women’s experiences with fibroids. Conceptualizations about fibroids are rooted in the race-gendered histories of Black women and the unique stressors that they face. Through interactions with doctors and among peers, Black women resist the unbearable burden of uterine fibroids through various coping strategies, but generally “keep it moving”. They avoid invasive surgeries through patient agency by being advocates for their medical treatment, self-researching, dialoguing with others, and directing doctor-patient interactions.
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Lin, Kun-Huang, and 林昆篁. "Use of different approaches in the management of uterine fibroids." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/48404983539343806067.
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碩士國立陽明大學
醫務管理研究所
102
Objectives: To determine the short-term effect between laparoscopic uterine artery occlusion without (LUAO) and with (LUVO) simultaneous blockage of anastomosis between the uterine and ovarian vessels in the management of women with fibroids. Materials and Methods: Fifty-one women with uterine fibroids were analyzed, including 27 women undergoing LUVO and 24 undergoing LUAO. The outcome was measured by comparing surgical technique (blood loss, operative time, complications, and success rate), patient compliance (postoperative pain, tolerance of food intake, free ambulation, and the return to work capability), and outcomes (symptom control, relapse of symptoms, re-intervention, and regularity of menstrual cycles) in both groups. Results: The general characteristics of the patients were similar in both groups. There were no statistical differences in surgical technique between the two groups. Compared with LUVO, LUAO had some advantages in its rapid postoperative recovery, less pain and earlier free ambulation. One-year outcome of both groups seemed to be similar without statistical difference. As medical cost, patients who received LUAO need to pay for NT 35,094. Patients who received LUVO need to pay extra NT 4,800 for 4 blood clips using in blockage of anastomosis between the uterine and ovarian vessels. Conclusions: The finding of better recovery and lower medical cost among the patients undergoing LUAO procedure without compromising short-term outcome, compared with LUVO procedure, is worthy of future investigation.
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Lu, Hao Sheng, and 呂豪笙. "Analysis of Chinese Herbal Medicine Network and Core Treatments in Uterine Fibroids." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/8jbrgt.
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Lin, Chia-Ying, and 林佳穎. "Association between Exposure to Air Pollution and the risk of Uterine Fibroids." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/3b7c53.
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HO, Ya-Lee, and 何雅利. "Factors Associated with Hysterectomy among Women with Uterine Fibroids – A Population-Based Study in Taiwan." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/8da532.
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LIU, HSIAO-YUN, and 劉曉雲. "Myomectomy for Uterine Fibroids Women：Short-time Change in Symptoms and Health Related Quality of Life." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/8v99hu.
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碩士國立臺北護理健康大學
護理研究所
105
Abstract Background: Women with uterine fibroids have irregular menstruation, abnormal bleeding, abdominal pain and other symptoms affecting their physical activity, activities, work and family. Thus, they choose surgical treatment, but still worry about postoperative symptoms and quality of life. Objective: To explore the important factors affecting the symptoms and quality of life of patients with uterine fibroids before and after resection of uterine fibroids, and to explore the symptoms of uterine fibroids and the short-term changes of quality of life, as well as the time factors that affect the symptoms and the impact of life quality. Methods: A total of 60 women who had undergone uterine myomectomy were collected from a medical center in the northern region. The data were collected from the structured questionnaire. The tools included basic demography and disease. Questionnaire, symptomatic disorder scale, healthy life quality scale, etc., were collected from the subjects in the preoperative, postoperative week, month, and three months. The data were compiled and analyzed by statistical software SPSS 19.0 for windows. Results: The most serious symptoms of uterine fibroids were the morst in the preoperative symptoms, the worst quality of life was improved, and the degree of symptoms was significantly decreased with the time, while the quality of life was significantly improved and the statistically significant difference was statistically significant. The three most common pre-operative symptoms that affected quality of life preoperatively in order of severity were "bleeding", "perception of distress", and "pain". The three factors that affected quality of life preoperatively were "attention", "perception of self", and "activity". One week after surgery, the top three symptoms that affected the of patients were "sleep condition", "perceptual distress", and "pain"; while the worst factors postoperative quality of life were "sexual function", "activity", and "control". The top three symptoms were "sleep", "bleeding", and "pain", and the worst factors of postoperative quality of life were: "sexual function", "attention", "mood", "control" at one month after operation. Three months after the operation, the top three symptoms were "bleeding", "sleep", and "pain", while the worst factors that affected quality of life were: "sexual function "," attention ", and " emotion ". Those with a university education were less affected by the symptoms, while those with a lower education level were more affected by the symptoms. The without employment were more severely affected by symptoms and had poorer quality of life. The most important prediotive factor of this study was the level of severity of the symptoms of uterine fibroids that affect their quality of life. Conclusion/clinical: Clinical care staff should be aware of the preoperative and postoperative symptoms in patients with uterine fibroids in order to provide individual care measures to help the case effectively to deal with symptoms. For those with emotional distress clinical care staff may consider psychological consultants to help women to reduce stress and reduce the impact on their quality of life. Key words: myomectomy, symptom distress, health-related quality of life, longitudinal study
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CHUANG, LI-HSUEH, and 莊麗雪. "Application of Muscle Meridian Therapy in Treating Gynecological Diseases: A Case of Uterine Fibroids Treatment." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/hf64fm.
