FIGO classification of uterine fibroids according to 

FIGO classification of uterine fibroids according to 

Source publication
Article
Full-text available
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications. Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies m...

Similar publications

Article
Full-text available
Study Objective This study aimed to investigate the morbidity of laparoscopic myomectomy (LM) versus open myomectomy (OM), including intraoperative blood loss, duration of surgery, hospital stay, and complications and to evaluate the criteria for selection of cases suitable for LM. Design This was a retrospective study. Setting This study was con...
Article
Full-text available
Objective: To compare the effectiveness of perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy. Material and methods: A randomized controlled trial involving women with uterine leiomyoma who underwent abdominal myomectomy was conducted at a tertiary facility...
Article
Full-text available
Purpose The CHOICES study compared short-term resource utilization, facility costs, and perioperative patient outcomes between transcervical fibroid ablation (TFA) with the Sonata® system and myomectomy through a case-matched comparative trial design. This is the first facility-level comparative study conducted for TFA. Patients and Methods The st...
Article
Full-text available
Introduction Robotic-assisted laparoscopic myomectomy (RALM) is being increasingly performed for large and multiple uterine myomas because of precise surgery and offers many short-term benefits over conventional surgeries; however, long-term effects in terms of reproductive outcome are not studied well. Our study aims at finding the pregnancy rate...
Article
Full-text available
Uterine fibroids are the commonest Gynecological benign tumor which affect reproductive age women. Surgical management of large fibroid uterus create multiple challenges to both surgeon and the patient. This is a case of large fibroid uterus in an unmarried lady, grown up to the level of xiphisternum which treated with successful myomectomy through...

Citations

... More conservative approaches, such as uterine artery embolization (UAE) or thermo-ablative techniques like MRI-guided focused ultrasound (MRgFUS), are also available [5]. MRgFUS induces localized coagulative necrosis, identified with the non-perfused volume (NPV) (tissue without blood flow evaluated at the end of the treatment) [4,6], which is correlated with fibroid shrinkage potential, making it a noninvasive and convenient option. However, it may lead to a need for further intervention [7][8][9][10]. ...
Article
Full-text available
Purpose To assess the long-term outcomes of MR-guided focused ultrasound (MRgFUS) for treating uterine fibroids, focusing on re-intervention rates, pregnancy outcomes, and the onset of menopause over a 7-year follow-up period. Materials and Methods We conducted a historical cohort study of 99 women with symptomatic uterine fibroids who underwent MRgFUS between 2013 and 2020 at a single tertiary medical center. Data collection included patient demographics, treatment details, and follow-up interviews. Re-intervention rates were evaluated using Kaplan–Meier curves and Cox regression analysis to identify predictors of further treatments, with a specific focus on age-related differences. Results Over a median follow-up of 6.1 years, 33.1% of women required re-intervention for persistent fibroid symptoms. The median patient's age was 43 years old. Women aged ≤ 43 years had significantly higher re-intervention rates than those aged 44 + years (47.5% vs. 16.7%, p = 0.005). Multivariable Cox regression identified age as the sole significant predictor of re-intervention (HR44+vs. <43 0.303 95% CI 0.128–0.714, p = 0.006). Sixteen women conceived after MRgFUS, resulting in 21 pregnancies, with 72.2% live births and a spontaneous miscarriage rate of 22.2%. The mean age of menopause was 51.4 years, similar to global averages. Conclusions MRgFUS is a practical, noninvasive option for treating symptomatic uterine fibroids. Older women show lower re-intervention rates. Pregnancies post-MRgFUS are possible, and the procedure does not appear to affect the onset of menopause. Age remains a crucial predictor for further re-intervention.
... A selective estrogen receptor modulator (SERM) raloxifene hydrochloride (RLH) is commonly recognized for its therapeutic use in treating postmenopausal osteoporosis and lowering the risk of invasive breast cancer in postmenopausal women (Bulun 2013;Davydov et al. 2017;Dolmans et al. 2019;Donnez and Dolmans 2016;Levy 2008;Patel et al. 2024a, b;Sabry and Al-Hendy 2012;Stewart et al. 2016). While RLH has an estrogenic antagonistic impact on reproductive organs like the breast and uterus, it is known to work as an estrogenic agonist on the metabolism, central nervous system, skeleton, and cardiovascular system (Ağardan et al. 2016a;Murthy et al. 2020a). ...
