CLINICAL AND DIAGNOSTIC ASPECTS OF UTERINE LEIOMYOMA AND ITS COMORBID COURSE WITH GENITAL ENDOMETRIOSIS
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i1.14525Keywords:
uterine leiomyoma, genital endometriosis, menstrual function, metrorrhagia, chronic endometritis, infertility, ivf, ultrasound diagnosticsAbstract
SUMMARY. Both uterine leiomyoma (UL) and genital endometriosis have many clinical features, including pelvic pain, menstrual irregularities, and decreased fertility, but it is unknown whether these abnormalities coexist by chance or due to common etiological factors.
The aim – to analyze the clinical and diagnostic characteristics of patients with intramural UL and its comorbid course with genital endometriosis.
Material and Methods. The study included 63 patients diagnosed with intramural leiomyoma UL and genital endometriosis, who were divided into a group with comorbid pathologies (n=33) and a group with isolated uterine leiomyoma (n=30). 5 patients had a history of cycles of controlled ovarian stimulation using ART and a diagnosis of infertility. Patients underwent bimanual examination of the internal genital organs and pelvic ultrasound.
Results. Among patients with both comorbid course of UL and endometriosis and isolated UL, there was a significant prevalence of patients with uterine bleeding (81.82 and 73.33 %, respectively), dysuria (45.45 % and 40.00 %, respectively), mucous (54.55 % and 56.67 %, respectively) and bloody (45.45 % and 43.33 %, respectively) secretions; 100 % of women had uterine enlargement (bimanual) during gynecological examination. Regarding menstrual function, the age of onset of menstruation in both study groups was significantly lower (by 7.50 % and 7.79 %, respectively); bleeding was significantly longer (by 2.01 times and 1.77 times, respectively), the proportion of people with hypermenorrhea (54.55 % and 56.67 %, respectively) and the proportion of people with irregular menstrual cycles (33.33 % and 29.17 %, respectively) is significantly higher than in the control group. At the same time, patients with a solid myomatous node predominate in the group with comorbid UL and endometriosis, and patients with multiple nodes (c2=11.15; p<0.05) predominate in the group with isolated LM, and the maximum node diameter in patients with comorbid UL and endometriosis is 24.42 % higher than in patients with isolated UL.
Conclusions. The same clinical and diagnostic characteristics of patients with intramural UL and its comorbid course with genital endometriosis were established, except for the prevalence of solid myomatous nodes with a significantly higher maximum node diameter under the condition of comorbidity.
References
Wise, L.A., & Laughlin-Tommaso, S.K. (2016). Epidemiology of uterine fibroids: from menarche to menopause. Journal Clinical Obstetetrics and Gynecology, 59(1), 2-24. DOI: 10.1097/GRF.0000000000000164. DOI: https://doi.org/10.1097/GRF.0000000000000164
Stewart, E.A., Cookson, C.L., & Gandolfo, R.A. (2017). Epidemiology of uterinefibroids: a systematic review. BJOG : An International Journal of Obstetrics and Gynecology, 124, 1501-1512. DOI: 10.1111/1471-0528.14640. DOI: https://doi.org/10.1111/1471-0528.14640
Whiteman, M.K., Kuklina, E., Jamieson, D.J., Hillis, S.D., & Marchbanks, P.A. (2010). Inpatient hospitalization for gynecologic disorders in the United States. Americal Journal of Obstetrics and Gynecology, 202, 541. DOI: 10.1016/j.ajog.2009.12.013. DOI: https://doi.org/10.1016/j.ajog.2009.12.013
Martin-Merino, E., Wallander, M.A., Andersson, S., Soriano-Gabarro, M., & Rodriguez L.A. (2016). The reporting and diagnosis of uterine fibroids in the UK: an observational study. BMC Womens Health, 16, 45. DOI: 10.1186/s12905-016-0320-8. DOI: https://doi.org/10.1186/s12905-016-0320-8
Zondervan, K.T., Becker, C.M., Missmer, S.A., & Longo D.L. (2020). Endometriosis. The New England Journal of Medicine, 382, 1244-1256. DOI: 10.1056/NEJMra1810764. DOI: https://doi.org/10.1056/NEJMra1810764
Rapkin, A.J., Nathan, L., Berek, J.S., & Novak, E., (eds). (2012). Pelvic pain and dysmenorrhea. Berek & Novak's gynecology. 15th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 291-301. DOI: 10.22037/ijpr.2020.1100961.