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碩士萬能科技大學
經營管理研究所在職專班
106
The advent of the era of 3C products has overturned social progress and lifestyles. With the promotion of healthy concepts, many diseases cannot be cured under Western medicine. One of the traditional Chinese meridian methods of sacral conditioning provides the need for alternative medical services. I have been engaged in modern techniques for conditioning muscles for more than a decade. From my clinical experience, I found that the diseases of many patients will relapse if they are not cured. After years of collection and discussion, it has been found that uterine fibroids are one of the most common repetitive problems in gynecological diseases. This study proposes cases from clinical cases. With the use of tendon conditioning techniques, we have followed the system of tendons to explore the causes of uterine fibroids. By using tendon conditioning chniques, it is possible to achieve significant improvements. This approach can also be used to the improvement of other diseases. If positive incentives can be given in the future, in combination with sports and leisure and tourism health industries, the traditional folk-therapy can be utilized, and a complete system of folk-therapeutic can be constructed to build a healthy and peaceful environment and society.
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Lally, Olivia. "The quality of life of women who suffer from uterine fibroids when is the dysfunction enough? /." 2007. http://proquest.umi.com/pqdweb?did=1414119681&sid=1&Fmt=2&clientId=42585&RQT=309&VName=PQD.
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Thesis (M.A.)--Northern Kentucky University, 2007.Made available through ProQuest. Publication number: AAT 1447104. ProQuest document ID: 1414119681. Includes bibliographical references (p. 75-77)
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Koomson, Jacqueline Nyarkoa. "The role of estrogen receptors alpha and beta in the development of uterine leiomyomas." Thesis, 2017. https://hdl.handle.net/2144/23835.
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Uterine leiomyomas are benign tumors within the uterus, where patients present with symptoms such as abnormal bleeding, urinary retention, and pelvic pressure. The exact etiology of uterine leiomyomas is unknown, but numerous theories have been proposed, indicating a multifactorial mechanism, including lifestyle and steroid hormones. Uterine leiomyomas have become a public health concern due to the high cost of treatment as well as the high prevalence within African American communities. Currently, many treatment options exist, ranging from conservative treatments that address symptoms, to surgical intervention to remove the uterus. Research efforts thus far have determined the relationship between the role of estrogen in the growth of uterine leiomyomas (which has led to development of medications that target different approaches to estrogen synthesis) and its effects in the pathogenesis. Studies have shown that estrogen acts on estrogen receptor subtypes, ER and ER. This study examines the role of these two receptors in estrogenic effects, and how these effects relate to the development of uterine leiomyomas. Available research has shown that each receptor has its unique functions and impacts the growth of tumors differently. There is conflicting evidence in how the number of receptors and surrounding environment modulate leiomyomas, with some studies reporting that it is the corepressors and/or coactivators that ultimately determine the influence of estrogenic effects. However, the general consensus of such studies suggests that estrogen receptor-specific therapeutic intervention is a novel area with great potential. The primary benefit of estrogen receptor-specific treatment, such as selective estrogen receptor modulators, is the ability to regulate physiological processes that contribute to the growth of uterine leiomyomas. Future directions of research include confirming the exact roles of ER and ER and harnessing the effects of their differing functions to manage uterine leiomyomas.
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Кочарян, Александр Суренович, А. А. Макаренко, and Дин Шао Цзе. "Психологические особенности женщин с гинекологической патологией." Thesis, 2015. http://repository.kpi.kharkov.ua/handle/KhPI-Press/22878.
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Dzebu, Munyadziwa Jane. "The perceptions of women with fibroids from diverse cultures regarding hysterectomy." Diss., 2007. http://hdl.handle.net/10500/2411.
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The purpose of this study was to explore and describe contributing factors that influence the perceptions of women with fibroids from diverse cultures regarding hysterectomy. The area of research was delimited to issues of hysterectomy among women with fibroid uterus.
The study employed a descriptive explorative method and data were collected by means of structured questionnaires. The study was conducted in one academic referral hospital, over a period of six months. The respondents were the patients with fibroid uterus and the doctors and nurses in the gynaecological units of the hospital. The majority of the patients indicated that they were afraid of undergoing a hysterectomy because of the social stigma associated with this life-saving procedure, such as alienation or marginalization by members of their respective communities. The nursing staff and gynaecologists in the unit emphasized the deep-seated fear of hysterectomy amongst women from diverse cultures.
