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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2023; 83(04): 446-452
DOI: 10.1055/a-1996-2980
GebFra Science
Original Article/Originalarbeit

Sonographic Monitoring of Growth of Uterine Myomas in Untreated Women and Respective Influence Factors

Article in several languages: English | deutsch
Vera Seidel
1   Obstetrics, Charité – Universitätsmedizin Berlin, Berlin, Germany
2   Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
,
Klaus Dieter Wernecke
3   Institut für Biometrie und Klinische Epidemiologie, Charité Universitätsmedizin Berlin, Berlin, Germany
4   SOSTANA GmbH, Berlin, Germany
,
Antonia Lukrezia Bellingkrodt
2   Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
,
Robert Armbrust
2   Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
,
Matthias David
2   Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin, Germany
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Abstract

Research Question What are the growth patterns of uterine myomas in untreated premenopausal women? Which factors influence the growth rate of uterine myomas in premenopausal women?

Method All premenopausal women who presented to the outpatient myoma consultation clinic between January 2005 and March 2022 at least twice were screened. Exclusion criteria were hormonal therapy, pregnancy, and postmenopausal status.

Results A total of 189 patients were included in our study which focused on the respective largest uterine myoma of each woman. An ideal linear growth over time was assumed. Most myomas (82%) increased in size. The mean annual growth of these myomas was 68.42 cm3. The most important prognostic factor for growth was the initial size of the myoma. The absolute annual growth of myomas measuring > 50 cm3 at first presentation was higher compared to smaller myomas (p < 0.001). The relative annual growth rate was highest for myomas measuring between 20 and 50 cm3 at the initial presentation (p = 0.003). The relative annual growth rate in women older than 40 years was significantly lower than that in women below the age of 40 years (p = 0.003).

Conclusion Overall, it is difficult to make an individual prognosis about the growth pattern of a uterine myoma in a specific patient. It should be noted especially in asymptomatic patients that spontaneous regression of myoma size can also occur in premenopausal women.

Key words

myoma - fibroid - myoma growth - ultrasound - premenopause - uterus


Publication History

Received: 09 September 2022

Accepted after revision: 01 December 2022

Article published online:
05 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References/Literatur

