Uterine Fibroids

Uterine fibroid is the most common benign tumor in women,
above all in childbearing age because of estrogen-dependency. In fact,
in this age group, it has an incidence of 25-30% and requires different
management and treatment depending on various factors such as location, volume, number and symptoms. Fibroids originate from the uterine smooth muscle component, they can be single or more often multiple and their size can range from a few millimeters to more than 20 cm in diameter. Depending on their location within the uterine wall, they are classified into: submucosal fibroids which develop below the endometrium protruding, in some cases, into the uterine cavity; intramural fibroids which grow in the thickness of the myometrium; subserosal fibroids which originate below the peritoneal serosa. Our review takes into account the literature data on the various practical techniques for the treatment of uterine fibroids, emphasizing in particular those concerning the usefulness and effectiveness of uterine artery embolization (UAE). In fact, the UAE is an interventional radiologic technique of more recent introduction that, in appropriately selected cases, may represent a minimally invasive alternative to hysterectomy and myomectomy procedures.

Dr. Bogdan Amza | Clinica Venart Cluj-Napoca. Informatii si programari +40 364 140 261-chirurgie bariatrica cluj, tratament obezitate cluj, tratament varice cluj, chirurgie generala cluj. Fibromul uterin-cauze, simptome, riscuri, investigații, tratament si recuperare Fribromul uterin este o afectiune medicala care afecteaza cel putin una din trei femei din Romania. Conform anumitor studii efectuate in tara noastra, 40% dintre femeile de pana in 35 de ani sufera de fibrom uterin, iar doamnele in jurul vastei de 50 de ani sunt afectate de fibrom uterin in proportie de pana la 80%. Aceasta boala afecteaza femeile atat din punct de vedere fizic, dar mai ales din punct de vedere emotional si psihic, modificand calitatea vietii femeilor. Fibromul uterin apare in special la femeile fertile, la varste cuprinse intre 30 si 40 de ani. Ce este fibromul uterin? Fibromul uterin este o formatiune celulara care se dezvolta fie in interiorul uterului, fie la exteriorul uterului, fie pe peretele uterului. Fibromul uterin este o tumora fibroasa BENIGNA, adica necancerosa. In timp fibromul uterin creste si isi poate schimba forma, localizarea si influenteaza chiar simptomele pacientei. In plus, poate cauza chiar schimbarea formei uterului. Fibromul uterin NU se dezvolta inaintea aparitiei ciclului menstrual, el fiind imposibil in cazul fetelor aflate la pubertate. De ce se formeaza fibromul uterin? Dereglarile hormonale favorizeaza aparitia fibromului uterin. Odata format, fibromul uterin continua sa creasca influentat de hormonii estrogeni si progesteron. In timpul sarcinii organismul femeii produce o cantitate mai mare de estrogeni, insa dupa menopauza productia de estrogeni scade considerabil.

This paper discusses how both the female and male reproductive systems work.  The assessment also explains a few infertility issues prominent in men and women.  Not only does it discuss the issues, but furthermore discusses how a couple could go about overcoming such issues.

Uterine leiomyoma also known as fibroid is a medical problem of the female reproductive tract and prevalent among black women of child-bearing age. Monosodium glutamate (MSG), a popular food seasoning agent is an oestrogen disruptor but its intake has not been linked to fibroid. Fibroid has no known chemotherapy and hysterectomy leaves huge financial burden with side effects. It is necessary to determine its safer management method. This work investigated the effects of aqueous extracts of (turmeric) and (ginger) on uterus and kidney sections of rats with monosodium glutamate-induced leiomyoma. Twenty-eight rats were used. They were divided into four groups of seven rats each and acclimatized. Fibroid was induced on three groups after daily ingestion of 750mg/kg body weight of MSG for 28 days. Negative control had no fibroid. Positive control had fibroid but remained untreated. Groups III and IV also had fibroid. Groups III and IV were continuously ingested with the same dose of MSG for the next 28 days with daily oral treatment using 250mg/kg body weight aqueous extracts of turmeric and ginger, respectively. Histological examinations were performed on the 2 and 4 weeks, respectively, on two rats from each group for the next 28 days. Results showed nephrotoxic effects of MSG with endometrial degeneration. Group III rats gave mild histological textures of their tissues compared with Group IV rats. MSG ingestion is nephrotoxic but the use of turmeric aqueous extract alleviated this effect and could be used in fibroid of management. : Leiomyoma, monosodium glutamate (MSG), (turmeric), (ginger), uterus, kidneys. Curcuma longa Zingiber officinale Curcuma longa Zingiber officinale nd th Eze-Steven: Histopathological effect of turmeric and ginger on leiomyoma in rats

