Thesis(M.S.)--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references.

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 128-145). Available also in a digital version from Dissertation Abstracts.

Thesis (M.S.)--Georgia State University, 2007. / Title from title page. Yu-sheng Hsu, committee chair; Xu Zhang, Jia-wei Liu, committee members. Electronic text (44 p. : ill. (some col.)) : digital, PDF file. Description based on contents viewed Oct. 10, 2007. Includes bibliographical references (p. 35-36).

Abstract Because endometriosis is considered to be the primary cause of infertility in women and the diagnosis is known to be delayed by many years, it is important to understand the association between endometriosis and infertility. The purpose of this cross-sectional, secondary data analysis study was to determine whether there was an association between the age of women when diagnosed with endometriosis and infertility. Using the general model of total patient delay (i.e., the Andersen model) as a theoretical foundation, data for this study was collected by assessing patient medical records of women with endometriosis at multiple OB-GYN clinics in Eastern North Carolina. Multiple logistic regression was conducted to determine potential association between variables. The results presented that diagnosis at an older age and presence of uterine fibroids are significant risk factors for infertility among women with endometriosis. From the results, it can be concluded that infertility may be preventable in women diagnosed with endometriosis and uterine fibroids in younger age. This study presents positive social change by preventing infertility amongst women who suffer from both endometriosis and uterine fibroids; potentially creating preventative programs aimed at better educating women on the risks of endometriosis and uterine fibroids (especially when presented together).

Thesis (M.A.)--Northern Kentucky University, 2007. / Made available through ProQuest. Publication number: AAT 1447104. ProQuest document ID: 1414119681. Includes bibliographical references (p. 75-77)

Introduction: The human menstrual cycle is regulated by sex-steroid hormones, including oestrogen (E), progesterone (P4) and androgens which act by ligand binding to their cognate receptors. Perturbation of the complex series of events governing the menstrual cycle may lead to heavy menstrual bleeding (HMB). This is a common debilitating condition and often associated with uterine fibroids. There remains an unmet need for effective, long-term medical treatment so women avoid surgery and preserve their fertility. Selective progesterone receptor modulators (SPRMs, e.g. ulipristal acetate, UPA) are synthetic ligands that bind the progesterone receptor (PR). Many SPRMs have been developed but only mifepristone (for the management of unwanted pregnancy) and UPA are in current clinical use. UPA is licensed for the intermittent treatment of symptomatic fibroids. SPRMs have potential utility for treatment of HMB as administration rapidly induces amenorrhoea but the mechanisms by which this is achieved are unknown. SPRM administration results in unique endometrial morphological changes (progesterone receptor modulator-associated endometrial changes; PAEC). Despite endometrial unopposed estradiol exposure these morphological changes do not appear to be associated with malignancy or pre-malignancy risk. Indeed endometrial cell proliferation appears reduced despite relative progesterone-antagonism. Based upon findings with other SPRMs it was hypothesised that: (i) administration of UPA would have an endometrial specific effect upon the reproductive tract, with regard to alteration in morphology, localisation of sex steroid receptors (SSR) and cell proliferation.; (ii) administration of UPA would impact upon progesterone-regulated (Pregulated) genes in the endometrium. Methods: The data presented within this thesis are derived from biopsies obtained at hysterectomy from the endometrium, fallopian tubes and cervices of women with symptomatic fibroids administered UPA for 8-15 weeks. Samples were obtained for histological assessment, immunohistochemistry and RNA extraction for subsequent quantitative RT-qPCR of sex-steroid receptors (SSR) and proliferation markers. In addition key P-regulated genes within the endometrium were investigated by RT-qPCR and selected protein expression. To further interrogate the anti-proliferative effect, RNA was extracted from “paired” endometrial biopsies from the same woman in the proliferative phase of the menstrual cycle and following subsequent treatment with UPA for at least eight weeks and microarray gene analyses undertaken. Results: Morphological alteration of the endometrium with UPA administration was consistent with previously published data, but with a higher prevalence than previously described. There was a striking alteration in expression and localization of SSRs, particularly PR and androgen receptor (AR), and alteration of many P-regulated genes, consistent with UPA acting with low progesteroneagonism within the endometrium. There was no alteration of SSR expression within the cervix and proliferation was unchanged. Fallopian tube morphology and SSR expression was consistent with proliferative phase but cell proliferation was reduced following UPA administration, consistent with secretory phase levels. Microarray analyses identified multiple transcripts altered relative to proliferative phase, with GREM2 the most significantly down-regulated gene and MUC1 one of the most significantly upregulated genes. Consistent with low levels of mitotic figures and cell proliferation, the most down regulated KEGG pathway was the cell cycle. Multiple elements within this were subsequently validated (RT-qPCR) and included key regulators of all elements of the mitotic cell cycle, many of which were novel to those previously described following administration of another SPRM, mifepristone. In summary the novel data presented in this thesis considerably extend the data available to date concerning the actions of the SPRM, UPA, on the female reproductive tract, and increases knowledge regarding a compound with promising utility for the management of the debilitating complaint of HMB.

