Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding

Friedman, Jaclyn A.; Wong, Jackie; Chaudhari, A.; Tsai, Shih-Tzer; Milad, Magdy P.

doi:10.1097/gco.0000000000000475

Cited by 31 publications

(21 citation statements)

References 44 publications

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“…Myomectomy was done in more than two-thirds of those who received surgical management due to the fact that fibroids was the most common structural cause of bleeding; its fertility sparing benefit and popularity among the study participants who were women of reproductive age. This finding corroborates with that reported in a systematic review [19] which reported that among women with myomas at risk of abnormal uterine bleeding; myomectomy is a gold-standard treatment option for those women who wish to preserve their fertility. This is coupled by its safety, minimal invasiveness and greater patient satisfaction [19,20] as corroborated in the current study's findings.…”

Section: Plos Onesupporting

confidence: 91%

“…This finding corroborates with that reported in a systematic review [19] which reported that among women with myomas at risk of abnormal uterine bleeding; myomectomy is a gold-standard treatment option for those women who wish to preserve their fertility. This is coupled by its safety, minimal invasiveness and greater patient satisfaction [19,20] as corroborated in the current study's findings.…”

Section: Plos Onesupporting

confidence: 91%

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Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya

2020

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Abnormal uterine bleeding (AUB) affects 30% of reproductive age women globally. However, there are limited local studies evaluating the management of these women. The diagnostic guideline using structural and functional causes of AUB adopts the PALM-COEIN criteria, namely: Polyp; Adenomyosis; Leiomyoma; Malignancy and Hyperplasia; Coagulopathy; Ovulatory dysfunction; Endometrial; Iatrogenic; and Not yet classified. This study aimed to determine the clinical bleeding patterns, adherence to PALM-COEIN diagnosis guidelines and management of AUB among women in their reproductive age. This was a cross-sectional study among 108 women with AUB aged 18–45 years was conducted at the gynaecology department of Moi Teaching and Referral Hospital in Western Kenya between April 2018 and April 2019. Their sociodemographic and clinical characteristics were collected using interviewer administered structured questionnaire and chart reviews. Adherence to diagnosis recommendations was assessed using PALM COEIN classification. Descriptive and inferential data analysis was conducted at 95% confidence interval. The median age was 30 (IQR: 22, 41) years with prolonged bleeding as the most predominant pattern at 41.7%. Bleeding patterns were significantly associated with age (p = 0.04). Only 16.7% were diagnosed as per the PALM-COEIN criteria with PALM and COEIN accounting for 60% and 40% respectively. Leiomyoma (44.5%) was the common cause of AUB. Laboratory evaluation included: pregnancy tests, full haemogram, hormonal profile and biopsy. Most (79.6%) of the women had abdominopelvic ultrasound done. Medical management was provided for 78.7% of women. Prolonged bleeding was the most common pattern with medical management preferred. There is need for in-hospital algorithms to ensure adherence to PALM-COEIN guidelines.

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Section: Plos Onesupporting

confidence: 91%

Section: Plos Onesupporting

confidence: 91%

Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya

2020

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“…Many strategies or principles for decreasing the risk of developing IUA, such as the reduced use of electrosurgery and the minimization of trauma to the healthy endometrium and myometrium, have been proposed [ 73 , 74 , 75 , 76 , 77 , 78 , 79 ]. Additionally, many biomaterial agents, barrier methods, and cell or bio-agent therapies have been applied [ 14 , 16 , 24 , 27 , 28 , 29 , 30 , 31 , 35 , 37 , 40 , 43 , 44 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Figure 3 shows the recent development of agents available for the primary prevention of IUA after uterine surgery.…”

Section: Primary Prevention Of Intrauterine Adhesion (Iua)mentioning

confidence: 99%

“…First, the impact of surgical technology on the development of IUA should be considered, although it is unknown whether one technique is better than another [ 2 ], partly because of the presence of many confounding uncontrolled variables, meaning the data were derived with difficulty [ 73 ]. The most frequently discussed areas of surgical technology fit into five categories: (1) types of intrauterine instrumentation, (2) types of energy (bipolar or unipolar systems), (3) types of distending media (normal saline, dextran water or glycine), (4) types of intrauterine pressure (low pressure versus high pressure), and (5) preoperative additional therapy or postoperative additional therapy.…”