Article
Full-text available
The selective estrogen receptor modulator (SERM) raloxifene hydrochloride (RLH) is used extensively in the management and prevention of breast cancer and osteoporosis. Recent clinical studies show the repurposing of RLH in various diseases based on its structure and some clinical trials studies. Optimizing the clinical effectiveness of this important drug requires a thorough review of the formulation techniques, patent environment, and analytical procedures. The purpose of this study is to give a thorough understanding of dug repurposing with the most recent formulation strategies, patents, and analytical methods related to RLH. Highlighting recent developments, pointing out current issues, and suggesting future lines of inquiry and development are the objectives. A thorough literature analysis was carried out with an emphasis on repurposing of RLH for various diseases and analytical techniques employed in the measurement and quality control of RLH. These techniques included spectroscopic, chromatographic, and electrochemical approaches. Key advancements and trends were found by analyzing patent databases. The evaluation also looked into formulation techniques intended to improve the medicine’s therapeutic efficacy and bioavailability, notably cutting-edge drug delivery methods. For the study of RLH, the review identifies several sophisticated analytical techniques that provide increased accuracy and robustness. Significant innovation has been revealed by the patent landscape, particularly in formulations targeted at enhancing solubility and bioavailability. Notable formulation techniques that overcome the drawbacks of conventional techniques include transdermal patches, nanoparticulate systems, and various drug delivery techniques. Graphical Abstract
... Surgery is also ideal treatment for twisted pedunculated subserosal uterine leiomyomas. Myomectomy, which can be performed via laparoscopy or laparotomy, is the preferred therapy option for pedunculated subserosal leiomyomas in women of reproductive age [ 12 ]. For our patient, we opted for a total hysterectomy with right annexectomy. ...
... 10,11 Recently, GnRH-a has been increasingly employed in patients with intramural fibroids to diminish the magnitude of the fibroids and to mitigate their recurrence following surgical intervention. 12,13 Furthermore, given the positive impact of GnRH-a on endometrial receptivity and their therapeutic effects on intramural fibroids, we hypothesize that a GnRH-a-HRT protocol could enhance reproductive outcomes in individuals with thin endometrium and intramural fibroids undergoing FET. If validated, this individualized medical treatment plan would establish a foundation for clinical interventions aimed at maximizing patient benefits. ...
Article
Full-text available
Background Both intramural myomas and thin endometrium exert a detrimental influence on the outcomes of assisted reproductive technology (ART). The downregulation of gonadotropin releasing hormone agonists (GnRH-a) is regarded as an effective approach to reducing the size of intramural fibroids and enhancing endometrial receptivity. Consequently, we conducted this study to assess whether the GnRH-a combined with hormone replacement therapy (GnRH-a-HRT) can improve reproductive outcomes in frozen embryo transfer cycles for patients with a thin endometrium (≤7 mm) and intramural fibroids. Methods This retrospective cohort study encompassed 360 patients who underwent frozen embryo transfer following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Patients were stratified into three groups based on the endometrial preparation protocol: the natural cycle (NC) group (n=96), the hormone replacement therapy (HRT) group (n=180), and the GnRH-a-HRT group (n=84). The live birth rate (LBR) was designated as the primary outcome, while clinical pregnancy rate (CPR), miscarriage rate, and ectopic pregnancy rate were classified as secondary outcomes. Results The LBR and CPR in the GnRH-a-HRT group were significantly higher than those in both the HRT group and the NC group (both P < 0.0001). A logistic regression model indicated that the LBR was significantly higher in the GnRH-a-HRT group compared to both the HRT group (odds ratio, 0.269; 95% confidence interval, 0.114–0.637; P = 0.003) and the NC group (odds ratio, 0.524; 95% confidence interval, 0.457–0.956; P = 0.023). Subgroup analyses based on the number and dimension of fibroids demonstrate the positive efficacy of the GnRH-a–HRT regimen. Conclusion Compared to NC and HRT protocol, improved reproductive outcomes were observed in the GnRH-a–HRT group. These findings provide valuable insights for exploration of the underlying mechanisms by which the GnRH-a-HRT protocol enhances reproductive outcomes in patients of thin endometrium with intramural fibroids.
