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Article ; Online: Non-surgical management of uterine fibroids.

Tropeano, Giovanna / Amoroso, Sonia / Scambia, Giovanni

2008 Volume 14, Issue 3, Page(s) 259–274

Abstract: ... uterine fibroids have provided new techniques and new medications. This review summarizes the existing literature ... Background: Efforts to develop alternatives to surgery for management of symptomatic ... the safety and effectiveness of UAE for women with symptomatic fibroids. The current available data are ...

Abstract	Background: Efforts to develop alternatives to surgery for management of symptomatic uterine fibroids have provided new techniques and new medications. This review summarizes the existing literature on uterine artery embolization (UAE) and investigational studies on four newer approaches. Methods: PubMed, Cochrane and Embase were searched up to December 2007. Studies reporting side-effects and complications and presenting numerical data on at least one outcome measure were included. Results: Case studies report 50-60% reduction in fibroid size and 85-95% relief of symptoms following UAE. The largest of these studies reported an in-hospital complication rate of 2.7% (90 of 3041 patients) and a post-discharge complication rate of 26% (710 of 2729 patients). Eight studies compared UAE with conventional surgery. Best evidence suggested that UAE offered shorter hospital stays (1-2 days UAE versus 5-5.8 days surgery, 3 randomized controlled trials (RCTs)) and recovery times (9.5-28 days UAE versus 36.2-63 days surgery, 3 RCTs) and similar major complication rates (2-15% UAE versus 2.7-20% surgery, 3 RCTs). Four studies analysing cost-effectiveness found UAE more cost-effective than surgery. There is insufficient evidence regarding fertility and pregnancy outcome after UAE. Five feasibility studies after transvaginal temporary uterine artery occlusion in 75 women showed a 40-50% reduction in fibroid volume and two early studies using magnetic resonance guided-focused ultrasound showed symptom relief at 6 months in 71% of 109 women. Two small RCTs assessing mifepristone and asoprisnil showed promising results. Conclusions: Good quality evidence supports the safety and effectiveness of UAE for women with symptomatic fibroids. The current available data are insufficient to routinely offer UAE to women who wish to preserve or enhance their fertility. Newer treatments are still investigational.
MeSH term(s)	Arteries ; Constriction ; Embolization, Therapeutic ; Estrenes/therapeutic use ; Female ; Hormone Antagonists/therapeutic use ; Humans ; Leiomyoma/therapy ; Mifepristone/therapeutic use ; Oximes/therapeutic use ; Receptors, Progesterone/antagonists & inhibitors ; Ultrasonic Therapy/methods ; Uterine Neoplasms/therapy ; Uterus/blood supply
Chemical Substances	Estrenes ; Hormone Antagonists ; Oximes ; Receptors, Progesterone ; Mifepristone (320T6RNW1F) ; asoprisnil (72W09924WP)
Language	English
Publishing date	2008-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1286738-x
ISSN	1460-2369 ; 1355-4786
ISSN (online)	1460-2369
ISSN	1355-4786
DOI	10.1093/humupd/dmn006
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Zs.A 4378: Show issues

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Article ; Online: New treatment options for nonsurgical management of uterine fibroids.

Lee, SiWon / Stewart, Elizabeth A

Current opinion in obstetrics & gynecology

2023 Volume 35, Issue 4, Page(s) 288–293

Abstract: ... for conservative management of uterine fibroids became available, it is important to counsel patients on possible ... Purpose of review: Uterine fibroids is a common problem in reproductive-age individuals ... of bone density and a modest reduction in uterine volume with few hypogonadal side effects. Magnetic resonance ...

Abstract	Purpose of review: Uterine fibroids is a common problem in reproductive-age individuals, frequently causing abnormal uterine bleeding, bulk symptoms, and adverse reproductive outcomes. Traditionally, almost half of the women with symptomatic fibroids received surgery for definitive treatment. There are a growing number of nonsurgical options for treatment that have become available for patients who desire conservative treatment or those with contraindications to surgery. Recent findings: The introduction of oral gonadotropin-releasing hormone antagonists in combination with low-dose physiologic hormonal therapy demonstrated improvement in heavy menstrual bleeding, pain, and quality of life with preservation of bone density and a modest reduction in uterine volume with few hypogonadal side effects. Magnetic resonance-guided focused ultrasound surgery and uterine artery embolization continue to be minimally invasive procedural alternatives to hysterectomy that are safe and effective. Summary: As more options for conservative management of uterine fibroids became available, it is important to counsel patients on possible options based on the size, location, and number of the fibroids as well as severity of the symptoms, plans for pregnancy, how close they are to menopause and their treatment goals.
MeSH term(s)	Pregnancy ; Humans ; Female ; Uterine Neoplasms/surgery ; Quality of Life ; Leiomyoma/surgery ; Uterus ; Uterine Artery Embolization
Language	English
Publishing date	2023-05-03
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	1049382-7
ISSN	1473-656X ; 1040-872X
ISSN (online)	1473-656X
ISSN	1040-872X
DOI	10.1097/GCO.0000000000000880
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Zs.A 3048: Show issues

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Article ; Online: Vilaprisan phase 2B trial: a timely efficacy and safety study of a novel selective progesterone receptor modulator for nonsurgical management of uterine fibroids.

