Uterus

Vasomotor symptoms are the most widely recognized menopause symptoms in Western nations, with at least 75% of women reporting hot flashes or night sweats during or after the menopause transition. Many women struggle to choose between treatments, given lack of data on direct comparisons of different treatments, concerns about short-term adverse effects and longer-term treatment risks, and confusion about complementary or alternative remedies with unclear evidence of benefit.

Author/s:

Alison J Huang, Stephanie Faubion, Deborah Grady

Uterine Fibroids

Alex Haga — Tue, 23 Apr 2024 17:28:25 +0000

Date Added:

April 23, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

April 10, 2024

URL:

Uterine Fibroids

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.0447

Keywords

MeSH

A review of current knowledge regarding uterine fibroids and what to do about them. James W. Mold, MPH

Commercial full text (fees may apply)

View

Uterine fibroids are sex–steroid responsive benign tumors primarily composed of smooth muscle cells and extracellular matrix that develop in the wall of the uterus.1 They are one of the most common neoplasms in reproductive-aged women. Lifetime prevalence estimates in premenopausal women range from 40% to 89%, depending on the method of detection, the study population, and the ages of those studied. Fibroids can range in size from less than 1 cm to more than 20 cm. Although not all individuals with fibroids have symptoms, typical symptoms include abnormal uterine bleeding/heavy menstrual bleeding (AUB/HMB), pelvic bulk symptoms (protruding abdomen, pressure on bladder and bowels), pain, and reproductive morbidity (ie, infertility). Due to their high prevalence and associated symptoms, fibroids are the leading cause of hysterectomy in the US and account for up to $34 billion annually in direct and indirect costs.

Author/s:

Marsh, E.E., Wegienka, G., Williams, D.R.

Diagnosis and management of endometriosis

Rowan Hutchins — Sun, 19 Mar 2023 05:00:00 +0000

Date Added:

March 19, 2023

Journal/Publication:

CMAJ

Publisher:

Canadian Medical Association

Publication Date:

March 14, 2023

Issue:

Volume:

195

Pages:

E363-E371

URL:

Diagnosis and management of endometriosis

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1503/cmaj.220637

Keywords

PMID (1):

36918177

MeSH

A concise summary of what we know about endometriosis. James W. Mold, MD, MPH

Free full text

View

Endometriosis is a chronic condition defined by the presence of endometrial-like tissue outside of the uterus, which can lead to estrogen-driven inflammation. The extent of disease can be highly variable, ranging from minimal peritoneal deposits to deep disease that can invade into the bowel, bladder and ureter and, more rarely, spread to extrapelvic (e.g., cutaneous, thoracic) sites. Endometriosis is a complex disease that has considerable impact on the quality of life of those affected and that has no cure. It remains poorly understood. We review the epidemiology, pathophysiology, diagnosis and management of endometriosis, based on the best available evidence and clinical guidelines

Author/s:

Allaire, Catherine, Bedaiwy, Mohamed, Yong, Paul

Rethinking mechanisms, diagnosis and management of endometriosis

Devin Evans — Fri, 26 Feb 2021 06:00:00 +0000

Date Added:

February 26, 2021

Journal/Publication:

Nature Reviews Endocrinology

Publication Date:

September 5, 2020

Issue:

Volume:

Pages:

666-682

URL:

Rethinking mechanisms, diagnosis and management of endometriosis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1038/s41574-019-0245-z

Keywords

PMID (1):

31488888

MeSH

Our understanding of endometriosis has evolved substantially over the last decade. This is a fairly recent review of the current conceptualization of this multi-system inflammatory disease. James W. Mold, MD, MPH

Free full text

View

Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.

Author/s:

Chapton, Charles, Marcellin, Louis, Borghese, Bruno, Santulli, Pietro

Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women's Health Initiative Randomized Clinical Trials

Brian Desmarais — Mon, 03 Aug 2020 15:08:08 +0000

Date Added:

August 3, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

July 28, 2020

Issue:

Volume:

324

Pages:

368-380

URL:

Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women's Health Initiative Randomized Clinical Trials

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jama.2020.9482.

MeSH

Association of HRT and breast cancer. James W. Mold, MD, MPH

Commercial full text (fees may apply)

View

Abstract

Importance: The influence of menopausal hormone therapy on breast cancer remains unsettled with discordant findings from observational studies and randomized clinical trials.

Objective: To assess the association of prior randomized use of estrogen plus progestin or prior randomized use of estrogen alone with breast cancer incidence and mortality in the Women's Health Initiative clinical trials.

Design, setting, and participants: Long-term follow-up of 2 placebo-controlled randomized clinical trials that involved 27 347 postmenopausal women aged 50 through 79 years with no prior breast cancer and negative baseline screening mammogram. Women were enrolled at 40 US centers from 1993 to 1998 with follow-up through December 31, 2017.

Interventions: In the trial involving 16 608 women with a uterus, 8506 were randomized to receive 0.625 mg/d of conjugated equine estrogen (CEE) plus 2.5 mg/d of medroxyprogesterone acetate (MPA) and 8102, placebo. In the trial involving 10 739 women with prior hysterectomy, 5310 were randomized to receive 0.625 mg/d of CEE alone and 5429, placebo. The CEE-plus-MPA trial was stopped in 2002 after 5.6 years' median intervention duration, and the CEE-only trial was stopped in 2004 after 7.2 years' median intervention duration.

Main outcomes and measures: The primary outcome was breast cancer incidence (protocol prespecified primary monitoring outcome for harm) and secondary outcomes were deaths from breast cancer and deaths after breast cancer.

Results: Among 27 347 postmenopausal women who were randomized in both trials (baseline mean [SD] age, 63.4 years [7.2 years]), after more than 20 years of median cumulative follow-up, mortality information was available for more than 98%. CEE alone compared with placebo among 10 739 women with a prior hysterectomy was associated with statistically significantly lower breast cancer incidence with 238 cases (annualized rate, 0.30%) vs 296 cases (annualized rate, 0.37%; hazard ratio [HR], 0.78; 95% CI, 0.65-0.93; P = .005) and was associated with statistically significantly lower breast cancer mortality with 30 deaths (annualized mortality rate, 0.031%) vs 46 deaths (annualized mortality rate, 0.046%; HR, 0.60; 95% CI, 0.37-0.97; P = .04). In contrast, CEE plus MPA compared with placebo among 16 608 women with a uterus was associated with statistically significantly higher breast cancer incidence with 584 cases (annualized rate, 0.45%) vs 447 cases (annualized rate, 0.36%; HR, 1.28; 95% CI, 1.13-1.45; P < .001) and no significant difference in breast cancer mortality with 71 deaths (annualized mortality rate, 0.045%) vs 53 deaths (annualized mortality rate, 0.035%; HR, 1.35; 95% CI, 0.94-1.95; P= .11).

Conclusions and relevance:

In this long-term follow-up study of 2 randomized trials, prior randomized use of CEE alone, compared with placebo, among women who had a previous hysterectomy, was significantly associated with lower breast cancer incidence and lower breast cancer mortality, whereas prior randomized use of CEE plus MPA, compared with placebo, among women who had an intact uterus, was significantly associated with a higher breast cancer incidence but no significant difference in breast cancer mortality.

Author/s:

Chlebowski, R.T., Anderson, G.L., Aragaki, A.K., Manson, J.E., Stefanick, M.L., Pan, K., Barrington, W., Kuller, K.H., Simon, M.S., Lane, D., Johnson, K.C., Rohan, T.E., Gass, M.L.S., Cauler, C.A., Paskett, E.D., Sattari, M., Prentice, M.L.