... Additionally, all fibroids located entirely outside the uterus are classified as type 8. Mixed fibroids typically refer to those with both intramural and submucosal components and are classified as types 2-5. Submucosal fibroids (types 0-2) are often treated with hysteroscopic resection, whereas intramural or subserosal types (types 3-7) may require laparoscopy or laparotomy [8]. Misclassifying a FIGO type 2 fibroid as type 3 or 4 could result in unnecessary invasive surgery, whereas underestimating submucosal involvement may result in incomplete resection, persistent symptoms, or complications such as uterine rupture in future pregnancies [9]. ...
Article
Full-text available
Purpose Correctly classifying uterine fibroids is essential for treatment planning. The objective of this study was to assess the accuracy and reliability of the FIGO classification system in categorizing uterine fibroids via organ-axial T2WI and to further investigate the factors associated with uterine compression. Methods A total of 130 patients with ultrasound-confirmed fibroids were prospectively enrolled between March 2023 and May 2024. These patients underwent MR examinations, including body-axial T2W (sagittal and axial) and organ-axial T2W (high resolution with oblique coronal and double oblique axial). For postprocessing, the interobserver agreements between two radiologists and the interagreements between two MR examinations and operational descriptions were evaluated via kappa statistics. The accuracy of axial and organ-axial T2W assessments in the FIGO classification of uterine fibroids was compared when surgical outcomes were used as the gold standard. The Kruskal‒Wallis test was used to compare the differences in cavity deformation across various FIGO classifications. Spearman’s rank correlation test was used to analyze the correlation between the FIGO classification and the parameters of uterine cavity deformation. Results In total, 170 fibroids from 130 patients were included. Compared with body-axial T2WI, organ-axial T2WI showed better interobserver agreement and greater interagreements with operational descriptions, with kappa values of 0.877 (P = 0.04) and 0.932 (P = 0.037), respectively. The accuracy of the organ-axial T2WI assessment in determining the FIGO classification of uterine fibroids was greater than that of the body-axial T2WI assessment, with an accuracy of 92.9% (P < 0.01). Thirty-two (38.1%) fibroids showed cavity deformation according to organ-axial T2WI, including fibroids with FIGO types 0–7 and 2–5. Among these factors, the size of the fibroids (S), base width (B), depth of compression (D), D/B, D/S, and compression angle (A) significantly differed among the different FIGO types of fibroids (P < 0.05). Compression angle exhibited a linear correlation with the FIGO type (P < 0.001). Conclusion Compared with body-axial T2WI, organ-axial T2WI provides greater accuracy on the basis of the FIGO classification, which is more consistent with surgical outcomes. Given the excellent reliability and accuracy of the preoperative FIGO classification, organ-axial T2WI can contribute to treatment planning.
... However, such procedures may not align with the reproductive goals and preferences of many patients . Emerging non-surgical interventions such as uterine artery embolization (UAE), focused ultrasound surgery (FUS), and pharmacological therapies have revolutionized treatment paradigms by offering effective symptom relief with minimal invasiveness [4][5] . In the field of Obstetrics and Gynecology, CenteringPregnancy is lauded as a standout intervention to improve maternal and neonatal outcomes. ...
Article
Full-text available
OBJECTIVE: Uterine fibroids significantly affect the quality of life of women, with symptoms including excessive bleeding, pain, and infertility. Non-surgical interventions have emerged as effective alternatives to invasive procedures like hysterectomy.To evaluate the outcomes of non-surgical interventions for uterine fibroids, including symptom severity, fibroid size reduction, and patient satisfaction, at Mardan Medical Complex, with a focus on patient-centered outcomes. METHOD: this study was conducted after ethical aproval at gynea b ward mardan medical complex.the study assessed demographic data, clinical characteristics, and treatment outcomes, including symptom relief and quality-of-life measures. data were statistically analyzed using descriptive and inferential methods, with significance determined at p < 0.05. RESULT: This study analyzed data from 150 patients receiving uterine artery embolization (UAE), focused ultrasound surgery (FUS), and pharmacological therapy. UAE showed the highest symptom reduction (60%), followed by FUS (50%) and pharmacological therapy (40%). Size reduction was consistent across all modalities, with no statistically significant differences observed (p>0.05). CONCLUSION:Non-surgical approaches such as UAE and FUS are effective and patient-centered alternatives for managing uterine fibroids. Tailored treatments are critical for optimizing patient satisfaction and clinical outcomes.