Magnay, Julia L

Fertility and sterility

2019 Volume 111, Issue 2, Page(s) 249–250

MeSH term(s)	Female ; Humans ; Leiomyoma ; Receptors, Progesterone ; Steroids
Chemical Substances	Receptors, Progesterone ; Steroids ; vilaprisan
Language	English
Publishing date	2019-01-02
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80133-1
ISSN	1556-5653 ; 0015-0282
ISSN (online)	1556-5653
ISSN	0015-0282
DOI	10.1016/j.fertnstert.2018.10.033
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Article ; Online: Non-puerperal uterine inversion

Francis C Ezenwankwo / Osemen E Okojie / Adaiah P Soibi-Harry / Babasola O Okusanya

Journal of Clinical Sciences, Vol 18, Iss 1, Pp 69-

An uncommon presentation - A case report

2021 Volume 72

Abstract: ... of a fleshy mass. A clinical diagnosis of chronic uterine inversion due to a pedunculated submucous fibroid ... Spontaneous nonpuerperal uterine inversion is an exceedingly rare gynecological event ... When it occurs, it is often due to an intrauterine polypoid mass attached to the uterine fundus, eventually ...

Abstract	Spontaneous nonpuerperal uterine inversion is an exceedingly rare gynecological event. When it occurs, it is often due to an intrauterine polypoid mass attached to the uterine fundus, eventually pulling the uterus inside out over time as the mass increases in size. We present a case of nonpuerperal uterine inversion in a 32-year-old female who presented with heavy vaginal bleeding and vaginal protrusion of a fleshy mass. A clinical diagnosis of chronic uterine inversion due to a pedunculated submucous fibroid was made and was surgically managed with a vaginal myomectomy combined with an exploratory laparotomy and surgical reduction under general anesthesia. Good clinical acumen and surgical skills are invaluable for accurate diagnosis and appropriate treatment of nonpuerperal uterine inversion.
Keywords	fibroids ; inversion ; laparotomy ; nonpuerperal ; uterine ; Medicine (General) ; R5-920
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Unicornuate uterus with a functional non-communicating horn in adolescent.

A Jalil, Rawan Abdulrahim / Alsada, Abeer Isa

BMJ case reports

2021 Volume 14, Issue 8

Abstract: ... the laparoscopic approach, an expert surgeon prefers definitive management to excise the rudimentary horn. ... This study presents a rare case of a non-communicating functional rudimentary horn. A 16-year-old unmarried ... with the non-communicating rudimentary horn on the right side. Laparoscopic excision of the horn was planned ...

Abstract	Common causes of pelvic pain are primary dysmenorrhoea, Müllerian duct anomalies, outflow obstruction, leiomyoma, endometriosis and adenomyosis. Unicornuate uterus with a rudimentary horn is a rare congenital malformation of the female genital tract, asymptomatic because of lack of functional endometrium. This study presents a rare case of a non-communicating functional rudimentary horn. A 16-year-old unmarried Yemeni female adolescent with a history of irregular painful menstrual period visited Obstetrics and Gynaecology outpatient clinic. Pelvic ultrasound was conducted showing an asymmetrical uterine configuration with the non-communicating rudimentary horn on the right side. Laparoscopic excision of the horn was planned for the patient. Non-communicating rudimentary horn with functional endometrium should be considered as a differential diagnosis in the female adolescent with obstructive uterine symptoms. Early diagnosis is crucial. Using the laparoscopic approach, an expert surgeon prefers definitive management to excise the rudimentary horn.
MeSH term(s)	Adolescent ; Dysmenorrhea/etiology ; Endometriosis ; Female ; Humans ; Laparoscopy ; Pregnancy ; Urogenital Abnormalities/complications ; Urogenital Abnormalities/diagnostic imaging ; Urogenital Abnormalities/surgery ; Uterus/diagnostic imaging ; Uterus/surgery
Language	English
Publishing date	2021-08-26
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-242874
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Article ; Online: Non-surgical Management of Myomas.

