Nutrition and Metabolic Health · Dietary Patterns
Alsharif SA et al., 2024 · Nutrition and Cancer
Impaired vitamin D status is highly prevalent among women with UFs. The objective of this first-ever systematic review and meta-analysis was to summarize the effect of vitamin D supplementation on the size of uterine fibroids (UFs). We performed a comprehensive literature search for published randomized controlled trials (RCTs) in Medline, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to September 2022. Five trials including 511 participants (256 cases and 255 controls) were included. Pooling results from five trials, which compared size of UFs between experimental and placebo groups, revealed that vitamin D supplementation could significantly decrease the size of UFs (standardized mean difference [SMD]: -0.48, 95% confidence interval [CI]: -0.66, -0.31) and cause improvement in serum level of vitamin D compared to placebo group (SMD: 3.1, 95% CI: 0.66, 5.55). A significant effect was observed in the subset of trials administering vitamin D supplementation for >8 wk (SMD: -0.62, 95% CI: -0.88, -0.37). In conclusion, vitamin D supplementation significantly increases serum levels of vitamin D and reduces the size of UFs. However, larger, well-designed RCTs are still needed to determine the effect of vitamin D on other parameters of UFs.
Fibroids · Fibroid Management
Stewart EA et al., 2024 · N Engl J Med
Clinical Practice review. Case: A 33-year-old gravida 0 Black woman presents to her primary care clinician with From the Divisions of Reproductive heavy menstrual bleeding and abdominal bloating. She is noted to have iron- Endocrinology (E.A.S.) and Gynecology (S.K.L.-T.), Department of Obstetrics and deficiency anemia. Evaluation for thalassemia and sickle cell anemia is negative. She Gynecology, the Department of Physiolo- has no hematochezia and no family history of colon cancer or inflammatory bowel gy and Biomedical Engineering (E.A.S.), disease. She describes her menses as regular and monthly, lasting for 8 days, and the Division of Endocrinology, Depart- ment of Medicine (E.A.S.), the Depart- unchanged over time. She uses eight or nine tampons per day for the three heaviest ment of Surgery (E.A.S., S.K.L.-T.), and the days of her cycle and occasionally has menstrual accidents. She is in a Ph.D. program Women’s Health Research Center (E.A.S., and anticipates pursuing pregnancy in 2 years. Ultrasonography reveals an enlarged S.K.L.-T.), Mayo Clinic, and the Mayo Clinic College of Medicine and Science (E.A.S., uterus with multiple fibroids and normal ovaries. How would you treat this patient? Uterine fibroids (leiomyomas) are myometrial masses (Fig. 1) and Rochester, MN 55905. are the leading indication for hysterectomy. Fibroids affect 70 to 80% of N Engl J Med 2024;391:1721-33. persons with a uterus during their lifetime.1 Up to 50% of persons with 10.1056/NEJMcp2309623 fibroids have symptoms, including heavy and prolonged menstrual bleeding, Copyright © 2024 Massachusetts Medical Society. anemia-associated fatigue, pelvic pressure, and both menstrual and nonmenstrual CME pain. Fibroids can cause compression of surrounding structures with resultant bulk-related symptoms, including in the bowel (constipation), bladder (urinary frequency, urgency, or retention), and vagina (painful intercourse). Slow growth of uterine fibroids is typical, although both shrinkage and growth spurts do occur.2 Fibroid-related morbidity is compounded by underdetection and its symptoms being attributed to other conditions, such as gastrointestinal or hematologic dis- ease. Owing to the stigma associated with discussing menstruation, many persons with long or heavy menses are unaware that their experience is abnormal. Symp- tomatic persons often receive a delayed diagnosis. In one third of patients, diag- nosis can take 5 years, with some patients waiting more than 8 years.3 Delays in diagnosis adversely affect fertility, quality of life, and financial welfare,4,5 and in a qualitative study, 95% of persons with symptomatic fibroids reported psycho- logical sequelae, including depression, worry, anger, and body-image distress.6 Menstruation-related stigma and shame inhibit discussion, study, advocacy, and innovation in this field. A total of 50 to 72% of persons who receive a diagnosis of uterine fibroids on the basis of ultrasonography were not previously aware that they had fibroids, which suggests a potential role for wider ultrasonographic assess- ment for this common condition.
Nutrition and Metabolic Health · Dietary Patterns
Barnard ND et al., 2023 · Frontiers in nutrition
Endometriosis is characterized by the presence of endometrial tissues outside the uterine lining, typically on the external surface of the uterus, the ovaries, fallopian tubes, abdominal wall, or intestines. The prevalence of endometriosis in North America, Australia, and Europe is \~1-5% in women of reproductive age. Treatment options for endometriosis are limited. While over-the-counter medications may be used to reduce acute pain, hormonal treatments are common and may interfere with fertility. In more severe cases, laparoscopic excision procedures and even hysterectomies are used to treat the pain associated with endometriosis. Nutritional interventions may be helpful in the prevention and treatment of endometriosis and associated pain. Reducing dietary fat and increasing dietary fiber have been shown to reduce circulating estrogen concentrations, suggesting a potential benefit for individuals with endometriosis, as it is an estrogen-dependent disease. Meat consumption is associated with greater risk of developing endometriosis. Anti-inflammatory properties of plant-based diets may benefit women with endometriosis. Additionally, seaweed holds estrogen-modulating properties that have benefitted postmenopausal women and offers potential to reduce estradiol concentrations in pre-menopausal women. Furthermore, consumption of vitamin D has been shown to reduce endometrial pain via increased antioxidant capacity and supplementation with vitamins C and E significantly reduced endometriosis symptoms, compared with placebo. More randomized clinical trials are needed to elucidate the role of diet in endometriosis.
Fibroids · Fibroid Management
Cetin E et al., 2020 · Current opinion in obstetrics & gynecology
Uterine fibroids are the most common benign neoplasms of the female reproductive tract and one of the major public health concerns. Although most women with uterine fibroids are asymptomatic, over 30% of them will present with varying symptoms. This review focuses on the role of non-hormonal mediators and pathways in uterine fibroid biology. Furthermore, it provides data regarding the most recent findings in the field of compounds, which use those non-hormonal pathways in the medical therapy of uterine fibroids. Complex signaling pathway alterations are crucial for uterine fibroid development. The topic of the pathophysiology of uterine fibroids focuses mostly on steroids and other hormones. However, other very important pathways exist, and some of them are independent of hormones. Some of the most important pathways, which are non-hormonal, but in some cases still hormone-depended, include growth factors, cytokines and inflammation, Smad proteins, wingless type/β-catenin and others. Much more is known about hormonal than about non-hormonal signaling in uterine fibroids. Growth factors, early life exposure and inflammation are key factors in uterine fibroid biology. Numerous agents depend on those pathways and may find their place in the current and future therapy of uterine fibroids.