Актуальность. Проведение эмболизации маточных артерий (ЭМА) как метода лечения миомы матки связано с риском развития разнообразных осложнений, среди которых отмечают тромбоэмболию легочных артерий (ТЭЛА). Описание клинического случая. Больной 36 лет, не имеющей на момент поступления патологии сердечно-сосудистой системы, в связи с фибромиомой матки была выполнена ЭМА. Спустя сутки после процедуры у больной наблюдалось удушье, падение АД, а в дальнейшем полное прекращение сердечной деятельности. После реанимационных мероприятий ритм сердца и АД восстановились, диагностирована ТЭЛА, проведен поэтапный системный внутривенный тромболизис (урокиназа, нефракционированный гепарин). После проведенного лечения состояние больной улучшилось. Заключение. ТЭЛА является нередким и весьма грозным осложнением ЭМА. Для его предупреждения перед выполнением процедуры пациентки должны быть тщательно обследованы на предмет наличия скрытого тромбоза и при его наличии необходимо провести соответствующие лечебные мероприятия.

Objective: to compare the histological findings of different methods of diagnosis of abnormal uterine bleeding with histopathology after hysterectomy. Patients and methods: 100 patients above the age of forty with abnormal uterine bleeding was selected for the study, including all patients who underwent D&C , pipelle, ryle suction and hysteroscopic guided biopsy and within 2 months, hysterectomy. The sensitivity, specificity, positive and negative predictive values and accuracy of each diagnostic method were studied. Results: the accuracy for D&C, pipelle, ryle suction and hysteroscopic guided biopsy for diagnosing endometrial carcinoma was (81.5%) ,(71.2%),(73.1%), (83.4%) respectively and for diagnosing endometrial hyperplasia with atypia (78.2%), (69.22%), (74.7%),(81.2%) respectively and for diagnosing endometrial polyp (25.7%),(16%),(18.9%),(91.6%) respectively. Conclusion: D&C biopsy has better accuracy than pipelle and ryle suction biopsy in the diagnosis of endometrial pathologies in patient with abnormal uterine bleeding but all were not adequate method for focal endometrial pathologies determination whereas hysteroscopy is considered the gold standard and a valuable method for diagnosing abnormal uterine bleeding with accurate local uterine pathology determination .

Uterine leiomyoma’s are noncancerous growths of the uterus1 and represent the most common benign tumors of the female reproductive tract. Fibroids affect 20-50% of women of reproductive age, while its presence in the adolescent population has not been well documented. The etiology of uterine fibroids is unclear; however, their growth is regulated by ovarian steroids, and growth factors. Multiple uterine leiomyoma’s represents a great challenge for diagnosis and therapy. Several new therapies show promise, but are still at the experimental stage.2 This report illustrates the case of a 22 year old woman presenting to the gynecology department with an 8-month history of progressively increasing abdominal size associated with pain. There was no history of nausea, vomiting, weight loss, loss of appetite or menstrual irregularities. Physical examination and ultrasound pelvis suggested multiple enlarged uterine fibroids. A myomectomy was performed and multiple fibroids were resected weighing 4.5kg. The patient’s postoperative evolution was uneventful and she was discharged from the hospital on the fourth postoperative day.

Any reasonable surgeon of gynecology should know this BASIC information and know that the morcellation device is flawed and would spread disease and kill women. However, Storz and J&J pushed only for sales of the device and the scheduling of operations using the device. They have used fear and ignorance of women to prey upon them.  There was NO concern whatsoever as to the outcome for the women patients by Storz, J&J, and surgeons using the device. Their main focus was and still is profit and income for themselves and stock holders. The fact that I have to write this document and bring this to enforcement reflects the failure of our current systems that are in place.