Bakgrund: Myom är den vanligaste gynekologiska benigna tumören hos kvinnor i fertil ålder. Det finns idag läkemedelsbehandlingar, invasiva ingrepp och icke-invasiva ingrepp vid behandling av myom. Utvecklingen av läkemedel mot myom är lågprioriterat, eftersom de främst är benigna och snarare leder till sjuklighet än dödlighet. De läkemedel som idag används vid behandling av myom är ulipristal, GnRH-agonister, NSAID, tranexamsyra, p-piller eller hormonspiral. Ulipristal och GnRH-agonister har utöver förbättring av symtom som alla de senast nämnda, en effekt på reducering av myomstorlek. Icke-invasiva ingrepp innefattar idag myolys, embolisering av arteria uterina och fokuserad ultraljudskirurgi under MRI-vägledning, framtagna för att slippa operativa ingrepp. Myomektomi och hysterektomi är två operativa ingrepp som genomförs om inga andra behandlingar fungerar, eftersom de medför en längre återhämtningstid och en större risk för komplikationer. Mifepriston är en antiprogesteron, vilket innebär att den hämmar progesterons effekt. Progesteron i sin tur spelar en stor roll i utvecklingen av ett myom. Behandling med läkemedlet har i många olika studier visat goda resultat både i avseende på myomstorlek, symtom, livskvalité och biverkningar. Syfte: Syftet med examensarbetet var att undersöka om mifepriston är ett säkert och effektivt läkemedel vid behandling av myom hos kvinnor. Metod: Examensarbetet är en litteraturstudie och baseras på 6 olika randomiserade kontrollerade vetenskapliga studier som undersökte mifepristons effekt och säkerhet vid behandling av myom. Studierna hämtades från PubMed. Resultat: Samtliga studier visade en reducering i myomvolym, en förbättring av symtom och milda biverkningar med olika doseringar av mifepriston vid behandling av myom. I 2 av studierna undersöktes livskvalitén vilket ökade hos de personer som behandlades med mifepriston. Slutsats: Det är svårt att dra generella slutsatser vilken dos och behandlingstid som är optimala på grund av de olika behandlingstiderna, doseringarna och studieuppläggen som användes i samtliga studier. Dock har mifepriston en god effekt avseende på reducering i myomstorlek, symtom, biverkningar och livskvalité. Det krävs dock fler studier för att säkerställa dosering och behandlingstid samt fler jämförelser med andra behandlingsalternativ som idag finns för behandling av myom.

