Symptoms of uterine myomas: data of an epidemiological study in Germany

Foth, Dolores; Röhl, Friedrich-Wilhelm; Friedrich, Cornelia; Tylkoski, Heike; Rabe, T.; Römer, Thomas; Kitay, Ann; Ahrendt, Hans-Joachim

doi:10.1007/s00404-016-4239-y

Cited by 33 publications

(32 citation statements)

References 25 publications

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“…[5][6][7] Uterine fibroid-associated pain is the second most debilitating problem. [8][9][10] Although contraceptives are first-line medical treatments for uterine fibroid symptoms, 11 the quality of evidence for their use is low. 7,12 Injectable long-acting gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide acetate) are effective; however, hypoestrogenic sequelae limit their duration of use or lead to the administration of additional hormonal therapy to mitigate side effects.…”

Section: Take Down Policymentioning

confidence: 99%

Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy

et al. 2021

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BACKGROUNDUterine fibroids are a common cause of heavy menstrual bleeding and pain. Treatment with the combination of relugolix (an oral gonadotropin-releasing hormonereceptor antagonist), estradiol, and norethindrone acetate, administered once daily, may have efficacy in women with uterine fibroids and heavy bleeding while avoiding hypoestrogenic effects. METHODSWe conducted two replicate international, double-blind, 24-week, phase 3 trials involving women with fibroid-associated heavy menstrual bleeding. Participants were randomly assigned in a 1:1:1 ratio to receive once-daily placebo, relugolix combination therapy (40 mg of relugolix, 1 mg of estradiol, and 0.5 mg of norethindrone acetate), or delayed relugolix combination therapy (40 mg of relugolix monotherapy, followed by relugolix combination therapy, each for 12 weeks). The primary efficacy end point in each trial was the percentage of participants with a response (volume of menstrual blood loss <80 ml and a ≥50% reduction in volume from baseline) in the relugolix combination therapy group, as compared with the placebo group. Key secondary end points were amenorrhea, volume of menstrual blood loss, distress from bleeding and pelvic discomfort, anemia, pain, fibroid volume, and uterine volume. Safety and bone mineral density were assessed. RESULTSA total of 388 women in trial L1 and 382 in trial L2 underwent randomization. A total of 73% of the participants in the relugolix combination therapy group in trial L1 and 71% of those in trial L2 had a response (primary end point), as compared with 19% and 15%, respectively, of those in the placebo groups (P<0.001 for both comparisons). Both relugolix combination therapy groups had significant improvements, as compared with the placebo groups, in six of seven key secondary end points, including measures of menstrual blood loss (including amenorrhea), pain, distress from bleeding and pelvic discomfort, anemia, and uterine volume, but not fibroid volume. The incidence of adverse events was similar with relugolix combination therapy and placebo. Bone mineral density was similar with relugolix combination therapy and placebo but decreased with relugolix monotherapy. CONCLUSIONSOnce-daily relugolix combination therapy resulted in a significant reduction in menstrual bleeding, as compared with placebo, and preserved bone mineral density in women with uterine fibroids. (Funded by Myovant Sciences; LIBERTY 1 [L1] and LIB-ERTY 2 [L2] ClinicalTrials.gov numbers, NCT03049735 and NCT03103087, respectively.

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Section: Take Down Policymentioning

confidence: 99%

Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy

et al. 2021

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“…Uterine fibroids are highly prevalent and can produce significant symptoms in affected women, including heavy menstrual bleeding, pelvic pressure, and dysmenorrhea. [11][12][13][14] While the most common treatment for fibroids is hysterectomy, transcervical RF ablation offers the potential for uterine conservation, significant symptom relief, a minimally invasive incisionless procedure, and brief treatment and recovery times. Surgical reintervention rates have been reported as ranging from 0.7% to 8% at 12 months and 11.8% at a mean of 64 months.…”