Nowadays, uterine myomas represent a very common clinical
entity. Approximately 20%-40% of the women in the reproductive
age have uterine myomas [1,2]. However, in menopause there is
a significant decrease in the incidence of uterine myomas [2,3]. A
lot of patients with uterine myomas have no symptoms, because
these tumors are usually asymptomatic [1]. Nevertheless, patients
with uterine myomas may have: abnormal uterine bleeding, pelvic
pain, pressure complaints, infertility and pregnancy-related complications
[1,3,4].

Background: To evaluate the clinical efficacy and safety effect of Ovaryl tablet a marketed herbal formulation of Mercury Laboratories Ltd., in Poly cystic Ovarian Syndrome. Methods: 58 women patients’ age range between 20 to 40 years, suffering from Poly cystic Ovarian Syndrome symptoms like hirsutism, irregular periods, ovulation, volume of ovary, weight and serum insulin levels. Results: A significant improvement was observed in clinical symptoms like hirsutism, irregular periods and ovulation after MOT medication.Laboratory investigation showed decrease in Serum Insulin levels. A minimum decrease of 2.87% and 36.73% maximum decrease of serum insulin levels were observed on 90th day of MOT treatment. 22.06% maximum and 1.55% minimum decrease of ovary volume in Right Ovary. 24.39% maximum and 1.37% minimum decrease of ovary volume in Left Ovary was observed. Upper Abdomen USG was normal in all the 58 patients, no cyst was reported. Conclusion: Poly cystic Ovarian Syndrome symptoms...

The present study aims at the analysis of data obtained from patients with Uterine Fibroid. The studies consist of data obtained from 105 patients in respect of clinical and follow up actions for the treatment of Fibroid. Non-parametric methods viz., Kaplan-Meier, Product-limit method, Log Rank Test and Cox Regression models have been used for analyzing the Fibroid data. The analysis revealed the significant role played by certain variables in the survival of patients with Fibroids.

Abstract
Fibroids are the most common benign gynaecological tumour. Most of the fibroids are situated in the body of the
uterus, but 1-2% of cases, are confined to cervix. We report two cases with huge central cervical fibroid with
uterus sitting on the fibroid i.e. lantern on the St. Paul’s. Both were treated by total hysterectomy. One of them
was complicated with iatrogenic pelvic ureter transection that repaired intraoperative.
Key words: Cervical fibroid, ureteric  injury, hysterectomy

Uterine fibroids affect about 25% of women of reproductive age. This study, therefore, aims to relate Age at Menarche (AAM) and pelvic pain with the occurrence of Uterine Leiomyomata (UL) in SouthEastern Nigeria. The study was carried out in the radiology lab of three hospitals and two diagnostic Centers covering the three senatorial zones in Imo State, Nigeria; Owerri, Orlu and Okigwe. A non-interventional cross-sectional descriptive study with eligible participants (3301)was recruited by convenience sampling method using a structured questionnaire. AAM was found as a significant factor of UL (p=0.0001, χ 2 = 140.64). This indicates that for the menarche age of 11 years or less, the risk of having UL is significantly 6 times more compared to that of the 12-13 years menarche age (p< 0.0001, RR=6.24, 95%CI = 4.88-7.88), and 7.5 times more compared to risk at not less than 14 years menarche age (p< 0.0001, RR=7.53, 95%CI = 5.16-11.12).The result of this study demonstrates a significant correlation between age at menarche and the occurrence of uterine fibroids. Early menarche age increases the risk of uterine fibroid incidence, whereas pelvic pain is more likely a gynaecological manifestation of uterine fibroid, rather than a risk factor.

Uterine myoma is a benign monoclonal solid tumor of the pelvis emanating from the smooth muscle tissue of the myometrium. Previously, it was considered that only hyperestrogens are the cause of the appearance and growth of fibromatosis. The high prevalence of uterine fibroids in the population forces the scientific world to explore the most subtle pathogenetic mechanisms in order to find an individual, personalized approach to its treatment.

The last decade has been quite rich with new data on the pathogenesis of uterine fibroids, and yet, none of the theories of the initiation of the pathological process not been fully studied. At the same time, experts understand the situation and have a certain resource for pathogenetically influence on the growth of fibroids. “Turning off” the action of steroid hormones, and especially progesterone, is possible to create the conditions for the natural involution of fibroids. Therefore, the appearance of ulipristal acetate has changed the views on treatment and preoperative preparation of women with uterine myomas.

