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Symptoms of uterine myomas: data of an epidemiological study in Germany

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PurposeCurrently, no reliable data are available concerning the type and frequency of symptoms in premenopausal women with uterine myomas. Methods2296 women were examined by means of vaginal ultrasound for the presence of myomas in seven gynaecological outpatient departments in Germany. From this population, 1314 premenopausal women between the ages of 30 and 55 years were evaluated to determine the type and frequency of myoma-related symptoms and their relationship to anamnestic factors, and the number, size, and location of the myomas. Standardised questionnaires were used to record the symptoms. ResultsPrevalence: In almost every second premenopausal woman (n = 639; 48.6%), uterine myomas were diagnosed. The frequency of myomas increased continuously with age and was highest in women between 46 and 50 years (65.2%). Age itself was found to be the main risk factor for the presence of myomas (p < 0.001). Symptoms: 54.3% (n = 347) of the women suffered from myoma-related symptoms. The four main symptoms were identified as: Heavy menstrual bleeding (40.7%), dysmenorrhoea (28.2%), lower abdominal pain (14.9%), and intermenstrual bleeding (14.1%). In the majority of cases, the symptoms occurred simultaneously. Determinants for symptoms: Symptoms did not follow a clear age-related trend, whilst the number and size of the myomas did determine the presence of symptoms. The main influencing factor for the presence of intermenstrual bleeding was the location of the myomas. Conclusions The high prevalence of uterine myomas highlights the importance of the diagnosis uterine myomas in standard gynaecological practice: The presence of only one myoma caused symptoms in 46.5% and small myomas of up to 2 cm in diameter resulted in symptoms in 39.5%.
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GENERAL GYNECOLOGY
Symptoms of uterine myomas: data of an epidemiological study
in Germany
Dolores Foth
1
Friedrich-Wilhelm Ro
¨hl
2
Cornelia Friedrich
3
Heike Tylkoski
4
Thomas Rabe
5
Thomas Ro
¨mer
6
Ann Kitay
2
Hans-Joachim Ahrendt
7
Received: 16 May 2016 / Accepted: 8 November 2016 / Published online: 21 November 2016
Springer-Verlag Berlin Heidelberg 2016
Abstract
Purpose Currently, no reliable data are available con-
cerning the type and frequency of symptoms in pre-
menopausal women with uterine myomas.
Methods 2296 women were examined by means of vaginal
ultrasound for the presence of myomas in seven gynaeco-
logical outpatient departments in Germany. From this
population, 1314 premenopausal women between the ages
of 30 and 55 years were evaluated to determine the type
and frequency of myoma-related symptoms and their
relationship to anamnestic factors, and the number, size,
and location of the myomas. Standardised questionnaires
were used to record the symptoms.
Results Prevalence: In almost every second pre-
menopausal woman (n=639; 48.6%), uterine myomas
were diagnosed. The frequency of myomas increased
continuously with age and was highest in women between
46 and 50 years (65.2%). Age itself was found to be the
main risk factor for the presence of myomas (p\0.001).
Symptoms: 54.3% (n=347) of the women suffered from
myoma-related symptoms. The four main symptoms were
identified as: Heavy menstrual bleeding (40.7%), dys-
menorrhoea (28.2%), lower abdominal pain (14.9%), and
intermenstrual bleeding (14.1%). In the majority of cases,
the symptoms occurred simultaneously. Determinants for
symptoms: Symptoms did not follow a clear age-related
trend, whilst the number and size of the myomas did
determine the presence of symptoms. The main influencing
factor for the presence of intermenstrual bleeding was the
location of the myomas.
Conclusions The high prevalence of uterine myomas
highlights the importance of the diagnosis uterine myomas
in standard gynaecological practice: The presence of only
one myoma caused symptoms in 46.5% and small myomas
of up to 2 cm in diameter resulted in symptoms in 39.5%.
Keywords Uterine myomas Prevalence of myomas
Heavy menstrual bleeding, dysmenorrhoea, lower
abdominal pain
Introduction
Uterine myomas are the most frequent benign solid
tumours of the female genital tract. Myomas are subject to
considerable individual variability in terms of their
appearance and clinical relevance. They develop submu-
cosally, intramurally, subserously, intracervically, and/or
In memory of Prof. Hans-Joachim Ahrendt.