Section: Discussionmentioning

confidence: 99%

Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology

Pschadka¹,

Engelhardt²,

Niehoff³

et al. 2019

Journal of Gynecologic Surgery

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Background: Transcervical radiofrequency (RF) ablation of uterine fibroids is an incisionless procedure to treat nonpedunculated uterine fibroids, including those that are not amenable to operative hysteroscopy. However, its safety and effectiveness regarding fertility and fecundity have not been established, including among women with infertility. Case: A 38-year-old nullipara with infertility since 2008 and a recent complaint of refractory dysmenorrhea in association with a uterine fibroid underwent transcervical RF ablation with the Sonata Ò System (Gynesonics, Redwood City, CA) to treat the symptomatic myoma. Unsuccessful assisted reproduction (intracytoplasmic sperm injection/embryo transfer) as confirmed by negative pregnancy testing had been attempted 1 month preablation, and a second embryo transfer after thawing the previously cryopreserved pronuclei was performed 7 months postablation. Results: RF ablation with the Sonata System resulted in a 68% reduction in fibroid volume noted on sonography 2 months post-treatment along with resolution of the patient's dysmenorrhea. No residual fibroid was noted on sonography 7 months postablation. A second attempt at assisted reproduction produced an uncomplicated pregnancy that resulted in vacuum-assisted vaginal delivery of a liveborn infant at term weighing 3670 g with Apgar scores of 9 1 /10 5 /10 10. Pelvic sonography 4 months postpartum an unremarkable uterus, again, with no evidence of a fibroid remnant. Conclusions: This is the first report of a pregnancy and delivery in an infertile couple who underwent transcervical RF ablation of a uterine fibroid followed by assisted reproduction.

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“…Die sonografisch bestimmte Größe korrelierte jedoch mit der Stärke der Dysmenorrhö (besonders bei kleinen Myomen) (p = 0,003) und einem Druckgefühl im Unterbauch (p = 0,02) sowie die submuköse Lage mit einer Hypermenorrhö (p = 0,01) [26]. Foth et al zeigten mit einer Odds Ratio von 4, dass die Myomanzahl den stärksten Einfluss auf das Auftreten von Dysmenorrhö hat (p = 0,001) [30]. Andere Autoren haben bei Fehlannahme vieler Myome vermehrten Druck auf die Blase und bei Fehlannahme eines besonders großen Myoms verstärkten Druck im Unterbauch im Vergleich zu wenigen bzw.…”

Section: Diskussionunclassified

Comparison of Clinical Symptoms of Assumed vs. Actual Uterine Fibroids – Symptoms Described by Patients and Ultrasound Findings

Knudsen

Wernecke

Kentenich³

et al. 2019

Geburtshilfe Frauenheilkd

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Purpose How many women assume that they have fibroids but are found not to have fibroids on ultrasound examination? How severe are the physical symptoms reported by these women compared to the symptoms reported by women with actual uterine fibroids? Are the symptoms more severe if the patient believes that she has at least one relatively large (dominant) fibroid or more than 3 fibroids? Material and Methods A total of 1548 patients completed an anonymous questionnaire in which they were asked about the number of their fibroids, dysmenorrhea and premenstrual symptoms, dyspareunia and bleeding disorders (using a numerical analog scale between 0 – 10). The questionnaire was administered in a hospital-based fibroid clinic. The information provided by the patients was then compared with transvaginal or abdominal ultrasound findings. The symptoms reported by women with and without fibroid(s) were compared. Results 1045 out of 1548 patients fulfilled the studyʼs inclusion criteria. Contrary to the information they provided, no fibroid(s) were detected in 6% (62 of 1045 patients) of patients on ultrasound examination. Of these women, 87% had dysmenorrhea, 79% had premenstrual pain and 57% reported dyspareunia. The severity of the symptoms was found not to be associated with the assumed size or number of fibroid(s). There was no significant difference in the pain reported by women without and by women with fibroids. Reporting a feeling of strong pressure on the bladder (OR: 1.18) or abdomen (OR: 1.12) or constipation (OR: 1.16) increased the likelihood of detecting a fibroid on ultrasound investigation. Conclusions The presence of manifest symptoms (dysmenorrhea, dyspareunia, premenstrual pain, bleeding disorders) does not allow conclusions to be made about the number or size of fibroids or about which therapy is indicated. Even an erroneous assumption about the presence of fibroids may result in patients experiencing symptoms.

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Symptoms of uterine myomas: data of an epidemiological study in Germany

Abstract: The high prevalence of uterine myomas highlights the importance of the diagnosis uterine myomas in standard gynaecological practice: The presence of only one myoma caused symptoms in 46.5% and small myomas of up to 2 cm in diameter resulted in symptoms in 39.5%.

Cited by 33 publications

References 25 publications

Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy

Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy

Term Delivery in an Infertile Patient after Transcervical Radiofrequency Fibroid Ablation and Assisted Reproductive Technology

Comparison of Clinical Symptoms of Assumed vs. Actual Uterine Fibroids – Symptoms Described by Patients and Ultrasound Findings

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