Fibroids · Fibroid Management
Mitro SD et al., 2024 · JAMA network open
Fibroids are benign neoplasms associated with severe gynecologic morbidity. There are no strategies to prevent fibroid development. To examine associations of hypertension, antihypertensive treatment, anthropometry, and blood biomarkers with incidence of reported fibroid diagnosis in midlife. DESIGN, SETTING, The Study of Women's Health Across the Nation is a prospective, multisite cohort study in the US. Participants were followed-up from enrollment (1996-1997) through 13 semiannual visits (1998-2013). Participants had a menstrual period in the last 3 months, were not pregnant or lactating, were aged 42 to 52 years, were not using hormones, and had a uterus and at least 1 ovary. Participants with prior fibroid diagnoses were excluded. Data analysis was performed from November 2022 to February 2024. Blood pressure, anthropometry, biomarkers (cholesterol, triglycerides, and C-reactive protein), and self-reported antihypertensive treatment at baseline and follow-up visits were measured. Hypertension status (new-onset, preexisting, or never [reference]) and hypertension treatment (untreated, treated, or no hypertension [reference]) were categorized. Participants reported fibroid diagnosis at each visit. Discrete-time survival models estimated hazard ratios (HRs) and 95% CIs for associations of time-varying hypertension status, antihypertensive treatment, anthropometry, and biomarkers with incident reported fibroid diagnoses. Among 2570 participants without a history of diagnosed fibroids (median [IQR] age at screening, 45 [43-48] years; 1079 [42.1%] college educated), 526 (20%) reported a new fibroid diagnosis during follow-up. Risk varied by category of hypertension treatment: compared with those with no hypertension, participants with untreated hypertension had a 19% greater risk of newly diagnosed fibroids (HR, 1.19; 95% CI, 0.91-1.57), whereas those with treated hypertension had a 20% lower risk (HR, 0.80; 95% CI, 0.56-1.15). Among eligible participants with hypertension, those taking antihypertensive treatment had a 37% lower risk of newly diagnosed fibroids (HR, 0.63; 95% CI, 0.38-1.05). Risk also varied by hypertension status: compared with never-hypertensive participants, participants with new-onset hypertension had 45% greater risk of newly diagnosed fibroids (HR, 1.45; 95% CI, 0.96-2.20). Anthropometric factors and blood biomarkers were not associated with fibroid risk. Participants with untreated and new-onset hypertension had increased risk of newly diagnosed fibroids, whereas those taking antihypertensive treatment had lower risk, suggesting that blood pressure control may provide new strategies for fibroid prevention.
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.
Fibroids · Fibroid Management
Hajhashemi M et al., 2019 · Caspian journal of internal medicine
Uterine leiomyomas (fibroids) are the most common benign pelvic tumors in women of reproductive age with an incidence ranging from 5.4% to 77%, Also, there is a high prevalence of vit D deficiency in Iran and there are the numbers of in vivo and vitro biological studies on the relationship of vitamin D and uterine leiomyomas. The aim of this study was to evaluate the effect of vit D supplementation on the size of uterine leiomyoma in women with vit D deficiency. This double-blind prospective clinical trial was performed on 69 patients with uterine leiomyomas who had vit D deficiency. Group A (n=35) was treated with vit D 50,000 IU every 2 weeks for 10 weeks, while group B (n=34) received placebo with same color and shape. Finally, the leiomyoma size in both groups was compared (IRCT: 20160521027998N5). After a 10-week intervention, 25-hydroxyvitamin D3 levels were significantly higher in group receiving vitamin D (36.08 vs 16.25 ng/ml). (P<0.001) Leiomyomas size in vit D group significantly decreased as compared to placebo group (52.58 vs 61.11 mm, respectively). Our results showed that administration of vit D3 may reduce the size of leiomyoma. It seems that vitamin D administration is the effective way to treat leiomyoma.