The purpose of this study is to determine features of uterine leiomyoma on Magnetic Resonance Imaging (MRI) that identify predictors of response to Uterine Arterial Embolization (UAE). MRI images were obtained before and after UAE in 35 women. These images were analyzed for uterine and fibroid size changes along with fibroid border characteristics and location for a total of 73 fibroids. Fibroids were classified as either smooth or lobulated based on border appearance on MR imaging to determine any differences in mean fibroid volume reduction post-embolization. The mean decrease in fibroid volume from pre-embolization to post-embolization was 48.1% ± 28.6 % (SD) (P < 0.001). No statistical difference was detected in the mean volume reduction between lobulated and smooth fibroids, 40.6% ± 23.1% (SD) and 50.9% ± 30.2% (SD) respectively, with a confidence interval [-25.1, 4.6, SEM 7.5, Df 71], single factor ANOVA (F[1,71]=1.88, Fcrit=3.98, p=0.17). However, some difference was detected in the failure rate of lobulated versus smooth fibroids to embolization, 5% and 9.4% respectively, ANOVA (F [1, 71]= 0.37, Fcrit= 3.98, p > 0.1), albeit at low statistical power. Also no difference was detected in mean fibroid volume reduction between intramural, submucosal, and subserosal fibroids. Thus, we introduced a novel characteristic by which to classify uterine fibroids based upon border appearance on MR imaging.

BACKGROUND: Uterine fibroids affect a quarter of the female population. The advent of minimally invasive gynecological surgery has revolutionized fibroid removal. The aims of this study were to analyze the variables correlated to myomectomies and establish predictive variable models. METHODS: From 2007 to 2009, 966 patients underwent myomectomy. 30 variables surrounding the myomectomies were analyzed. All variables were transformed into categorical variable and analyzed for normal distribution. The variables were cross-tabulated and analyzed for correlation using a Pearson Chi-Square statistic. Correlated variables underwent multinomial logistic regression analysis to obtain predictive models. Conclusion: A complete examination of all types of myomectomies support existing relationships between variables and provide novel correlations and predictions.

Also known as uterine fibroids, leiomyomas occur in 70% of women. A uterine leiomyoma is a benign growth in the muscular wall of the uterus which, if left untreated, can grow, and affect surrounding organs, leading to complications, including hemorrhage and death. Symptomatic women often experience pain and debilitating menstrual cycles which, in turn, result in poor health, poor quality of life, and loss of income. Preventative and treatment services in Florida could benefit from the characteristics of women affected the most by this disease in the state. Thus, we describe the demographic characteristics and estimate the prevalence rate of uterine leiomyomas among women 18 years and older in Florida between 2010 to 2019. Data was obtained from Florida’s Agency for Healthcare Administration and analyses included descriptive statistics with prevalence rate estimation and geolocation. Over the decade studied, we identified 232,475 cases, almost half (49.2%) of which were reported among white women, with women in their forties having the highest frequency. Florida counties with the highest prevalence rates (e.g., Miami-Dade, Broward, and Palm Beach) are the seat to densely populated cities. Over the decade analyzed, the prevalence rate (95% CI) was estimated at 284.8 (284.21, 285.39) cases of uterine leiomyomas per 100,000 women 18 years and older. Compared to non-Hispanic white women, black, Hispanic, and other women of color presented with higher prevalence rate ratios (4.84, 1.87, and 1.58, respectively). While most women diagnosed with uterine fibroids in Florida were non-Hispanic white in their forties, results evidence noticeable disparities by race, ethnicity, age, and county of residence. Counties with the highest prevalence rates were urban and densely populated with more access to healthcare, unlike counties with the lowest prevalence rates. Overall, results point at important unmet needs in leiomyoma prevention and treatment services for women in Florida.

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.

Abstract can be viewed in PDF document. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

Introduction: Uterine fibroids are the most common benign tumours of female genital tract with the peak incidence in the 4th and 5th decennium. The aetiology of uterine fibroids still remains poorly understood. Genetic factors play undisputed role in the onset of uterine fibroids. Up to date numerous gene mutations were identified in certain percentage of patients with uterine fibroids. One of the candidate genes is Fumarate hydratase gene (FH). Heterozygous germiline mutations of FH cause two hereditary syndromes: Multiple smooth muscle tumours of the skin and uterus (MCUL1)/ Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC) characterised by leiomyomata of the skin, early onset uterine fibroids between 20-30 years of age and renal papillary carcinoma. The aim of our thesis was to identify the frequency of FH mutations in patients with early onset sporadic uterine fibroids. Methods: Patients with the diagnosis of uterine fibroids up to the age of 30 years were enrolled in the study. Control group consisted of patients with absence of uterine fibroids. Activities of Fumarate hydratase and control protein Citrate synthase were measured in lymphocytes and compared to the results obtained from the healthy controls. Mutation analysis of FH gene was performed. Activity of Fumarate...