... • Abnormalities of the uterus: Transcervical resection of adhesions is advised for individuals with uterine adhesions prior to pregnancy; nevertheless, the management of other congenital malformations of the genital tract remains controversial. Our institution adopts the FIGO classification for uterine leiomyomas, along with prior reviews [16], and the management protocols are as follows: Type 0 myomas are completely located within the uterine cavity, while type 1 myomas are less than 50% intramural. Hysteroscopic myomectomy is recommended for both type 0 and type 1 myomas, and GnRH agonists or mifepristone are utilized to cure anemia prior to surgery. ...
Article
Full-text available
Background The treatment for recurrent pregnancy loss (RPL) has been addressed in international guidelines. However, limited studies have investigated the risk factors associated with pregnancy and live birth outcomes in patients with RPL after treatment. The objective of this study was to offer a comprehensive assessment of the risk factors for pregnancy loss in patients with a history of RPL following therapeutic interventions. Methods This retrospective cohort study involved 431 women in early pregnancy with a history of RPL who experienced treatment at the Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between June 2018 and June 2020. The main outcome measures were the ongoing pregnancy ≥ 12 weeks and the live birth outcomes. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for pregnancy loss < 12 weeks and live birth outcomes. Results Patient’s age and the prevalence of uterine malformations were significantly different between the patients with and without ongoing pregnancy ≥ 12 weeks (32.64 ± 5.08 vs. 31.54 ± 4.34, P = 0.026; 34.70% vs. 24.60%, P = 0.035). The risk of pregnancy loss < 12 weeks was significantly increased with age and those with uterine abnormalities (adjusted OR: 1.48 [95% CI: 1.05 to 2.07], P = 0.025; adjusted OR:1.78 [95% CI 1.11 to 2.79], P = 0.016). The risk of non-live birth was significantly increased in couples with parental karyotype abnormalities (adjusted OR: 0.08 [95% CI 0.01 to 0.76], P = 0.029). No statistically significant differences were found between the patients with and without ongoing pregnancy ≥ 12 weeks and live birth regarding number of miscarriages, BMI, thyroid stimulating hormone, thyroid peroxidase antibody, thyroglobulin antibody, homa insulin-resistance, parental karyotype abnormality, B lymphocyte, NK cells, antinuclear antibody, antithrombin III activity, platelet aggregation function, anticardiolipin antibody, lupus anticoagulant, homocysteine, protein C, protein S, anti-β2 glycoprotein antibody, anti-phosphatidylserine and thromboelastograms. Conclusions In patients with RPL after treatment, age and uterine anomalies were identified as risk factors linked to pregnancy loss < 12 weeks, while parental karyotype abnormalities were recognized as an independent risk factor affecting live birth outcomes. Clinical trial number Not applicable.
... Uterine fibroids are the most common benign pelvic tumors of the female genital tract and may severely decrease quality of life in affected individuals. 1,2 Common symptoms are heavy menstrual bleeding with or without secondary anemia, pelvic pressure, bowel dysfunction, urinary dysfunction, dyspareunia, low back pain and impaired fertility. 3 When recommending treatment, patients' symptoms, number and location of fibroids, desire for pregnancy, and risks of different treatment options must be considered. ...
Article
Full-text available
Introduction The objective of this study was to evaluate the effectiveness and acceptability of ultrasound guided microwave ablation for treating symptoms related to uterine fibroids. Material and Methods This was a prospective interventional study. Patients with symptomatic uterine fibroids were included at Danderyd Hospital, Sweden, from January 2020 to August 2023. All patients were treated with percutaneous or vaginal ultrasound guided microwave ablation. Primary outcome was reduction of fibroid symptoms evaluated by the validated uterine fibroid symptom and quality of life (UFS‐QoL) questionnaire at 6 months post‐treatment. Location of each fibroid was noted. Secondary outcomes included reduction of menstruation blood loss, change in hemoglobin, ferritin and Anti‐Müllerian hormone, fibroid volume difference, hospitalization, acceptability, and postoperative pain. Clinical trials registration number NCT04240262. Results Symptoms from uterine fibroids decreased by 37% (p < 0.001) on the symptom severity scale and health‐related quality of life increased by 74% (p < 0.001). Menstrual blood loss decreased by 38% (p < 0.001) according to the Pictorial Bleeding Assessment Chart and median fibroid shrinkage of the three largest treated fibroids was 64% (p < 0.001). Highest median shrinkage rate (82) was seen in submucous fibroids. A total of 110 of 113 (97%) patients left the hospital on the day of treatment. We experienced one adverse event (0.8%) Clavien Dindo grade 3. Acceptability was high and postoperative pain was mild to moderate. Conclusions Microwave ablation is a highly acceptable minimally invasive method for treating symptoms related to uterine fibroids in patients who desire uterus preservation. Submucosal fibroids showed more favorable treatment results.
