Fibroid vascularisation assessed with 3D Power Doppler as predictor for fibroid related symptoms and quality of life; a pilot study

Background: Uterine fibroids present differently, from well vascularised up to calcified, with some causing heavy menstrual bleeding (HMB). Objectives: To investigate the association between fibroid vascularisation and HMB, other fibroid related symptoms and quality of life (QOL). Materials and Methods: A single centre pilot study was carried out in the Netherlands. Women with a maximum of two fibroids who chose expectant management were included. 3D sonography including power doppler was performed at baseline and at 3, 6 and 12 months follow up. Women were asked to complete the Pictorial Blood Assessment Chart (PBAC) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires at every visit. Main outcome measure: The association between fibroid vascularisation and HMB. Results: 53 women were included in the study. Baseline fibroid vascularisation, measured as vascular index (VI) is associated with PBAC score; a 1% higher VI at baseline leads to an 11 point increase in PBAC score over time (RC 10.99, p=0.05, 95% CI -0.15 – 22.12). After correction for the baseline variables ethnicity and fibroid type the association becomes stronger (P<0.05). Fibroid volume at baseline and HMB are also associated: a 1 cm3 larger fibroid leads to 0.6 points increase in PBAC score over time (RC 0.56, p=0.03, 95% CI 0.05 – 1.07). Conclusions: This study highlights that both fibroid vascularisation and fibroid volume may be associated with an increase in menstrual blood loss, other fibroid related symptoms and QOL over time. What is new? We used 3D power doppler to predict symptomatic fibroids.

Serum Vascular Endothelial Growth Factor Levels and Uterine Fibroid Volume

Background: Tumor size is related to variations associated with molecular markers. In recent years, it has been reported that investigation of tumor volume has become very popular. Measurement of uterine fibroids volume is very important for treatment response. Objective: The aims of this study is to find the correlation of VEGF levels and uterine fibroids volume. Methods: Observational analytic study was carried out on 80 patients with uterine fibroids indicated myomectomy. Each sample was examined for VEGF levels and volume of myoma tissue post myomectomy was measured by using Archimedes' law. Correlation test using the Spearman test. Results: A total of 80 samples of patients were examined for VEGF levels and uterine fibroids volume. The median VEGF is 360 pg/mL, the median uterine fibroids volume is 325 ml. The Spearman’s test shows p values ​​(<0.01) and r (0.999). Conclusion: There is a significant correlation between VEGF levels and uterine fibroids volume. The higher the VEGF level, the greater the volume of uterine fibroids. Keywords: VEGF, uterine fibroids volume, Archimedes law *Corresponding author: Rajuddin e-mail: [email protected] dan [email protected]

Ulipristal Acetate Efficacy in a Patient with Symptomatic Fibroid and Concomitant Pulmonary Embolism

Ulipristal acetate (UPA) is an effective drug for the treatment of symptomatic uterine fibroids. The drug is highly effective in controlling bleeding control and in the recovery of anemia. Here, we report the case of a woman with severe menorrhagia due to a uterine fibroid and with concomitant pulmonary embolism, a serious life-threatening condition. UPA was shown to be effective in reducing fibroid volume and controlling symptoms, without worsening the underlying embolic disease. No adverse events were observed, and the patient has completely recovered.

The role of Ulipristal Acetate in infertile women with submucous fibroids

Background The presence of submucous fibroids strongly impacts on IVF results, therefore, this patients should be considered for surgical or medical treatment. The aim of this study was to assess the role of Ulipristal acetate (UPA), a selective progesterone receptor modulator, in restoring uterine cavity deformation due to submucous fibroids, in infertile patients attempting an IVF treatment. Methods Infertile patients with submucosal fibroid (Type 1 and Type 2 according to FIGO classification) were enrolled and received 1 to 3 treatment cycles of UPA, according to their response, as reflected by fibroid volume reduction and restoration of normal uterine cavity. Results 26 patients underwent UPA treatment revealed a mean volume reduction of their fibroids of 41%. A total of 15 (57.6%) biochemical pregnancy were obtained, resulting in 13 (50%) ongoing pregnancy and 9 (34.6%) healthy babies were already delivered. Conclusion Restoration of normal uterine cavity by UPA treatment prior to IVF treatment avoids surgery and enhances the pregnancy rate.

Role of Mifepristone in treatment of uterine fibroid: an experience from tertiary care centre in South India

Background: Uterine fibroid are the most common benign tumour of the uterus and is seen in 20% of women in their reproductive age group. The aim of the study was to evaluate effect of Mifepristone on uterine fibroid with reference to reduction in size of fibroid and change in symptomatic profile.Methods: It is a hospital based interventional study conducted at KIMS Hubli hospital. 98 patients with symptomatic fibroid uterus were given 50mg of Mifepristone on alternate day for 3 months.Results: Mifepristone treatment significantly reduced mean PBAC score from baseline score of 212.61 to 20.39 at the end of 3rd month of therapy. Mean fibroid volume also reduced significantly from baseline value of 237.95cm3 to 30.45cm3 after 3 months of treatment. At the end of therapy hemoglobin was raised from 9.57g/dl at baseline to 10.42g/dl after 3 months of treatment. No major side effects were observed, and 7% patients had hysterectomy.Conclusions: Mifepristone is very useful option in perimenopausal women with symptomatic fibroid. It reduces fibroid size and its symptoms without any major side effects. However, future long term RCTs are needed to assess the safety and efficacy of Mifepristone.

Study the effect of mifepristone on fibroid and uterine volume

Background: Fibroid is the most common benign tumour of the uterus affecting 20% of women of reproductive age group and is the most common indication for hysterectomy accounting for about 40% of all hysterectomies in premenopausal women. This study was undertaken to study the effect of Mifepristone, which is a progesterone receptor modulator with antagonistic action, on fibroid and uterine volume.Methods: The study was conducted in the Department of Obstetrics and Gynaecology, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun over a period of 12 months. A total of 40 patients were included in the study.Results: Mean baseline fibroid volume decreased by 49.17% at 1 month and by 77.4% and 3months of treatment with Mifepristone. Mean baseline uterine volume decreased by 34.13% at 1 month, and further reduction by 58.3% at the end of treatment.Conclusions: The study shows that there is a significant reduction in fibroid and uterine volume in patients treated with mifepristone.