The study found that women need information about their bodies and how they function. Health education is also needed for women and their communities. Research is needed amongst members of different communities and diverse cultures to voice their perceptions of women undergoing hysterectomy because of ill health.Health Studies
M.A. (Health studies)
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Pan, Kuan-Chou, and 潘冠州. "High Intensity Focused Ultrasound for Uterine Fibroid Thermal Therapy." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/51713775644881846983.
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碩士國立臺灣大學
醫學工程學研究所
94
Uterine fibroids are the most common pelvic tumors in women and even it may affect fertility. The interventions for uterine fibroid are myomectomy, hysterectomy and uterine fibroid embolization (UFE). All of these surgical interventions are invasive until the exposure of focused ultrasound surgery. It can provide non-invasive intervention and largely decrease the probability of complications and post-operation bedrid time. Because of less invasive, focused ultrasound has become a promising tool for localized tumor therapy. Clinical tests, however, have shown that the main problems are long treatment time and skin burn which the ultrasound propagates through. In this study, based on a MRI compatible ultrasound treatment system, we carry out a simplified two - medium simulation for uterine fibroid intervention. The system is composed of four transducers which are oriented in an incident angle of 30 degrees to the skin – water interface to heat the target from four separate paths. Compared with single path stacking treatment which is used commonly on the present, using the system could disperse absorbed power in the skin under the condition of the same total power output. Soaking skin behind the target region in cooling degased water during operation aims to prevent over- heating in the skin. If the two transducers of the diagonal line operate simultaneously, it could lessen the treatment time. Compared with simulation results of multiple path treatment of our system and single path stacking treatment, multiple path treatment could provide precise heating intervention in a shorter time and diminish temperature elevation of the skin.
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Ramos, Ana Rita Roque Ribeiro de Andrade. "Miomas Uterinos: abordagem terapêutica atual e perspetivas futuras." Master's thesis, 2018. http://hdl.handle.net/10316/82145.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaO leiomioma uterino é um tumor ginecológico benigno frequente, atingindo 20-40% das mulheres em idade reprodutiva. Esta patologia associa-se a morbilidade significativa, afeta a qualidade de vida da mulher e representa a principal causa de histerectomia em Portugal. O presente artigo de revisão bibliográfica pretende analisar as atuais opções terapêuticas dos leiomiomas uterinos bem como as novas formas de tratamento médico que têm sido desenvolvidas. O tratamento médico tem como objetivo o controlo da sintomatologia e pode permitir ainda a redução da dimensão do tumor, abrangendo diversas classes farmacológicas tais como estroprogestativos, progestativos, agonistas da GnRH e moduladores seletivos dos recetores de progesterona. As técnicas minimamente invasivas no contexto da miomectomia, a embolização das artérias uterinas e os ultrassons de alta intensidade foram desenvolvidos com o intuito de preservar o útero, diminuir o tempo de recuperação e as complicações, constituindo assim alternativas à cirurgia convencional. Novos alvos terapêuticos como a gestrinona, a cabergolina, a vitamina D, os moduladores dos fatores de crescimento e a terapia génica poderão constituir abordagens futuras do tratamento farmacológico, verificando-se nos resultados preliminares uma redução da dimensão dos tumores, no entanto carecem de ensaios clínicos que fortaleçam a evidência da sua eficácia. O desenvolvimento de novas terapias farmacológicas bem como a investigação sobre a aplicação clínica de medicamentos já existentes poderão alargar a aplicação e eficácia da terapêutica médica, afastando as técnicas cirúrgicas para opções de segunda linha.
Uterine leiomyoma is a frequent benign gynecological tumor, and it affects 20-40% women in reproductive age. It has significant morbidity, interfering with women’s quality of life and represents the major indication for hysterectomy in Portugal. This review article aims to analyze the therapeutic options available, as well as the emergent medical therapies.Current medical treatment has the objective of symptomatic control, but it may also allow tumor downsizing and includes estrogen-progestins, progestins, GnRH agonists and selective progesterone receptor modulators. Minimal invasive techniques during myomectomy, uterine artery embolization and high frequency ultrasounds were developed for uterus preservation in order to reduce both recovery time and complications, being alternative procedures to conventional surgery. New therapy options, like gestrinone, cabergoline, vitamin D, growth factor modulators and genetic therapy, could become future pharmacological options. Preliminary studies have demonstrated volume reduction, although more clinical trials are needed to strengthen the evidence of its efficiency. The development of new pharmacological therapies as well as research on the clinical application of existing drugs will enlarge the clinical application and efficacy of medical treatment and point the surgical techniques for second line options.-------------------------------------------------------------------------------------------------------------------------------
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"Molecular characterization of immortalized human uterine leiomyoma cell lines: A fibroid model." Tulane University, 2006.