Introduction: Uterine fibroids are the most common benign tumours of female genital tract with the peak incidence in the 4th and 5th decennium. The aetiology of uterine fibroids still remains poorly understood. Genetic factors play undisputed role in the onset of uterine fibroids. Up to date numerous gene mutations were identified in certain percentage of patients with uterine fibroids. One of the candidate genes is Fumarate hydratase gene (FH). Heterozygous germiline mutations of FH cause two hereditary syndromes: Multiple smooth muscle tumours of the skin and uterus (MCUL1)/ Hereditary leiomyomatosis and renal cell cancer syndrome (HLRCC) characterised by leiomyomata of the skin, early onset uterine fibroids between 20-30 years of age and renal papillary carcinoma. The aim of our thesis was to identify the frequency of FH mutations in patients with early onset sporadic uterine fibroids. Methods: Patients with the diagnosis of uterine fibroids up to the age of 30 years were enrolled in the study. Control group consisted of patients with absence of uterine fibroids. Activities of Fumarate hydratase and control protein Citrate synthase were measured in lymphocytes and compared to the results obtained from the healthy controls. Mutation analysis of FH gene was performed. Activity of Fumarate...

Background: Uterine fibriod (UF) or leiomyoma is the most frequent benign tumour upon lower genital tract and represents the most frequent indication for hysterectomy. The aetiology remains still unknown. The genetic factors contributing for the development of UF are being intensively investigated. The aim of our study was to look for possible genetic markers which could be used as prognostic tools for evaluation of an increased risk for development of UF. Methods: The study group enrolled 102 patients diagnosed with UF and 145 healthy controls. Ultrasonographic examination of the pelvis was performed and a single blood sample was taken in all women. Histological verification followed the surgery in the patient group. The principal of the cytokine gene polymorphisms detection is based on PCR reaction with sequence-specific primers. Results: A large spectrum of Th1/Th2 cytokine gene polymorphisms in patients with uterine fibroid was compared with control group. The frequencies of the majority of tested cytokine gene SNP in the patient cohort were not statistically different from the cytokine SNP in the control group. However, an intriguing association between polymorphisms of the IL-4 gene promotor at positions -590 C/T and -33 C/T, and the risk of leiomyoma was observed. The CC genotype of IL-4 at position...

Background: Uterine fibriod (UF) or leiomyoma is the most frequent benign tumour upon lower genital tract and represents the most frequent indication for hysterectomy. The aetiology remains still unknown. The genetic factors contributing for the development of UF are being intensively investigated. The aim of our study was to look for possible genetic markers which could be used as prognostic tools for evaluation of an increased risk for development of UF. Methods: The study group enrolled 102 patients diagnosed with UF and 145 healthy controls. Ultrasonographic examination of the pelvis was performed and a single blood sample was taken in all women. Histological verification followed the surgery in the patient group. The principal of the cytokine gene polymorphisms detection is based on PCR reaction with sequence-specific primers. Results: A large spectrum of Th1/Th2 cytokine gene polymorphisms in patients with uterine fibroid was compared with control group. The frequencies of the majority of tested cytokine gene SNP in the patient cohort were not statistically different from the cytokine SNP in the control group. However, an intriguing association between polymorphisms of the IL-4 gene promotor at positions -590 C/T and -33 C/T, and the risk of leiomyoma was observed. The CC genotype of IL-4 at position...

The purpose of this study was to explore and describe contributing factors that influence the perceptions of women with fibroids from diverse cultures regarding hysterectomy. The area of research was delimited to issues of hysterectomy among women with fibroid uterus. The study employed a descriptive explorative method and data were collected by means of structured questionnaires. The study was conducted in one academic referral hospital, over a period of six months. The respondents were the patients with fibroid uterus and the doctors and nurses in the gynaecological units of the hospital. The majority of the patients indicated that they were afraid of undergoing a hysterectomy because of the social stigma associated with this life-saving procedure, such as alienation or marginalization by members of their respective communities. The nursing staff and gynaecologists in the unit emphasized the deep-seated fear of hysterectomy amongst women from diverse cultures. The study found that women need information about their bodies and how they function. Health education is also needed for women and their communities. Research is needed amongst members of different communities and diverse cultures to voice their perceptions of women undergoing hysterectomy because of ill health. / Health Studies / M.A. (Health studies)