Section: Primary Prevention Of Intrauterine Adhesion (Iua)mentioning

confidence: 99%

Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision

Lee

Liu

Chen

et al. 2021

IJMS

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Intrauterine adhesion (IUA), and its severe form Asherman syndrome (Asherman’s syndrome), is a mysterious disease, often accompanied with severe clinical problems contributing to a significant impairment of reproductive function, such as menstrual disturbance (amenorrhea), infertility or recurrent pregnancy loss. Among these, its correlated infertility may be one of the most challenging problems. Although there are many etiologies for the development of IUA, uterine instrumentation is the main cause of IUA. Additionally, more complicated intrauterine surgeries can be performed by advanced technology, further increasing the risk of IUA. Strategies attempting to minimize the risk and reducing its severity are urgently needed. The current review will expand the level of our knowledge required to face the troublesome disease of IUA. It is separated into six sections, addressing the introduction of the normal cyclic endometrial repairing process and its abruption causing the formation of IUA; the etiology and prevalence of IUA; the diagnosis of IUA; the classification of IUA; the pathophysiology of IUA; and the primary prevention of IUA, including (1) delicate surgical techniques, such as the use of surgical instruments, energy systems, and pre-hysteroscopic management, (2) barrier methods, such as gels, intrauterine devices, intrauterine balloons, as well as membrane structures containing hyaluronate–carboxymethylcellulose or polyethylene oxide–sodium carboxymethylcellulose as anti-adhesive barrier.

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“…Containment systems like endoscopic bags are now available for both electrical and manual morcellation 17. For sub-mucous fibroids, hysteroscopic myomectomy is the treatment of choice to improve bleeding and to normalize the uterine cavity 18. In selective cases of UFs associated to metrorrhagia, in women who do not wish to preserve fertility, a treatment option could be also hysteroscopic endometrial ablation 12,13.…”

Section: Introductionmentioning

confidence: 99%

<p>Clinical Utility Of Elagolix As An Oral Treatment For Women With Uterine Fibroids: A Short Report On The Emerging Efficacy Data</p>

Neri

Melis

Giancane

et al. 2019

IJWH

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Uterine fibroids (UFs) are the most common gynaecological benign disease. Even though often asymptomatic, UFs can worsen women’s health and their quality of life, causing heavy bleeding and anaemia, pelvic discomfort and reduced fertility. Surgical treatment of UFs could be limited by its invasiveness and the desire to preserve fertility. Thus, effective medical therapies for the management of this condition are needed. Common drugs used to control bleeding, such us hormonal contraceptive or levonorgestrel-releasing intrauterine system, have no effect on fibroids volume. Among other more efficient treatments, the gonadotropin-releasing hormone (GnRH) agonist or the selective progesterone-receptor modulators have a non-neutral safety profile; thus, they are used for limited periods or for cyclic treatments. Elagolix is a potent, orally bioavailable, non-peptide GnRH antagonist that acts by a competitive block of the GnRH receptor. The biological effect is a dose-dependent inhibition of gonadal axis, without a total suppression of estradiol concentrations. For this reason, even though comparative studies between elagolix and GnRH agonists have not been performed, elagolix has been associated with a better profile of adverse events. Recently, elagolix received US FDA approval for the treatment of moderate to severe pain caused by endometriosis. Several clinical trials assessed the efficacy of elagolix for the treatment of heavy bleeding caused by UFs and the definitive results of Phase III studies are expected. Available data on elagolix and UFs showed that the drug, with or without low-dose hormone add-back therapy, is able to significantly reduce menstrual blood loss, lead to amenorrhea and improve haemoglobin concentrations in the majority of participants in comparison with placebo. The safety and tolerability profile appeared generally acceptable. The concomitant use of add-back therapy can prevent bone loss due to the hypoestrogenic effect and can improve safety during elagolix treatment.

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Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding

Cited by 31 publications

References 44 publications

Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya

Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya

Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision

<p>Clinical Utility Of Elagolix As An Oral Treatment For Women With Uterine Fibroids: A Short Report On The Emerging Efficacy Data</p>

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