&Dolores Foth
dfoth@t-online.de
1
MVZ PAN Institut fu
¨r Endokrinologie und
Reproduktionsmedizin, Zeppelinstr. 1, 50667 Cologne,
Germany
2
Institut fu
¨r Biometrie und Medizinische Informatik (IBMI),
Medizinische Fakulta
¨t der Otto-von-Guericke-Universita
¨t
Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
3
Frauenarztpraxis, Schalaunische Straße 6-7,
06366 Ko
¨then (Anhalt), Germany
4
Praxis fu
¨r Gyna
¨kologie und Geburtshilfe, Leipziger Straße
45B, 39120 Magdeburg, Germany
5
Universita
¨ts-Frauenklinik, Voßstr. 9, 69115 Heidelberg,
Germany
6
Klinik fu
¨r Gyna
¨kologie und Geburtshilfe, EVK Ko
¨ln-
Weyertal, Weyertal 76, 50931 Cologne, Germany
7
Praxis fu
¨r Frauenheilkunde und Klinische Forschung,
Halbersta
¨dter Str. 122, 39112 Magdeburg, Germany
123
Arch Gynecol Obstet (2017) 295:415–426
DOI 10.1007/s00404-016-4239-y
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Several studies investigated the correlation between submucous myoma characteristics and anemia with conflicting results [15][16][17][18][19][20][21][22]. ...
... Therefore, it is fundamental to identify the more relevant factors that influence hemoglobin levels in women with myomas to provide objective criteria for establishing the appropriateness of surgery. Several studies have investigated the correlation between menstrual bleeding patterns and myoma characteristics with conflicting results [15][16][17][18][19][20][21][22]. ...
... They found that symptomatic women with at least one submucous myoma are not at higher risk of becoming anemic than symptomatic women with non-submucous myomas. An epidemiological study in Germany obtained similar results [22]. The number and size of myomas, as determined by ultrasound, were significant risk factors for the presence of heavy menstrual bleeding, but there was no link between myoma location and heavy menstrual bleeding [22]. ...
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Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas >60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 > 10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if > of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.
... An online survey of 21,479 women from Brazil, Canada, France, Germany, Italy, South Korea, the UK and the US on the other hand found a self-reported incidence of 4.5-17.8% in women of reproductive age (12), indicating the importance of sample population, age bracket and genetic background to reported susceptibility. In up to 40% of patients, uterine fibroids cause HMB (13), and more than half of the patients experience combinations of symptoms such as HMB, pelvic pain, or infertility (14,15). FIGURE 1 | Hypothetical scenarios of a link between uterine fibroids and heavy menstrual bleeding. ...
... Uterine fibroids are classified according to their location relative to the uterine anatomy in the FIGO system (16), but while intermenstrual bleeding as a symptom of uterine fibroids has been shown to correlate with the position and number of fibroids (13), the causal link to HMB is unknown. The classification of both HMB and the FIGO system are not without problems, as consistency between surgeons is lacking [ Figure 1, (17)]. ...
... This structure can be seen as a "ring of fire" in ultrasound Doppler imaging, and it is separated from the myometrium by a clear cleft, as observed in histological images. The bursting of the vessels contained within the pseudocapsule could explain the HMB observed in women with uterine fibroids, in which case the symptom should correlate with the position of the fibroids, as the pseudocapsule only develops around intramural fibroids; this seems to be the case (13). The pseudocapsule is made up of the same cell types and shows the same biologic structure as the neighboring myometrium (83); however, the vasculature of the pseudocapsule might harbor structural defects that rend it susceptible to breaking, leading to HMB. ...
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Uterine Fibroids, or leiomyomata, affect millions of women world-wide, with a high incidence of 75% within women of reproductive age. In ~30% of patients, uterine fibroids cause menorrhagia, or heavy menstrual bleeding, and more than half of the patients experience symptoms such as heavy menstrual bleeding, pelvic pain, or infertility. Treatment is symptomatic with limited options including hysterectomy as the most radical solution. The genetic foundations of uterine fibroid growth have been traced to somatic driver mutations ( MED12, HMGA2, FH −/− , and COL4A5-A6 ). These also lead to downstream expression of angiogenic factors including IGF-1 and IGF-2, as opposed to the VEGF-driven mechanism found in the angiogenesis of hypoxic tumors. The resulting vasculature supplying the fibroid with nutrients and oxygen is highly irregular. Of particular interest is the formation of a pseudocapsule around intramural fibroids, a unique structure within tumor angiogenesis. These aberrations in vascular architecture and network could explain the heavy menstrual bleeding observed. However, other theories have been proposed such as venous trunks, or venous lakes caused by the blocking of normal blood flow by uterine fibroids, or the increased local action of vasoactive growth factors. Here, we review and discuss the evidence for the various hypotheses proposed.