A disproportionate number of African American women are at increased risk for uterine fibroid tumors (UF) compared to their Caucasian, Asian, and Hispanic counterparts. Researchers have indicated that women diagnosed with UF can have a poorer health-related quality of life (HRQOL) when compared to women who do not have a diagnosis of UF. The overall aim of this study was to explore the impact of UF symptoms on the HRQOL of African American women. A quantitative, cross-sectional design was employed utilizing the revised version of Wilson and Cleary's model of HRQOL. A sample was gathered of 80 participants who were African American women between age 30 and 45 years with a current diagnosis of UF. Linear and multiple hierarchical regressions were performed to determine the relationship among UF symptom severity and HRQOL based on 6 subscales of HRQOL (as measured by the UFS-QOL). There was a statistically significant association between symptom severity, the 6 subscale variables of HRQOL, and employment. No significant associations were observed with age, family history (hx) of UF diagnosis, body mass index, general health perception, overall quality of life, and symptom severity. The social change implication for this study is to provide information that can direct health care providers in the development of health maintenance programs that are sensitive to the needs of African American women diagnosed with UF. In addition it will promote the need for public health professionals and medical organizations to increase the availability of information related to UF symptoms and the impact of UF symptoms on HRQOL among women.

A disproportionate number of African American women are at increased risk for uterine fibroid tumors (UF) compared to their Caucasian, Asian, and Hispanic counterparts. Researchers have indicated that women diagnosed with UF can have a poorer health-related quality of life (HRQOL) when compared to women who do not have a diagnosis of UF. The overall aim of this study was to explore the impact of UF symptoms on the HRQOL of African American women. A quantitative, cross-sectional design was employed utilizing the revised version of Wilson and Cleary's model of HRQOL. A sample was gathered of 80 participants who were African American women between age 30 and 45 years with a current diagnosis of UF. Linear and multiple hierarchical regressions were performed to determine the relationship among UF symptom severity and HRQOL based on 6 subscales of HRQOL (as measured by the UFS-QOL). There was a statistically significant association between symptom severity, the 6 subscale variables of HRQOL, and employment. No significant associations were observed with age, family history (hx) of UF diagnosis, body mass index, general health perception, overall quality of life, and symptom severity. The social change implication for this study is to provide information that can direct health care providers in the development of health maintenance programs that are sensitive to the needs of African American women diagnosed with UF. In addition it will promote the need for public health professionals and medical organizations to increase the availability of information related to UF symptoms and the impact of UF symptoms on HRQOL among women.

Uterine Fibroids, medically termed uterine leiomyoma, are benign tumors of smooth muscle cells that grow in the uterus. While they are the most common pelvic neoplasm in women and fewer than 1 percent of fibroids develop into cancer, uterine fibroids can cause infertility, adverse pregnancy outcomes, and greatly affect one’s quality of life. Black women have been disproportionately affected by fibroids; when compared to white women, Black women are: 2-3 times more likely to have fibroids, diagnosed at a younger age, more likely to have 7 or more fibroids, more likely to have more severe and more troublesome symptoms (anemia, severe pelvic pain, constipation, and stomach aches), and have twice as many hysterectomies due to fibroids. Black women’s disproportionate affliction with uterine fibroids is particularly concerning given the historical medical injustices associated with Black women’s bodies and reproductive rights from slavery to present day. By placing Black women at the center of analysis and using a Black feminist epistemological framework, this study aims to make a unique contribution to medical sociology as well as literature on the theoretical and practical management of sickness and wellness among Black women in the United States. Using qualitative interviews and grounded theory methodology, the study examined how Black women frame the condition of having uterine fibroids. Specifically, the study investigated a) how Black women conceptualize having fibroids, b) how Black women’s conceptualizations of fibroids affect their feelings about selves or their lifestyles, c) the mechanisms, if any, by which Black women deal with uterine fibroids, d) how their multiple race, class, and gender identities affect their illness experiences and types of treatment that they seek, and e) how conventional and complementary/alternative medicine shapes Black women’s experiences with fibroids. Conceptualizations about fibroids are rooted in the race-gendered histories of Black women and the unique stressors that they face. Through interactions with doctors and among peers, Black women resist the unbearable burden of uterine fibroids through various coping strategies, but generally “keep it moving”. They avoid invasive surgeries through patient agency by being advocates for their medical treatment, self-researching, dialoguing with others, and directing doctor-patient interactions.