Uterine fibroids (UFs) are benign tumors of the female genital tract made of the smooth muscle of the uterus. UF growth depends mostly on the influence of the steroid hormones and selected growth factors. Transforming growth factor β (TGF-βs) is a polypeptide that consists of three isoforms: TGF-β1, TGF-β2, and TGF-β3. At present, TGF-β is considered to be one of the key factors in the pathophysiology of UFs. It plays a major role in cellular migration within the tumor, stimulates tumor growth, and enhances tumor metabolism. As a consequence of various dependencies, the synthesis and release of TGF-β in a UF tumor is increased, which results in excessive extracellular matrix production and storage. High concentrations or overexpression of TGF-β mediators may be responsible for clinically symptomatic UFs. The aim of this review was to check the available evidence for the influence of the TGF-β family on UF biology. We conducted their search in PubMed of the National Library of Medicine with the use of the following selected keywords: “uterine fibroid”, “leiomyoma”, and “transforming growth factor β”. After reviewing the titles and abstracts, more than 115 full articles were evaluated. We focused on the TGF-β-related molecular aspects and their influence on the most common symptoms that are associated with UFs. Also, we described how the available data might implicate the current medical management of UFs.

This article provides a detailed review of current knowledge on the role of vitamin D and its receptor in the biology and management of uterine fibroids (UFs). Authors present ideas for future steps in this area. A literature search was conducted in PubMed using the following key words: “uterine fibroid” and “vitamin D”. The results of the available studies, published in English from January 2002 up to April 2018, have been discussed. Vitamin D is a group of steroid compounds with a powerful impact on many parts of the human body. This vitamin is believed to regulate cell proliferation and differentiation, inhibit angiogenesis, and stimulate apoptosis. Nowadays, hypovitaminosis D is believed to be a major risk factor in the development of UFs. In many studies vitamin D appears to be a powerful factor against UFs, resulting in inhibition of tumor cell division and a significant reduction in its size, however, the exact role of this compound and its receptor in the pathophysiology of UFs is not fully understood. According to available studies, vitamin D and its analogs seem to be promising, effective, and low-cost compounds in the management of UFs and their clinical symptoms, and the anti-tumor activities of vitamin D play an important role in UF biology. The synergy between vitamin D and selected anti-UF drugs is a very interesting issue which requires further research. Further studies about the biological effect of vitamin D on UF biology are essential. Vitamin D preparations (alone or as a co-drugs) could become new tools in the fight with UFs, with the additional beneficial pleiotropic effect.

Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases.

Vitamin D is a group of steroid compounds soluble in fats. Vitamin D has powerful, pleiotropic effects all over the human body. It is synthesized in human skin, but can also be found in dietary supplements and fortified foods. Vitamin D receptors (VDR) can be found in many tissues, as well as in the female reproductive tract [1,2]. According to recent reports, it is believed that vitamin D has a beneficial effect on lowering the risk of various diseases, e.g. multiple forms of cancer, diabetes, cardiovascular diseases, metabolic syndrome, multiple sclerosis, inflammatory bowel diseases and uterine fibroids [1][2][3][4][5][6]. Vitamin D regulates cell proliferation and differentiation, inhibits angiogenesis and stimulates apoptosis [1,2,4,5]. Vitamin D levels are mostly measured using serum 25-hydroxyvitamin D (25(OH)D) concentration, which is considered to be the best known marker of vitamin D obtained through both diet and body synthesis. According to Holick, the vitamin D level should be higher than 30 ng/ml [1].Ethinylestradiol (EE2) is a derivative of 17β-estradiol (E2), the major endogenous human estrogen. EE2 is used in many forms of combined oral contraception (COC) and is one of the most commonly used medications for this purpose. Ethinylestradiol is hormonally effective by activating the estrogen receptor and thus exerts its estrogenic effects [7].Drospirenone is a steroidal progestin (of the spironolactone group) used in contraception and hormonal replacement therapy. It is also an aldosterone antagonist with potassium-sparing properties. It is an agonist of the progesterone receptor and an antagonist of the mineralocorticoid and androgen receptors, and hence a progestagen, antimineralocorticoid and antiandrogen. Drospirenone does not present any estrogenic or glucocorticoid or antiglucocorticoid activity. It has a potent antigonadotropic effect at sufficient dosages as a result of progesterone receptor activation. It has been stated that drospirenone has a pharmacological profile that is closely related to that of natural progesterone [8]. Drospirenone is about ten times more potent as an antimineralocorticoid in comparison to spironolactone [8][9][10]. The drospirenone antimineralocorticoid activity promotes sodium excretion and prevents water retention [10].It is believed that contraceptives containing estrogens or estrogens combined with progestins may affect 25(OH)D serum concentrations.

IntroductionA cesarean section is the most frequently performed surgery in modern obstetrics. In case of an incorrect wound healing process there is a risk of a persistent uterine wall defect. Nowadays, due to the high frequency of cesarean sections, obstetricians have to deal with the threat of uterine rupture due to pathological wound healing. It has been proven that isthmocele can cause abnormal uterine bleeding (AUB), pelvic pain (PP), and secondary infertility (SI), and can be a place of improper pregnancy placement.AimThis article presents our experience with isthmocele treatment. We describe our diagnostic process scheme, method of corrective surgery and main therapeutic outcomes.Material and methodsIn this manuscript we present a single center’s experience in isthmocele therapy. We have operated on 16 patients who suffered from abnormal uterine bleeding, pain disorders or secondary infertility possibly due to a cesarean scar defect.ResultsThe results obtained in our center are promising. In 9 of 11 (81.8%) women with abnormal bleeding we obtained complete resolution of symptoms. We had slightly worse results in the case of pelvic pain. In 4 (66.6%) of 6 patients the pain resolved completely. We have obtained 7 pregnancies in 11 (63.6%) patients operated on due to secondary infertility.ConclusionsIn our opinion, laparoscopic treatment seems to be currently one of the most effective methods in isthmocele therapy. Further investigation is necessary to determine the indications for surgery, suitable treatment strategies and appropriate care.

No abstract