Unreasonable use of medicine threatens patients with uterine myoma with adverse effects. Therefore, in modern conditions, a careful control is carried out to the choice of treatment method and patients to whom one or another method is indicated. Modern treatment of uterine myoma is a personalized approach and a combination of various methods (surgical and non-surgical).

To date, it has been shown that ulipristal acetate allows not only delaying surgery, but in some cases avoiding it altogether. After treatment with ulipristal acetate,

the therapeutic effect is more pronounced and lasts longer compared to other pharmacological regimens proposed earlier. This opens up great prospects for practical gynecology, including its outpatient level. With proper use, monitoring, and proper selection of patients, ulipristal acetate is an innovative strategy for organ-preserving uterine fibroids when surgical treatment is not indicated.

The uterine artery Doppler velocimetry (UADV) are described by authors in 108 women with history of hypertensive disorder of pregnancy (HDP) between the 10th and 13th week of pregnancy to identify those at higher risk for recurrent preeclampsia and to evaluate the efficacy of prophylactic pharmacological treatment in this subgroup of patients. Patients with abnormal flow values (RI > 0.58 and any notching) were immediately started on aspirin 100 mg/daily, replaced by daily subcutaneous injection of low molecular weight heparin from the 24th week till delivery. Concerning the maternal morbidity (expressed by abnormal both mean blood pressure and 24-hour proteinuria throughout pregnancy), the Authors found that the average pregnancy course in 20 (18.5%) prophylactic treated patients with altered 1st trimester UADV (group A) was better than in their previous pregnancies, however regarding the above parameters no significant difference (P > 0.05) was found between the patients treated and another cohort of patients (n =20), also extrapolated from the same pool of patients at risk for HDP, but with normal I trimester UADV studies (group B) who were not prophylactic treated. Both groups of patients were followed up from the time of Doppler studies till 6 weeks post partum. The study suggests that UADV in the late first trimester of pregnancy is useful in reducing the risk of preeclampsia in patients with history of HDP, allowing the prompt institution of prophylactic treatment in selected patients. Index Terms—About four key words or phrases in alphabetical order, separated by commas.

Objective: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients. Design: Retrospective analysis. Setting: Tertiary care advanced laparoscopic center. Patient(s): Twenty-eight infertile patients with at least one uterine leiomyoma of Ͼ5 cm in diameter. Intervention(s): Laparoscopic myomectomy. Main Outcome Measure(s): Occurrence of pregnancy, delivery rate, and pregnancy-related complications. Result(s): The average size of the myomas removed was 6 cm (range, 4 -13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n ϭ 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported. Conclusion(s): Laparoscopic myomectomy can be offered to patients who want to have children and who refuse to undergo an abdominal myomectomy. Patient selection as well as meticulous surgical technique are the key factors in achieving a successful outcome. (Fertil Steril 1999;71:571-4.

Background: To evaluate the clinical efficacy and safety effect of Ovoutoline Forte tablet a marketed herbal formulation of Emami Limited, in Dysfunctional Uterine Bleeding (DUB). Methods: 57 women patients&#39; age range between 20 to 40 years, suffering from Dysfunctional Uterine Bleeding symptoms like mid cycle bleeding, late cycle bleeding and irregular periods. Results: 100%, 96.49% and 94.74% improvement was observed in patients with DUB symptoms like mid cycle bleeding, late cycle bleeding and irregular periods after ZOFT medication respectively. Upper Abdomen USG was normal in all the 57 patients, no uterine fibroids was reported. Conclusion: Dysfunctional Uterine Bleeding symptoms like mid cycle bleeding, late cycle bleeding and irregular periods were taken care off.

Parasitic/Wandering fibroid is a subserosal uterine benign neoplasm with unusual locations that can puzzle radiological findings and diagnosis. In our study, a 63 years old female cadaver showed an accidental finding of a fibroid band extending from the anterior surface of the uterus to the lower part of the greater omentum. We aim to study the morphometry of the parasitic band with discussion on the development of the uterus and omentum to find possible congenital connections of this fibroid band.

