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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fibroids are a prevalent disorder occurring in at least half of American reproductive-age women. In general, the incidence and size increases with age. Most women never attribute or report any symptoms from their fibroids, and because of this the actual contribution of disease to symptoms of pelvic pain,menstrual symptoms, and infertility is poorly understood. The presence of fibroids can lead to multiple and disabling difficulties. Fibroids may cause pain and menstrual bleeding to the point of anemia. Fibroids clearly reduce fertility,increase preterm labor and delivery, and markedly increase the risk for cesarean delivery. Because the incidence varies according to population of interest, fibroids may explain some health disparities in different populations. For example,African Americans have a relatively poor outcome with assisted reproductive techniques compared with whites. Controlling for fibroid disease may explain this disparity, at least in part. Fibroids represent a tremendous public health burden on women and economic cost on society. Strategies to prevent, limit growth, and treat nonsurgically are needed. Fundamental and significant questions remain about fibroid disease,such as whether different clinical disease phenotypes (multiple versus single leiomyomas) contribute equally to symptoms and possess an equal likelihood of disease progression. For epidemiologic assessment of disease, a scoring system is urgently needed. Well-designed, controlled, prospective studies are still needed to define the natural history and correlate the presence of disease with symptomatology in women.
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PMID:Epidemiology of myomas. 1650 3

Information is still being collected on the long-term clinical responses and appropriate patient selection for UAE. Prospective RCTs have not been performed to compare the clinical results from UAE with more conventional therapies for symptomatic uterine leiomyomata. At least three attempts at conducting such RCTs have been unsuccessful because of poor patient accrual that related to differing patient expectation and desires, clinical bias, insurance coverage, and the tendency that patients who have exhausted other treatment options may be disposed more favorably to less invasive treatments. Other comparative studies have serious limitations. For example, the retrospective study that compared outcomes after abdominal myomectomy with UAE suggested that patients who received UAE were more likely to require further invasive treatment by 3 years than were recipients of myomectomy. Lack of randomization introduced a selection bias because women in the group that underwent UAEwere older and were more likely to have had previous surgeries. A prospective study of "contemporaneous cohorts," which excluded patients who had sub-mucosal and pedunculated subserosal myomas, sought to compare quality of life measures and adverse events in patients who underwent UAE or hysterectomy. The investigators concluded that both treatments resulted in marked improvement in symptoms and quality of life scores, but complications were higher in the group that underwent hysterectomy over 1 year. In this study,however, a greater proportion of patients who underwent hysterectomy had improved pelvic pain scores. Furthermore, hysterectomy eliminates uterine bleeding and the risk for recurrence of myomas. Despite the lack of controlled studies that compared UAE with conventional surgery, and despite limited extended outcome data, UAE has gained rapid acceptance, primarily because the procedure preserves the uterus, is less invasive, and has less short-term morbidity than do most surgical options. The cost of UAE varies by region, but is comparable to the charges for hysterectomy and is less expensive than abdominal myomectomy. The evaluation before UAE may entail additional fees for diagnostic testing, such as MRI, to assess the uterine size and screen for adenomyosis. Other centers have recommended pretreatment ultrasonography, laparoscopy, hysteroscopy, endometrial biopsy, and biopsy of large fibroids to evaluate sarcoma. Generally,after UAE the recovery time and time lost from work are less; however, the potential need for subsequent surgery may be greater when compared with abdominal myomectomy. Any center that offers UAE should adhere to published clinical guidelines,maintain ongoing assessment of quality improvements measures, and observe strict criteria for obtaining procedural privileges. After McLucas advocated that gynecologists learn the skill to perform UAE for managing symptomatic myomas, the Society of Interventional Radiology responded with a precautionary commentary on the level of technical proficiency that is necessary to maintain optimum results from UAE. The complexity of pelvic arterial anatomy, the skill that is required to master modern coaxial microcatheters, and the hazards of significant patient radiation exposure were cited as reasons why sound training and demonstration of expertise be obtained before clinicians are credentialed to perform UAE.A collaboration between the gynecologist and the interventional radiologist is necessary to optimize the safety and efficacy of UAE. The primary candidates for this procedure include women who have symptomatic uterine fibroids who no longer desire fertility, but wish to avoid surgery or are poor surgical risks. The gynecologist is likely to be the primary initial consultant to patients who present with complaints of symptomatic myomas. Therefore, they must be familiar with the indications, exclusions, outcome expectations, and complications of UAE in their particular center. When hysterectomy is the only option, UAE should be considered. Appropriate diagnostic testing should aid in the exclusion of most, but not all, gynecologic cancers and pregnancy. Other contraindications include severe contrast medium allergy, renal insufficiency, and coagulopathy. MRI may be used to screen women before treatment in an attempt to detect those who have adenomyosis; patients should be aware that UAE is less effective in the presence of solitary or coexistent adenomyosis. Because some women may experience ovarian failure after UAE, additional studies to determine basal follicle-stimulating hormone and estradiol before and after the procedure may provide insight into UAE-induced follicle depletion.UAE is a unique new treatment for uterine myomas, and is no longer considered investigational for symptomatic uterine fibroids. There is international recognition that data are needed from RCTs that compare UAE with surgical alternatives. Current efforts to provide prospective objective assessment of treatment outcomes and complications after UAE will help to optimize patient selection and clinical guidelines. FIBROID should provide critical data for the assessment of safety and outcomes measures for women who receive UAE for symptomatic uterine myomas.
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PMID:Uterine artery embolization as a treatment option for uterine myomas. 1650 11

