Management of leiomyomas in perimenopausal women

Ciarmela, Pasquapina; Ciavattini, Andrea; Giannubilo, Stefano Raffaele; Lamanna, P; Fiorini, Rosamaria; Tranquilli, Andrea Luigi; Christman, Gregory M.; Castellucci, Mario

doi:10.1016/j.maturitas.2014.04.011

Cited by 38 publications

(33 citation statements)

References 49 publications

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“…However, the common assumption that uterine fibroids (and their related symptoms) will be resolved by the approach of menopause may not always be valid. [25] A recent review by Ciarmela et al [26] reported that women in the perimenopausal period should be considered to have a higher risk of developing fibroids, and that for these women it is also plausible that existing fibroids may continue to grow. Moreover, immediately before menopause, women can experience several months or years of estrogen-dominated menstrual cycles, with a risk of a growth spurt of fibroids, considering their estrogen sensibility.…”

Section: Discussionmentioning

confidence: 99%

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Hypovitaminosis D and “small burden” uterine fibroids

et al. 2016

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The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and “small burden” uterine fibroids.This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with “small burden” uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the “study group” (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the “control group” (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis.In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = −0.18, P = 0.01) and the total volume of fibroids (r = −0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = −0.10, P = 0.16). In women of the “study group,” a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the “progression to extensive disease” was reported (13.2% vs 30.9%, P = 0.05).Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with “small burden” fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, immediately before menopause, women can experience several months or years of estrogen-dominated menstrual cycles, with a risk of a growth spurt of fibroids, considering their estrogen sensibility. [26] …”

Section: Discussionmentioning

confidence: 99%

Hypovitaminosis D and “small burden” uterine fibroids

et al. 2016

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“…Fibroids are not a contraindication to HRT use by women with POI (Ang, et al, 2001, Ciarmela, et al, 2014.…”

Section: Women With Poi and Fibroidsmentioning

confidence: 95%

ESHRE Guideline: management of women with premature ovarian insufficiency

et al. 2016

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“…Minimally invasive surgeries like hysteroscopic myomectomy (for submucosal fibroids), Laparoscopic myomectomy (for symptomatic subserosal and less commonly for intramural fibroids), abdominal myomectomy and hysterectomy (when woman no longer wishes to preserve uterus or fertility like in perimenopausal women or in women where sarcomatous changes are suspected on imaging). 11 Other less invasive procedure include uterine artery embolization and magnetic resonance guided focused ultrasound surgery (MRgFUS). 12 Medical management is used in patients for short term relief and as pre-operative adjunct treatment for reduction of size of the fibroid.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Mifepristone and Ulipristal acetate as an alternative to surgical management of uterine fibroids (Leiomyoma) in symptomatic patients of reproductive age group in Asian population

Kale

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Present study was a randomised prospective observational study carried out at Ashakiran Hospital and IVF centre Pune, Maharashtra, India to evaluate the efficacy, safety, and quality of life by using Ulipristal acetate 10 mg and Mifepristone 25 mg daily doses to treat uterine fibroids of two subgroups involving fibroids <3 cm and fibroids 3 to 5 cm all are in reproductive age group with symptomatic in nature over 3 months. Methods: A total number of 40 patients were recruited in the study of which they were divided into two groups according to the size of the fibroid as <3cm and 3-5cm as seen on transvaginal as well as transabdominal ultrasound. Further they were randomly assigned to either mifepristone or ulipristal orally with each category having 10 patients each to assess changes in fibroid size, in symptomatic pain reduction, menorrhagia and in quality of life. Results: The 25-mg dosage of Mifepristone is shown to be a good and effective way of treatment in fibroids less than 3 cm in achieving 40% reduction in size and 50% reduction in menorrhagia as compared to Ulipristal 10 mg which acts better in other subgroup of size 3-5 cm of fibroids. Conclusions: Still larger RCTs are needed to study the long-term benefits of these drugs.

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Management of leiomyomas in perimenopausal women

Cited by 38 publications

References 49 publications

Hypovitaminosis D and “small burden” uterine fibroids

Hypovitaminosis D and “small burden” uterine fibroids

ESHRE Guideline: management of women with premature ovarian insufficiency

Comparison between Mifepristone and Ulipristal acetate as an alternative to surgical management of uterine fibroids (Leiomyoma) in symptomatic patients of reproductive age group in Asian population

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