Aim We aim to discuss cases with gastrointestinal stromal tumor and leiomatosis peritoneal dissemeniata LPD regarding their diagnosis and surgical management with pitfalls related. We also aim to focus on management of multiple nodular serosal lesions. Method Two cases are presented. Both were diagnosed as advanced ovarian cancer on CT and ultrasound imaging by multiple nodular peritoneal lesions, omental cake and adnexal masses. Tumor markers were normal in both cases. Both were scheduled for exploratory laparotomy. One patient diagnosed with neurofibromatosis type I. Results Midline laparotomy was done for one case revealing normal adnexa with multiple fibroid uterus, peritoneal solid masses with large mesenteric and omental masses related to the small intestine. Total hysterectomy with bilateral salpingo-oophorectomy, total omentectomy and resection anastomosis for the small intestine with removal of macroscopic lesions were done. Midline line laparotomy was done for the second case revealing free adnexa with subserous vascular fibroids and omental fibroid solid masses. Total hysterectomy with bilateral salpingo-oophorectomy and total omentectomy and removal of macroscopic peritoneal lesions seen were done. The second case was diagnosed as Disseminated Peritoneal Leiomyomatosis, and the other case was diagnosed with multiple uterine fibroid and metastatic GIST on histopathology. Conclusion Disseminated Peritoneal Leiomyomatosis and metastatic GIST can be similar on imaging and operative findings. Also they are similar to other lesions especially peritoneal carcinomatosis as in advanced ovarian cancer. These pathologies should be kept on mind when encountering multiple solid nodular masses in the visceral and parietal wall peritoneum and the omentum on imaging and intra-operative especially with normal associated tumor markers of ovarian cancer as serum CA125. Surgical and postoperative management differ according to the pathology. These pathologies should be confirmed by histopathology and immunohistochemistry. Frozen section is highly needed in these cases to optimize management.

Conclusion: Ulipristal offers a unique opportunity to effectively and rapidly control menstrual bleeding in patients with uterine fibroids; thereby improving their quality of life while minimizing the probability of moderate-to-severe hot flashes that are common with leuprolide.

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In a prior randomized controlled study, patients treated with ulipristal acetate (UPA) or placebo for 3 months had a decrease in leiomyoma size. A total of 10 patients' tissue samples (5 placebo and 5 treated with 10 mg/d UPA) that underwent hysterectomy and tissue preservation were identified from this study. Quantitative real-time reverse transcriptase polymerase chain reaction and Western blotting were used to assess fold gene and protein expression of extracellular membrane (ECM) proteins: collagen 1A (COL1A), fibronectin (FN1), and versican (VCAN) of the samples. Confirmatory immunohistochemical analysis was performed. Changes in total matrix collagen were examined using Masson trichrome staining. Multiplex measurement of the matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases was performed. Compared to placebo-treated surgical specimens, 80% of the treated specimens showed decrease in VCAN protein, 60% showed decrease in FN1, but no consistent alteration in COL1A. This effect was also supported by immunohistochemistry where leiomyoma surgical specimens demonstrated decreased amount of FN1 and VCAN on UPA treatment. Increased MMP2 and decreased MMP9 in treated patient leiomyomas indicate both degradation of the matrix and inhibition of the pathway involved in matrix production. Treatment with UPA decreased fibroid volume in placebo-controlled, randomized trials. Treatment with UPA decreased gene expression and protein production in leiomyoma tissue, suggesting both an impact on water content and ECM protein concentration as a mechanism of ulipristal-mediated decrease in leiomyoma size.

Purpose Lipoma is the most second common mesenchy-mal tumor in the vulva. It is rarely seen at the Gyneco-logical clinic. The site and its painless nature delay presentation. Surgical excision and cosmetic approximation of the skin is the treatment of choice. Methods We present a case of asymptomatic huge vulval lipoma in a 40-year-old woman with submucus uterine myoma. Results Vulvar lipoma was excised with hysteroscopic resection of the myoma. Conclusions Uterine fibroids are common, and hys-teroscopy is main treatment for cavitary ones. Recognition of this benign vulvar swelling is important to differentiate it from other swellings and malignant neoplasms in the vulva. Uterine fibroids and lipomas are mesenchymal tumors that can occur simultaneously at different sites.

Abstract:
Lipoleiomyoma is a rare benign uterine tumour consisting of smooth muscles and mature adipose tissue.  They  are uncommon benign tumours of  the uterus and are considered to be a variant of uterine myomas. Their reported incidence  is  0.03 to 0.2%. Most cases cannot be distinguished clinically from leiomyoma and to a large extent diagnosis can be made on the typical gross appearance of the tumour. The majority of patients do not report any symptoms. Almost all of the cases have been reported in postmenopausal women and are predominantly located in the uterus; however, extrauterine locations have been reported as well.
Keywords : cervical leiomyoma, lipoleiomyoma, ultrasound.