Laughlin-Tommaso, Shannon K

Journal of minimally invasive gynecology

2017 Volume 25, Issue 2, Page(s) 229–236

Abstract: ... nonsurgical management of their myomas. In this review the available uterine-conserving treatment options ... Uterine myomas are a common condition and the leading cause of hysterectomy. Clinically, myomas ... occur in many women before childbearing is complete. Thus, women often seek uterine-conserving and ...

Abstract	Uterine myomas are a common condition and the leading cause of hysterectomy. Clinically, myomas can be challenging because they range from asymptomatic to causing severe, debilitating symptoms and occur in many women before childbearing is complete. Thus, women often seek uterine-conserving and nonsurgical management of their myomas. In this review the available uterine-conserving treatment options from medical management through minimally invasive procedures are discussed. To the extent of research available, the sustainability of symptom improvement and the effects on future fertility are reviewed. Future research may lead to therapies that reduce the risks of major surgery, decrease side effects, and offer primary or secondary prevention options.
MeSH term(s)	Disease Management ; Female ; High-Intensity Focused Ultrasound Ablation ; Humans ; Leiomyoma/therapy ; Life Style ; Radiofrequency Ablation/methods ; Uterine Artery Embolization/methods ; Uterine Neoplasms/therapy
Language	English
Publishing date	2017-08-15
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2186934-0
ISSN	1553-4669 ; 1553-4650
ISSN (online)	1553-4669
ISSN	1553-4650
DOI	10.1016/j.jmig.2017.08.642
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Zs.A 4205: Show issues

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Article ; Online: Non Puerperal Uterine Inversion Secondary to Submucosal Fibroid

Nilaj bagde / sefali shinde / vinita singh / Rahul satarkar / habung yaran

Journal of Clinical and Diagnostic Research, Vol 15, Iss 07, Pp 01-

A Case Report

2021 Volume 03

Abstract: ... but diagnosis can be difficult to make. The management of uterine inversion is always challenging for a surgeon ... Non Puerperal Uterine Inversion (NPUI) is a very uncommon condition. The incidence of puerparal ... A diagnosis of incomplete uterine inversion secondary to a submucous fibroid was made at exploratory ...

Abstract	Non Puerperal Uterine Inversion (NPUI) is a very uncommon condition. The incidence of puerparal uterine inversion make an estimate of 1/30,000 deliveries and NPUI approximately 17% of all uterine inversion. The most common cause which leads to uterine inversion is a submucous myoma attached to the fundus but diagnosis can be difficult to make. The management of uterine inversion is always challenging for a surgeon. In the present case a 38-year-old woman, presented with significant anaemia because of menorrhagia. She used to feel mass occasionally into the vaginal canal which never comes out of the introitus, the mass was elucidated as a fibroid polyp. On investigation, her haemoglobin was 6.6 gm%, with continous bleeding per vaginum, patient was transfused with three units packed red blood cells and planned for surgery. A diagnosis of incomplete uterine inversion secondary to a submucous fibroid was made at exploratory laparotomy. Total abdominal hysterectomy, right salpingectomy with left salpingo-oophorectomy was performed. The patient was discharged under satisfactory condition.
Keywords	salpingectomy ; salpingo-oophorectomy ; total abdominal hysterectomy ; Medicine ; R
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Non-puerperal Uterine Inversion Presented with Hypovolemic Shock.

Song, Yong Jung / Yang, Juseok / Yun, Hyun Sil / Lee, Sun Kyung / Kim, Hwi Gon / Lee, Dong Hyung / Choi, Ook Hwan / Na, Yong Jin

Journal of menopausal medicine

2016 Volume 22, Issue 3, Page(s) 184–187

Abstract: ... protruding vaginal mass and consider uterus-preserving management as surgical option when the future ... We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated ... abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge ...

Abstract	We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.
Language	English
Publishing date	2016-12-31
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	3021719-2
ISSN	2288-6761 ; 2288-6478
ISSN (online)	2288-6761
ISSN	2288-6478
DOI	10.6118/jmm.2016.22.3.184
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Article: Treatment of uterine leiomyomata with a luteinizing hormone-releasing hormone agonist: the possibility of nonsurgical management in selected perimenopausal women.

Nakamura, Y / Yoshimura, Y / Yamada, H / Ubukata, Y / Ando, M / Suzuki, M

Fertility and sterility

1991 Volume 55, Issue 5, Page(s) 900–905

Abstract: ... decreasing uterine volume and increasing hemoglobin concentration in premenopausal women with leiomyomata. ... of obstetrics and gynecology.: Patients: Twenty-five women, ages 36 to 54 years with symptomatic uterine ... micrograms/d).: Main outcome measures: Efficacies of treatment were assessed in terms of uterine volume ...