Uterine fibroids often cause symptoms of pelvic pain, pressure, and bleeding. Traditional therapies have included medical (eg, hormonal therapy) and surgical (eg, myomectomy, hysterectomy) options. Recently, uterine artery embolization was added to the treatment armamentarium. We describe an exciting new non-invasive treatment option using focused ultrasound with magnetic resonance imaging and summarize the early experience at the Mayo Clinic in Rochester, Minn, during the initial research studies of this new technology.
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PMID:Noninvasive treatment of uterine fibroids: early Mayo Clinic experience with magnetic resonance imaging-guided focused ultrasound. 1683 73

Increasing number of uterine malignancies have been reported in breast cancer patients using tamoxifen. Most of these are endometrial adenocarcinomas. However, only a few cases of endometrial stromal sarcomas have been reported to be linked with tamoxifen usage. A 58-year-old postmenopausal women who had been using tamoxifen for 4 years after a surgery for breast cancer is presented with chronic pelvic pain. Preoperative investigations were indicative of a uterine myoma so that a standard total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Postoperative histologic diagnosis was a uterine tumor resembling ovarian sex cord tumors, which is an exceedingly rare entity itself. The present case is the first designated diagnosis of this rare tumor, with a possible association of tamoxifen usage.
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PMID:Uterine tumor resembling ovarian sex cord tumors in a patient using tamoxifen: report of a case and review of literature. 1688 88

Uterine myoma is a common benign tumour in women and most cases do not require treatment. Excessive uterine bleeding is usually due to a submucous myoma or an intramural myoma that is encroaching into the uterine cavity. After eliminating endometrial malignancy, perimenopausal women could be managed expectantly or with gonadotrophin-releasing hormone agonist until menopause. Hysteroscopic myomectomy is highly effective in controlling menorrhagia that is related to submucous myoma. Concomitant endometrial ablation improves menorrhagia; however, the subsequent hysterectomy rate remains the same. For those with an intramural myoma, abdominal myomectomy results in good bleeding control. It could also be done by laparoscopic approach; however, the surgeon should have expertise in laparoscopic suturing and the uterine incision should be properly sutured. In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding. Compared with uterine artery embolization (UAE), it is associated with better improvement in pelvic pain. Nevertheless, UAE is a good alternative to hysterectomy.
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PMID:Treatment of uterine fibroids for abnormal uterine bleeding: myomectomy and uterine artery embolization. 1747 23

The incidence of uterine fibroid tumors increases as women grow older, and they may occur in more than 30 percent of women 40 to 60 years of age. Risk factors include nulliparity, obesity, family history, black race, and hypertension. Many tumors are asymptomatic and may be diagnosed incidentally. Although a causal relationship has not been established, fibroid tumors are associated with menorrhagia, pelvic pain, pelvic or urinary obstructive symptoms, infertility, and pregnancy loss. Transvaginal ultrasonography, magnetic resonance imaging, sonohysterography, and hysteroscopy are available to evaluate the size and position of tumors. Ultrasonography should be used initially because it is the least invasive and most cost-effective investigation. Treatment options include hysterectomy, myomectomy, uterine artery embolization, myolysis, and medical therapy. Treatment must be individualized based on such considerations as the presence and severity of symptoms, the patient's desire for definitive treatment, the desire to preserve childbearing capacity, the importance of uterine preservation, infertility related to uterine cavity distortions, and previous pregnancy complications related to fibroid tumors.
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PMID:Uterine fibroid tumors: diagnosis and treatment. 1755 38