Background & Objective: Uterine fibroids (UF) in pregnancy is a condition, where symptomatic or asymptomatic fibroids in the uterine cavity may cause complications in pregnancies. Placental abruption and preterm labor, occurs in late pregnancy, postpartum hemorrhage, caesarean section and retained placenta in perinatal period. This study aimed to reckon whether the surgical Caesarean myomectomy is still a gold standard in myoma removal in pregnant women. Materials & Methods: This study was retrospectively conducted in pregnant women deliveries with uterine fibroids who underwent Myomectomy with lower segment caesarean section (LSCS). The caesarean myomectomy cases were compared with LSCS alone controls in 1:2 ratio. The primary outcome is to minimize blood loss and need for blood transfusion. The secondary outcome is the length of surgery duration and hospital stay. Results: The outcome of case and control compared was 43 caesarean myomectomy with LSCS as case group and 86 LSCS Alone as control group. The incidence of hemorrhage in case group was 10 out of 43 while control was 2 out of 86 (2.32%) with P-value of 0.0017. The secondary outcome was the length of surgery duration and hospital stay which were found statistically significant between the case and control groups, with P-value = 0.0001 and 0.0072, respectively. Conclusion: Caesarean Myomectomy can be the effective surgical option to enucleate uterine myoma, and preserve uterus and jettison from eventful or symptomatic uterine fibroids. To have the chances for prevention of immediate or interval-myomectomy / hysterectomy and control of post-partum menstrual over bleeding.

Do you have uterine fibroids? If yes, then you may go through the uterine fibroid embolisation or UFE procedure. UFE can provide you with a fibroid- free and painless life. To lead a healthy life, consult with the doctor and get UFE treatment.

In Patwardhan’s method of delivery in obstructed labour, the incision over lower uterine segment is made at the level of the anterior shoulder of the baby as the head is deeply impacted. Anterior shoulder is then delivered along with the anterior arm by hooking a finger in the elbow if required posterior shoulder is rotated forward and is similarly delivered. The trunk, breech and the lower limbs are successively delivered by traction on arms aided by fundal procedure.

The purpose of this prospective multicenter study was to assess the safety and technical feasibility of volumetric Magnetic Resonance-guided High Intensity Focused Ultrasound (MR-HIFU) ablation for treatment of patients with symptomatic uterine fibroids.
Thirty-three patients with 36 fibroids were treated with volumetric MR-HIFU ablation. Treatment capability and technical feasibility were assessed by comparison of the Non-Perfused Volumes (NPVs) with MR thermal dose predicted treatment volumes. Safety was determined by evaluation of complications or adverse events and unintended lesions. Secondary endpoints were pain and discomfort scores, recovery time and length of hospital stay.
The mean NPV calculated as a percentage of the total fibroid volume was 21.7%. Correlation between the predicted treatment volumes and NPVs was found to be very strong, with a correlation coefficient r of 0.87. All patients tolerated the treatment well and were treated on an outpatient basis. No serious adverse events were reported and recovery time to normal activities was 2.3 ± 1.8 days.
This prospective multicenter study proved that volumetric MR-HIFU is safe and technically feasible for the treatment of symptomatic uterine fibroids.
• Magnetic-resonance-guided high intensity focused ultrasound allows non-invasive treatment of uterine fibroids. • Volumetric feedback ablation is a novel technology that allows larger treatment volumes • MR-guided ultrasound ablation of uterine fibroids appears safe using volumetric feedback.

ABSTRACT Introduction Uterine fibroids (UF) are benign tumors common in premenopausal women, with strong impact on the health-care systems. For many years, surgery represented the only therapy for symptomatic fibroids. However, clinicians are observing a switch from surgery to noninvasive methods; in particular, medical treatment has been shown to be efficacious in obtaining a bleeding reduction and in ameliorating patient conditions. Areas covered The authors review the current options available for the treatment of women with UF, with a special focus on the newest one, relugolix. It is an orally active non-peptide Gonadotropin-releasing hormone (GnRH)-receptor antagonist recently licensed for women with symptomatic fibroids. Relugolix is a well-tolerated safe drug; it is effective in inducing a dose-dependent decrease in menstrual blood loss, with faster reduction of heavy menstrual bleeding (HMB) and a greater shrinkage in fibroid volume compared to the current standard of GnRH agonist treatment. Expert opinion Relugolix is a promising drug for the non-surgical treatment of women with UF. To date, the only published data come from a well-selected Japanese female population study while results from worldwide ongoing studies are ongoing in order to confirm the efficacy of this GnRH agonist receptor.