Abstract	Objective: To evaluate the efficacy of luteinizing hormone-releasing hormone agonist (LH-RH-a) in the treatment of leiomyomata. Design: A retrospective randomized trial. Setting: Hospital department of obstetrics and gynecology. Patients: Twenty-five women, ages 36 to 54 years with symptomatic uterine leiomyomata, were divided into two groups according to the responsiveness to LH-RH-a: group A patients reached menopause after LH-RH-a, whereas resumption of menstruation occurred within 12 weeks after cessation of therapy in group B. Interventions: Luteinizing hormone-releasing hormone agonist was administered intranasally three times a day with 150 micrograms insufflation of one spray in each nostril (total dose: 900 micrograms/d). Main outcome measures: Efficacies of treatment were assessed in terms of uterine volume, hemoglobin concentrations, serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and bone density during and after treatment. Results: In both groups, hemoglobin concentrations increased significantly after 16 weeks of treatment. A significant reduction in uterine volume was observed in both groups. After completing therapy, there was no further significant change in uterine volume in group A, whereas uterine volume in group B returned to pretreatment values. Serum LH and FSH concentrations were suppressed during treatment, but those gonadotropins in group A increased significantly up to the menopausal levels after treatment. Serum E2 concentrations in both groups showed consistent suppression by the end of the first treatment cycle. After cessation of therapy, serum E2 levels on group A remained in the castrate range, whereas E2 in group B returned to pretreatment levels, concomitant with the return of normal ovulation. Conclusions: Intranasal administration of LH-RH-a was successful in significantly decreasing uterine volume and increasing hemoglobin concentration in premenopausal women with leiomyomata.
MeSH term(s)	Adult ; Bone and Bones/pathology ; Buserelin/therapeutic use ; Estradiol/blood ; Female ; Follicle Stimulating Hormone/blood ; Humans ; Leiomyoma/drug therapy ; Leiomyoma/pathology ; Luteinizing Hormone/blood ; Menopause ; Middle Aged ; Random Allocation ; Retrospective Studies ; Uterine Neoplasms/drug therapy ; Uterine Neoplasms/pathology ; Uterus/pathology
Chemical Substances	Estradiol (4TI98Z838E) ; Luteinizing Hormone (9002-67-9) ; Follicle Stimulating Hormone (9002-68-0) ; Buserelin (PXW8U3YXDV)
Language	English
Publishing date	1991-05
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	80133-1
ISSN	1556-5653 ; 0015-0282
ISSN (online)	1556-5653
ISSN	0015-0282
DOI	10.1016/s0015-0282(16)54296-4
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Zs.A 73: Show issues

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Article: Non-puerperal uterine inversion in a young woman: a case report.

Kouamé, A / Koffi, S V / Adjoby, R / Diomandé, F A / Effoh, D / Oussou, C / Kouakou, F

Journal of the West African College of Surgeons

2016 Volume 5, Issue 3, Page(s) 78–83

Abstract: ... with an unusual non-puerperal, total and chronic uterine inversion as a result of uterine leiomyoma managed ... Background: Uterine inversion is an uncommon complication in the non-puerperal period. Submucosal ... hysterectomy) approach. Histopathology confirmed the mass to be a sub-mucosal uterine leiomyoma. She has been ...

Abstract	Background: Uterine inversion is an uncommon complication in the non-puerperal period. Submucosal myoma is more frequently involved usually among women above 45 years old. Case presentation: A 28 year-old patient was admitted to the gynaecology emergency room in Cocody Teaching Hospital, Abidjan, Cote D'Ivoire with a large lobulated fleshy mass in the vulval area. She had been having pelvic pain, heaviness in the pelvis and bleeding per vaginam intermittently for 6 months for which she had been treated conservatively without improvement. The clinical examination was consistent with uterine inversion secondary to a mass in the fundus of the uterus. The uterus with the mass in the fundus was excised by a combined vaginal and abdominal (abdominal hysterectomy) approach. Histopathology confirmed the mass to be a sub-mucosal uterine leiomyoma. She has been followed up for 12 months without complaints. Conclusion: We have presented a young woman with an unusual non-puerperal, total and chronic uterine inversion as a result of uterine leiomyoma managed successfully by a combined abdominal and vaginal approach.
Language	English
Publishing date	2016-09-30
Publishing country	Nigeria
Document type	Case Reports
ISSN	2276-6944
ISSN	2276-6944
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