We report a case of a patient admitted to our hospital for acute pelvic pain. Ultrasounds and abdominal CT scan found a voluminous mass situated in the upper urinary bladder and contiguous to the uterus and to the ovaries. Magnetic resonance imaging identified a pedicle connecting the uterus to the mass which had an aspect of a necrobiotic leiomyoma. Laparoscopic surgery confirmed the diagnosis of acute torsion of a subserous uterine leiomyoma.
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PMID:Torsion of a uterine leiomyoma: MRI features. 1782 48

We report a case of retroperitoneal leiomyoma and a systematic review of the literature regarding this finding. A 45-year-old woman with menorrhagia and a complex pelvic mass underwent preoperative imaging and consequent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 13-cm retroperitoneal, pedunculated leiomyoma arising from the uterus anterior to the internal cervical os. Literature review identified 105 cases of retroperitoneal leiomyomata from 1941 through 2007, with 37 cases, including our own, containing sufficient information for analysis. Abstracted variables included patient age, race, obstetric and gynecologic history, presentation and duration of symptoms, investigations, management, surgical findings, pathologic and immunohistochemical characteristics, duration of follow-up, evidence of recurrence and its management. Mean age (+/-SD) of the population was 46.27 +/- 13.19 years. More than 40% of patients had either undergone hysterectomy for uterine leiomyomata previously or had concurrent uterine leiomyomata. Of patients, 25% were asymptomatic, 31.3% experienced abdominal fullness, 18.8% had urinary symptoms, 18.8% had weight loss, and 18.8% had pelvic pain. Diagnostic evaluation was inconclusive and surgical excision was undertaken in all but 1 case. Median leiomyoma size was 12.0 cm (range 2.0-37.0 cm) with most in the posterior retroperitoneum, independent of the uterus. Pathologic and immunohistochemical investigations were comparable with those of uterine leiomyomata. Surgery was mostly curative with 5 reported cases of recurrence, 3 of which were then considered sarcomatous. Retroperitoneal leiomyomata present diagnostic and therapeutic challenges, and as such require heightened surveillance.
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PMID:Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report. 1831 83

Uterine fibroids, the most common tumours in women of reproductive age, are asymptomatic in at least 50% of afflicted women. However, in other women, they cause significant morbidity and affect quality of life. Clinically, they present with a variety of symptoms: menstrual disturbances including menorrhagia, dysmenorrhoea and intermenstrual bleeding; pelvic pain unrelated to menstruation; and pressure symptoms such as a sensation of bloatedness, increased urinary frequency and bowel disturbance. In addition, they may compromise reproductive function, possibly contributing to subfertility, early pregnancy loss and later pregnancy complications such as pain, preterm labour, malpresentations, increased need for caesarean section, and postpartum haemorrhage. Large fibroids may distend the abdomen, which may be aesthetically displeasing to many women. Abnormal bleeding occurs in 30% of symptomatic women, and abnormal bleeding, bloating and pelvic discomfort due to mass effect constitute the most common symptoms. The incidence of fibroids is highest in Black women, who tend to have multiple and larger fibroids, and more symptomatic fibroids at the time of diagnosis. The prevalence of clinically significant myomas peaks in the perimenopausal years and declines after the menopause. It is not known why some fibroids are symptomatic while others are quiescent. The size, number and location of fibroids undoubtedly determine their clinical behaviour, but research has yet to correlate these parameters with clinical presentation of the fibroids.
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PMID:Clinical presentation of fibroids. 1837 19

Benign uterine fibroids, or leiomyomas, are the most common tumors found in gynecologic practice. Symptomatic fibroids present with menorrhagia, pelvic pain, leukorrhea, pressure and bloating, increased abdominal girth, and severe dysmenorrhea. Traditional treatment has relied on surgery because long-term medical therapies have demonstrated only minimal response. Uterine fibroid embolization (UFE) using particulate emboli to occlude the uterine arteries, thereby disrupting the blood supply to fibroids and leading to devascularization and infarction, has been reported to be effective in alleviating fibroid-related symptoms. UFE is a safe, effective, and durable nonsurgical alternative to hysterectomy.
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PMID:Uterine fibroid embolization: a viable alternative to hysterectomy. 1964 64


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