The Fibroid Growth Study: Determinants of Therapeutic Intervention

Abstract

Aims: The demographics, ethnicity, symptoms, lifestyle characteristics, and treatment outcomes are analyzed in participants of a study designed to evaluate uterine leiomyoma growth and correlate symptoms and outcomes in a clinically relevant population of women (Fibroid Growth Study). Methods: Women included in the Fibroid Growth Study (FGS) completed a medical history and physical examination, underwent T1-weighted and T2-weighted magnetic resonance image (MRI) scans, provided urine and blood samples at each scheduled MRI, and responded to an initial extensive telephone-administered questionnaire followed by abbreviated monthly questionnaire updates. Summary scores were developed to quantify stress, pain, and bleeding. The Wilcoxin test was used for statistical comparisons between study participant characteristics and tumor-related characteristics. Results: Participants included 116 premenopausal women, ranging in age from 20 to 54 years; 48% were black women, 41% were white women, 10% were women of other or multiple racial backgrounds, and 1% did not selfidentify. Over 90% of participants had multiple leiomyomas, and nearly a third had more than 10. Black women were younger and had more fibroids, but no differences were found in the proportions of black and white women choosing an intervention; 44% of black women and 40% of white women chose intervention during the study. Conclusions: There was no correlation between number of leiomyomas or uterine size and choosing treatment. However, women who opted for treatment were more symptomatic, with higher bleeding and pain scores, compared with the women with no intervention. Consequently, our study suggests that once women are symptomatic, black and white women choose surgery as a treatment method for the same reasons and at about the same rates. Moreover, our data suggest that bleeding and pain, not the size or multiplicity of fibroids, determine the choice for intervention. Therefore, aggressive management of pain and bleeding may be effective in reducing the need for surgical intervention.

Common fibroid-associated genes are differentially expressed in phenotypically dissimilar cell populations isolated from within human fibroids and myometrium

“…Fibroid development, symptomology, demographics and response to treatment is heterogeneous (Peddada et al 2008, Davis et al 2009, Zhao & Rogers 2013. This is reflected in our sample group (Table 1).…”

Short-term change in growth of uterine leiomyoma: tumor growth spurts

“…Both institutional review boards gave approval, and all participants provided signed consent. The methods have been described previously (7, 8). Briefly, participants were premenopausal women with clinical ultrasound evidence of at least one fibroid ≥ 5 cm in diameter or the uterus enlarged to a size of a typical 12-week pregnancy (200-250 cm 3 ) (9).…”

FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age

“…Like polyps and adenomyosis, many leiomyomas are asymptomatic, and frequently their presence is not the cause of AUB. Furthermore, leiomyomas have widely varying rates of growth, even in a single individual [30].…”