Objectives: To identify the different types of cervical dystrophy in the DAKAR region and make a comparison between the epidemiological and cytological aspects. Patients and Methods: 2391 cases of significant cervico-uterine smears performed in the period from August 1, 2014 to June 1, 2016. Data collection was performed at the laboratory of Cytology, Cytogenetics and Reproductive Biology of the CHU Aristide Le Dantec. Results: The average age of the patients was 47.72 years. Patients referred for routine checkups with no apparent clinical manifestations represented 43.16%. The women with more than 5 children were 8.67%, sometimes with multiple abortions. Infectious dystrophies accounted for 54.37%. Conclusion: Cervical dystrophy are benign lesions that could, by their persistence, lead to low-grade epithelial lesions.

OBJECTIVE To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients. DESIGN Retrospective analysis. SETTING Tertiary care advanced laparoscopic center. PATIENT(S) Twenty-eight infertile patients with at least one uterine leiomyoma of &gt;5 cm in diameter. INTERVENTION(S) Laparoscopic myomectomy. MAIN OUTCOME MEASURE(S) Occurrence of pregnancy, delivery rate, and pregnancy-related complications. RESULT(S) The average size of the myomas removed was 6 cm (range, 4-13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n = 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported. CONCLUSION(S) Laparoscopic myomectomy can be offer...

Despite the numerous studies on the factors involved in the genesis and growth of uterine leiomyomas, the pathogenesis of these tumors remains unknown. Intrinsic abnormalities of the myometrium, abnormal myometrial receptors for estrogen, and hormonal changes or altered responses to ischemic damage during the menstrual period may be responsible for the initiation of (epi)genetic changes found in these tumors. Considering these elements, we aimed to offer an overview about epigenetic and genetic landscape of uterine leiomyomas. Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases. Several studies showed that leiomyomas have a monoclonal origin. Accumulating evidence converges on the risk factors and mechanisms of tumorigenesis: the translocation t (12;14) and deletion of 7q were found in the highest percentages of recurrence; dysregulation of the HMGA2 gene has been mapped within the critical 12q14-q15 locus. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has been poorly explored. The growth factors with mitogenic activity, such as transforming growth factor-β3, fibroblast growth factor, epidermal growth factor, and insulin-like growth factor-I are elevated in fibroids and may have a role as effectors of the tumor promotion. The new clues on genetics and epigenetics, as well as about the growth factors that control normal and pathological myometrial cellular biology may be of great help for the development of new effective and less invasive therapeutic strategies in the near future.

Leiomyoma is considered as the commonest benign tumor of the genital tract. This case represents a multiparous woman who presented with a history of progressive abdominal distension. On examination, a mobile illdefined centrally located intra-abdominal mass was noticed. At laparotomy a parasitic fibroid attached to the greater omentum was seen. Resection of the mass and partial omentectomy was performed which was reported as leiomyoma by the histological examination. The patient had an uneventful post-operative recovery. She has been followed up for twelve months with no evidence of recurrence or residual disease. Keywords: Greater omentum; Parasitic leiomyoma; Serpentine; Uterus