... The proliferation of these tumors is regulated by estrogen, growth hormone, and progesterone. [1,2] The patient provided written informed consent after being fully briefed on the study's objectives, potential risks and benefits, and the intended use of the data for publication. The patient was assured of confidentiality and consented to the publication of the findings. ...
Article
Full-text available
Rationale Uterine leiomyomas, though commonly benign, can occasionally lead to serious complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This study aims to highlight the uncommon yet serious association between large uterine leiomyomas and thromboembolism, which is often overlooked in patients without traditional risk factors. It emphasizes the need for awareness, early diagnosis, and timely intervention to prevent complications in patients presenting with unexplained symptoms and pelvic masses. Patient concern A 38-year-old gravida 5, para 2 woman presented to the emergency room with left lower extremity swelling, pain, and discoloration, accompanied by dyspnea. She had no prior history of DVT or PE and did not have any known risk factors for venous thromboembolism. Diagnosis The patient was diagnosed with DVT and PE, confirmed by venous duplex ultrasound and abdominal and pelvic computed tomography, which revealed thrombus extension to the left iliac vein. Chest computed tomography angiography confirmed a partially occlusive thrombus in the pulmonary arteries. Intervention The patient underwent mechanical aspiration thrombectomy, followed by placement of a left iliac stent. Anticoagulation therapy with heparin was initiated post-thrombectomy. On the third day, a right supracervical hysterectomy was successfully performed. After surgery, anticoagulation was continued with heparin, and the patient was later discharged on apixaban for ongoing therapy. Outcomes The patient made full recovery with no recurrence of thromboembolic events at 11 months posttreatment. Lessons This case highlights the rare but serious complication of DVT and PE in patients with uterine leiomyomas. Timely intervention with thrombectomy, stent placement, and hysterectomy was effective in resolving the thromboembolic events.
... Although UF is asymptomatic in most cases, some patients experience significant symptoms including abnormal bleeding, pelvic pain, infertility, and obstetric complications [41]. Approximately one-third of patients with UF require clinical treatment, with hysterectomy being the only definitive option, resulting in the loss of fertility and potential complications [41]. ...
... Although UF is asymptomatic in most cases, some patients experience significant symptoms including abnormal bleeding, pelvic pain, infertility, and obstetric complications [41]. Approximately one-third of patients with UF require clinical treatment, with hysterectomy being the only definitive option, resulting in the loss of fertility and potential complications [41]. Our results suggested that gene-mediated CETP inhibition significantly ameliorated excessive and irregular menstruation, along with abdominal and pelvic pain. ...
Article
Full-text available
Objective Observational studies suggest that blood lipids are a risk factor for uterine fibroids (UFs) and that lipid-lowering drugs are beneficial for the treatment and prevention of UF; however, the conclusions are inconsistent. We aimed to determine the causal effects of lipids and lipid-lowering drugs on UFs using Mendelian randomization (MR). Methods Genetic variants from genome-wide association studies (GWAS) of lipid traits and variants in genes encoding lipid-lowering drug targets were extracted, and two independent UF GWAS were set as the outcome. Their effects on UF risk and related traits were estimated using the inverse variance weighted method. Results The MR analysis revealed that high density lipoprotein cholesterol (HDL-C, OR = 0.88, 95 % CI: 0.83–0.93, P = 3.58E-6) and triglycerides (TG, OR = 1.14, 95 % CI: 1.07–1.21, P = 6.83E-5) were protective factors and risk factors for UF, respectively. Drug-targeted MR analysis results indicated that genetically predicted inhibition of cholesteryl ester transfer protein (CETP) was associated with a lower UF risk (OR = 0.95, 95 % CI: 0.92–0.98, P = 7.83E-4), as well as reduced levels or risk of other UF-associated clinical traits, including estradiol level, excessive menstruation, abdominal and pelvic pain, myomectomy, and miscarriage. Conclusions Our study provides evidence that HDL-C and TG levels were causally associated with UF risk. Genetically proxied CETP inhibition may have a protective effect against UF, which warrants further investigation.