  • 1 Downes E, Sikirica V, Gilabert-Estelles J. et al. The burden of uterine fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol 2010; 152: 96-102
    CrossrefPubMedGoogle Scholar
  • 2 Utz-Billing I, Rothmann K, Kentenich H. et al. Prätherapeutische Ängste, Erwartungen, Wünsche und Informiertheit von Frauen mit Uterus myomatosus. Geburtshilfe Frauenheilkd 2006; 66: 763-768
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Segars JH, Parrott EC, Nagel JD. et al. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Hum Reprod Update 2014; 20: 309-333
    CrossrefPubMedGoogle Scholar
  • 4 Istre O. Management of symptomatic fibroids: conservative surgical treatment modalities other than abdominal or laparoscopic myomectomy. Best Pract Res Clin Obstet Gynaecol 2008; 22: 735-747
    CrossrefPubMedGoogle Scholar
  • 5 Ichimura T, Kawamura N, Ito F. et al. Correlation between the growth of uterine leiomyomata and estrogen and progesterone receptor content in needle biopsy specimens. Fertil Steril 1998; 70: 967-971
    CrossrefPubMedGoogle Scholar
  • 6 Peddada SD, Laughlin SK, Miner K. et al. Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci U S A 2008; 105: 19887-19892
    CrossrefPubMedGoogle Scholar
  • 7 Davis BJ, Haneke KE, Miner K. et al. The fibroid growth study: determinants of therapeutic intervention. J Womens Health (Larchmt) 2009; 18: 725-732
    CrossrefPubMedGoogle Scholar
  • 8 Kasai M, Ichimura T, Kawamura N. et al. Prediction of the shrinking rate of uterine leiomyoma nodules using needle biopsy specimens. Fertil Steril 2012; 98: 440-443
    CrossrefPubMedGoogle Scholar
  • 9 Tsuda H, Kawabata M, Nakamoto O. et al. Clinical predictors in the natural history of uterine leiomyoma: preliminary study. J Ultrasound Med 1998; 17: 17-20
    CrossrefPubMedGoogle Scholar
  • 10 DeWaay DJ, Syrop CH, Nygaard IE. et al. Natural history of uterine polyps and leiomyomata. Obstet Gynecol 2002; 100: 3-7
    PubMedGoogle Scholar
  • 11 Mavrelos D, Ben-Nagi J, Holland T. et al. The natural history of fibroids. Ultrasound Obstet Gynecol 2010; 35: 238-242
    CrossrefPubMedGoogle Scholar
  • 12 Moshesh M, Peddada SD, Cooper T. et al. Intraobserver variability in fibroid size measurements: estimated effects on assessing fibroid growth. J Ultrasound Med 2014; 33: 1217-1224
    CrossrefPubMedGoogle Scholar
  • 13 Nieuwenhuis L, Keizer A, Stoelinga B. et al. Fibroid vascularisation assessed with three-dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study. BJOG 2018; 125: 577-584
    CrossrefPubMedGoogle Scholar
  • 14 Levens ED, Wesley R, Premkumar A. et al. Magnetic resonance imaging and transvaginal ultrasound for determining fibroid burden: implications for research and clinical care. Am J Obstet Gynecol 2009; 200: 537.e1-537.e7
    CrossrefPubMedGoogle Scholar
  • 15 Diehl K, Alkatout I, Kanzow M. et al. Gutartige Tumoren des Uterus. Gynäkologe 2021; 54: 435-446
    CrossrefPubMedGoogle Scholar
  • 16 ACOG. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol 2008; 112: 387-400
    CrossrefPubMedGoogle Scholar
  • 17 Parker WH. Uterine myomas: management. Fertil Steril 2007; 88: 255-271
    CrossrefPubMedGoogle Scholar
  • 18 Schwartz PE, Kelly MG. Malignant transformation of myomas: myth or reality?. Obstet Gynecol Clin North Am 2006; 33: 183-198 xii
    CrossrefPubMedGoogle Scholar
  • 19 Parker WH. Uterine Fibroids: clinical Features. In: Tinelli A, Malvasi A. eds. Uterine Myoma, Myomectomy and minimally invasive Treatments. Cham: Springer International Publishing; 2015: 39-52
    Google Scholar
  • 20 Denschlag D, Ackermann S, Battista MJ. et al. Sarcoma of the Uterus. Guideline of the DGGG and OEGGG (S2k Level, AWMF Register Number 015/074, February 2019). Geburtshilfe Frauenheilkd 2019; 79: 1043-1060 DOI: 10.1055/a-0882-4116.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Testa AC, Di Legge A, Bonatti M. et al. Imaging techniques for evaluation of uterine myomas. Best Pract Res Clin Obstet Gynaecol 2016; 34: 37-53
    CrossrefPubMedGoogle Scholar
  • 22 Day Baird D, Garrett TA, Laughlin SK. et al. Short-term change in growth of uterine leiomyoma: tumor growth spurts. Fertil Steril 2011; 95: 242-246
    CrossrefPubMedGoogle Scholar
  • 23 Baird DD, Patchel SA, Saldana TM. et al. Uterine fibroid incidence and growth in an ultrasound-based, prospective study of young African Americans. Am J Obstet Gynecol 2020; 223: 402.e1-402.e18
    CrossrefPubMedGoogle Scholar
  • 24 Burger HG, Dudley EC, Robertson DM. et al. Hormonal changes in the menopause transition. Recent Prog Horm Res 2002; 57: 257-276
    CrossrefPubMedGoogle Scholar
  • 25 Ghosh S, Naftalin J, Imrie R. et al. Natural History of Uterine Fibroids: A Radiological Perspective. Curr Obstet Gynecol Rep 2018; 7: 117-121
    CrossrefPubMedGoogle Scholar
  • 26 Müller A, Thiel F, Binder H. et al. Myome – Teil 1. Geburtshilfe Frauenheilkd 2004; 64: R229-R244
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Müller A, Thiel F, Binder H. et al. Benigne Tumoren. Myome – Entstehung, Diagnostik und Klinik. Geburtshilfe Frauenheilkd 2012; 72: 705-707
    Article in Thieme ConnectPubMedGoogle Scholar