Despite a significant amount of research on the pathogenesis, diagnosis and treatment of uterine fibroids, many questions remain unanswered today. The appearance and progressive growth of this formation is the result of a whole complex of disorders in the female body: neurohumoral, genetic, inflammatory and others that suppress reproductive function and worsen the course of the disease. Given the number of key factors in the pathogenesis and pathophysiology of uterine fibroids, the treatment of this group of patients should be comprehensive, aimed at early detection, treatment of concomitant gynecological diseases and correction of hormonal disorders.
In recent decades, hormone therapy has been widely used for the conservative treatment of uterine hyperplastic diseases. However, according to some data, the use of COCs or intrauterine hormonal releasing system has a slight blocking effect on fibroid growth processes. Pharmacotherapy of the disease can be both a stage for preoperative preparation on the organ, and an independent unit for stabilizing the nodes and getting rid of surgical treatment. And although the results of conservative treatments indicate their effectiveness, it should be stated that the main method of treatment of uterine fibroids is surgery.
In the age of endoscopic surgery, this discussion has not exhausted itself and the modern approach to the treatment of uterine fibroids dictates the expansion of indications for organ-sparing operations. The choice of their methodology should be considered and determined by the size, location, clinical picture of the disease and the feasibility of preserving menstrual and reproductive function of women. Laparoscopic myomectomy is considered a minimally invasive and less traumatic intervention, contributes to a favorable course of the postoperative period and reduces pain. With effective organ-sparing surgical treatment of uterine fibroids in women of reproductive age, the menstrual cycle is normalized, reproductive function is restored, and pregnancies usually occur in 1,5-2 years after surgery.
Endoscopic treatments are now successfully used both for planning a pregnancy and for its onset. A significant amount of patients have an uncomplicated course of pregnancy and childbirth, even in the presence of multiple and small nodes. Of course, pregnant women with fibroids can not be considered as a homogeneous group of patients, clearly recommending the preservation of pregnancy. The predominant location and size of the tumor, the degree of pathological changes in the myometrium, the duration of the disease, the state of health of the woman, the age of the woman giving birth for the first time, determine different degrees of risk of pregnancy and childbirth for mother and fetus. The division of patients into risk groups allows to differentiate the question of the feasibility of maintaining pregnancy, to carry out appropriate clinical and laboratory examinations and preventive measures to prevent complications.

Leiomyoma is considered as the commonest benign tumor of the genital tract. This case represents a multiparous woman who presented with a history of progressive abdominal distension. On examination, a mobile illdefined centrally located intra-abdominal mass was noticed. At laparotomy a parasitic fibroid attached to the greater omentum was seen. Resection of the mass and partial omentectomy was performed which was reported as leiomyoma by the histological examination. The patient had an uneventful post-operative recovery. She has been followed up for twelve months with no evidence of recurrence or residual disease. Keywords: Greater omentum; Parasitic leiomyoma; Serpentine; Uterus

Uterine leiomyoma is commonly known as fibroid. Increased use of chemicals is believed to enhance its prevalence and monosodium glutamate is implicated. Fibroid is prevalent among black women with no known drug for its treatment. It is therefore necessary to determine a safer method for fibroid treatment. This work investigated effects of different aqueous extracts of Spondias mombin (hog plum) and Aspilia africana (wild sunflower) leaves on uterus and kidney cells of rats with monosodium glutamate (MSG)-induced fibroid. Twenty-eight rats used in this study were divided into four groups of seven rats each and acclimatized. Fibroid was induced on the Positive control, Groups III and IV, after daily ingestion of 750mg/kg body weight of MSG for 28 days. Negative control had no fibroid but the Positive control remained untreated. Groups III and IV were continuously ingested with same dose of MSG for the next 28 days with daily oral treatment using 250mg/kg body weight aqueous extracts of hog plum and wild sunflower, respectively. Histological examinations were performed on the 2 nd and 4 th weeks, respectively, on two rats from each group for the next 28 days. Results showed degenerated endometrial cells and preserved nephritic tissues after treatment with aqueous extracts of S. mombin leaves. There was mild hyperplasia of endometrial cells after treatment with extract of A. africana in the 2 nd week which differed from the 4 th week. MSG has nephrotoxic properties and aqueous extract of S. mombin alleviated MSG oxidative powers on rats' endometrial cells. With continuous ingestion, A. africana aqueous extract better preserved rat's endometrium from oxidizing action of MSG. These extracts could be used as safer chemotherapy in fibroid management.

Actuality: fibroids (leiomyoma, fibroids) of the uterus are a benign tumor of muscle and connective tissue of the uterus. The principal goals of treatment are to remove the tumor (surgery) or inhibition of tumor growth and regression of tumors (conservative treatment). Possibilities of hormonal therapy (gonadotropin-releasing hormone antagonists) are limited and involve a number of side effects. Clearly, any of these treatments affects the quality of life of patients.

Objective: to conduct a comparative assessment of the quality of life of patients after treatment of uterine fibroids by different methods