Find full textAbstract:
Human uterine leiomyomas (also known as fibroids, or myomas) are the most common benign tumors in women of reproductive age, affecting approximately 33% of all women and an estimated 77% of African American women. In the United States approximately 600,000 hysterectomies are performed annually at a cost of 1.7 billion dollars a year with fibroids accounting for 40% of procedures performed. Despite the high frequency of uterine leiomyomas and their major socioeconomic impact little research has been done in this area Many questions still remain to be answered concerning this disease. Therefore, we investigated a unique cell model to study uterine leiomyoma. First we characterized a novel immortalized cell line focusing on hormones and gene interactions. Cells were found to be estrogen responsive, and inhibited by ICI. High mobility group proteins are found in hormone responsive cancers such as breast, prostate, and benign uterine leiomyoma. We investigated an association between high mobility group proteins, estrogen, and estrogen receptors. From our data we concluded that high mobility group proteins are regulated by estrogen through the estrogen receptor pathway. Lastly using microarray technology we explored genes that may play a role in uterine leiomyoma growth. Our data suggest that growth of fibroids is not only activated through classic genomic pathways but also non-genomic pathways Our studies have tested a novel uterine leiomyoma cell line in hopes of establishing a universal model the field can use to study this important disease. Comparing our results with others in the field, we conclude that this cell line is an appropriate model for researching fibroids. Allowing researchers to explore molecular mechanisms involved in the etiology, growth and programmed cell death of these tumorsacase@tulane.edu
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Baptista, Marta Adriana Natário. "Fibromiomas e preservação da fertilidade." Master's thesis, 2019. http://hdl.handle.net/10316/89853.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: os fibromiomas ou fibroleiomiomas uterinos são os tumores benignos mais frequentes durante a idade reprodutiva. Podem causar grande desconforto no dia-a-dia da mulher e limitar o potencial da fertilidade feminina. Quando o tratamento é necessário, devem ser ponderados fatores como a idade, raça, desejo de gravidez futura e a classificação FIGO do fibromioma.Materiais e métodos: realizou-se a pesquisa através do Serviço da Biblioteca do Centro Hospitalar e Universitário de Coimbra e em plataformas, nomeadamente PUBMED, Mendeley e Google Scholar, com utilização das palavras-chave. Com o intuito de obter artigos de interesse para o tema, os artigos científicos foram selecionados pelos respetivos título e resumo, alargando-se a pesquisa a referências bibliográficas destes. Incluíram-se artigos em inglês e português, com restrição ao período entre 2013 e 2018.Resultados: há evidência significativa da associação dos fibromiomas submucosos com a infertilidade, assim como os fibromiomas intramurais com componente submucoso. Por outro lado, os fibroleiomiomas subserosos não se consideram causadores de infertilidade. As hipóteses sugeridas para explicitar os mecanismos pelos quais os fibromiomas influenciam negativamente a fertilidade compreendem a localização ou distorção do endométrio, o tamanho, a recetividade do endométrio para a implantação, a alteração das contrações uterinas ou da junção endo-miometrial.Conclusões: a ressetoscopia melhora os resultados reprodutivos das mulheres com fibromiomas submucosos que desejam engravidar após tratamento, sendo este o tratamento preferível. Os fibromiomas intramurais poderão ser excisados por laparoscopia, se indicação para tal, ainda que a evidência clínica seja dúbia. O acetato de ulipristal é o fármaco com maior potencial para utilização no contexto de preservação da fertilidade. Os métodos de tratamento minimamente invasivos não mostram resultados atrativos para doentes com desejo de posterior conceção.
Background: uterine fibroids or leiomyomas are the most frequent benign tumors during reproductive age. They may cause major discomfort in daily life routine and limit women’s fertility potential. When treatment needed, it should be considered age, ethnicity, desiring of pregnancy and fibromyoma FIGO classification. Methods: the key-words were used for article research through services of the Centro Hospitalar e Universitário da Universidade de Coimbra Library and platforms like PUBMED, Mendeley and Google Scholar. The articles were selected by both title and abstract, enlarged with references of the previously selected items. A period restriction was made from 2013 to 2018.Results: submucosal leiomyomas are associated with infertility with significant evidence, as for intramural fibromyomas with cavity distortion. On the other hand, subserosal leiomyomas are not considered for infertility. The suggested theories for explaining how fibromyomas negatively affect fertility outcomes are location or endometrial distortion, size, endometrial receptivity, changes of uterine contractions or endomyometrial junction.Conclusions: myomectomy improves reproductive outcomes for women with submucosal fibromyoma desiring to conceive after treatment. Intramural leiomyomas may be excised by the laparoscopic technique, even though the evidence is doubtful in some cases. Ulipristal acetate is the medical treatment that potentially may be used in the context of fertility preservation. Minimal invasive techniques do not show encouraging outcomes for women who wish to conceive in the future.