... [30][31][32][33] UF is associated with significant morbidity and substantial socioeconomic costs. [34][35][36] Data from a global systematic review of the cost of UF showed that the total direct and indirect cost after diagnosis or from surgical care ranged from US$11 717 to US$25 023 per patient per year. 37 In USA, the annual cost of UF to the economy was estimated to be between US$5.9 and US$34.4 billion with obstetrical complications contributing the highest fraction of the economic burden. ...
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Objective Studies, mainly from high-income countries, suggest that there are ethnic and racial variations in prevalence of uterine fibroids (UF). However, there have been few studies of the epidemiology of UF in sub-Saharan Africa (SSA). We reviewed published articles on the epidemiology of UF in SSA. Design This was a scoping review of literature. Settings We searched three databases (PubMed, African Wide Information (EBSCO) and African Journals OnLine (AJOL)). The search for eligible articles was conducted between December 2019 and January 2021. Primary and secondary outcome measures To describe the reported prevalence/incidence of, and risk factors for UF in SSA. Results Of the 1052 articles retrieved, 9 met the inclusion criteria for review. The articles were from Nigeria (4/9), Ghana (2/9), Cameroon (1/9), Kenya (1/9) and South Africa (1/9). Two studies from pathology departments and three studies from radiology departments reported prevalence of UF. We did not find any study on the incidence or genomics of UF in SSA. Of the three studies that reported on the risk factors of UF, only one case–control study that was conducted using retrospective data of attendees at a gynaecological clinic conducted multivariable analysis. Conclusion There is lack of robust epidemiological studies of the prevalence, incidence and risk factors of UF in SSA. There is urgent need to study epidemiological and genomics risk factors of UF in SSA because UF is the most common gynaecological neoplasm in this population where it is associated with significant morbidity and occasional, usually perioperative, mortality.
... Fibroids cause different symptoms, and hypermenorrhoea is the main symptom with the prevalence of 40-54%. The next common symptoms are dysmenorrhea and lower abdominal pain [3,4]. In 48% cases, fibroids are the cause of severe hypermenorrhoea with anaemia [5]. ...
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This authoritative textbook provides a much-needed guide for postgraduate trainees preparing for the European Board and College of Obstetrics and Gynaecology (EBCOG) Fellowship examination. Published in association with EBCOG, it fully addresses the competencies defined by the EBCOG curriculum and builds the clinical practice related to these competencies upon the basic science foundations. Volume 2 covers the depth and breadth of gynaecology, and draws on the specialist knowledge of four highly experienced Editors and over 100 contributors from across Europe, reflecting the high-quality training needed to ensure the safety and quality of healthcare for women. It incorporates key international guidelines throughout, along with colour diagrams and photographs for easy understanding. This is an invaluable resource, not only for postgraduate trainees planning to sit the EFOG examination, but also for practising specialists looking to update their knowledge and skills to meet the ever-evolving complexity of clinical practice.
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Uterine leiomyoma is the most common pelvic tumor in women, but the actual prevalence is unknown. To review the literature on the prevalence of uterine leiomyoma, presenting symptoms, and medical management. On April 1-30, 2014, a PubMed search for studies reported in English was conducted using the terms "uterine leiomyoma," "prevalence," and "symptoms." Another search was performed using the terms "uterine leiomyoma" and "treatment." All trial types other than internet-only studies were included. Animal studies were excluded from the prevalence/symptom review, but included in the medical management review. Prevalence rates were recorded on the basis of imaging modality, cohort studied, ethnic origin, and age. Studies involving asymptomatic women revealed a trend in prevalence similar to that in symptomatic women, and showed that leiomyomas are more common in this cohort than previously recognized. Affected patients can present with many complaints, but no single symptom has been shown to be specific for this tumor. Various medical therapies are reviewed, summarizing efficacy and toxicity. Further research needs to be conducted on the prevalence in asymptomatic women. Current and future medical management options provide promising results in symptom reduction. Copyright © 2015. Published by Elsevier Ireland Ltd.
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