Agarwal, S.K., Chapron, C., Giudice, L.C., Laufer, M.R., Leyland, N., Missmer, S.A, Sukhbir, S.S., & Taylor, H.S. (2019). Clinical diagnosis of endometriosis: a call to action. Amecican Journal of Obstetrics and Gynecology, 220, 354. DOI: 10.1016/j.ajog.2018.12.039. DOI: https://doi.org/10.1016/j.ajog.2018.12.039
Leyendecker, G., Bilgicyildirim, A., Inacker, M., Stalf, T., Huppert, P., Mall Bottcher, G., & Wildt, L. (2019). Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study. Archive Gynecology and Obstetrics, 291, 917-932. DOI: 10.1007/s00404-014-3437-8. DOI: https://doi.org/10.1007/s00404-014-3437-8
George, A.V., Allaire C., Laberge, P.-Y., & Leyland, N. (2015). The Management of Uterine Leiomyomas. Journal of Obstetrics and Gynaecology Canada, 37(2), 157-178. DOI: 10.1016/S1701-2163(15)30338-8. DOI: https://doi.org/10.1016/S1701-2163(15)30338-8
Miura, S., Khan, K.N., Kitajima, M., Hiraki, K., Moriyama, S., Masuzaki, H., Semejita, T., Fujishita, A., & Ishimaru, T. (2006). Differential infiltration of macrophages and prostaglandin by different uterine leiomyomas. Human Reproduction, 21, 2545-2554. DOI: 10.1093/humrep/del205. DOI: https://doi.org/10.1093/humrep/del205
Terry, K.L., De Vivo, I., Hankinson, S.E., & Missmer, S.A. (2010). Reproductive characteristics and risk of uterine leiomyomata. Fertility and Sterility, 94(2703), 2703-2707. DOI: 10.1016/j.fertnstert.2010.04.065. DOI: https://doi.org/10.1016/j.fertnstert.2010.04.065
Yasui, T., Hayashi, K., Okano, H., Kamio, M., Mizunuma, H., Kubota, T., Lee, J.-S., & Suzuki, S. (2018). Uterine leiomyomata: a retrospective study of correlations with hypertension and diabetes mellitus from the Japan Nurses’ Health Study. Journal of Obstetrics and Gynaecology, 38, 1128-1134. DOI: 10.1080/01443615.2018.1451987. DOI: https://doi.org/10.1080/01443615.2018.1451987
Nnoaham, K.E., Webster, P., Kumbang, J., Kennedy, S.H., & Zondervan, K.T. (2012). Is early age at menarche a risk factor for endometriosis? A Systematic review and meta-analysis of case–control studies. Fertility and Sterility, 98, 702-712. DOI: 10.1016/j.fertnstert.2012.05.035. DOI: https://doi.org/10.1016/j.fertnstert.2012.05.035
Moini, A., Malekzadeh, F., Amirchaghmaghi, E., Kashfi, F., Akhoond, M.R., Saei, M., & Mairbolok, M.H. (2013). Risk factors associated with endometriosis among infertile Iranian women. Archives of Medical Science, 9, 506-514. DOI: 10.5114/aoms.2013.35420. DOI: https://doi.org/10.5114/aoms.2013.35420
Sangi-Haghpeykar, H., & Poindexter, A.R. (1995). Epidemiology of endometriosis among parous women. Obstetrics and Gynecology, 85, 983-992. DOI: 10.1016/0029-7844(95)00074-2. DOI: https://doi.org/10.1016/0029-7844(95)00074-2
Wei, M., Cheng, Y., Bu, H., Zhao, Y., & Zhao, W. (2016). Length of Menstrual Cycle and Risk of Endometriosis: A Meta-Analysis of 11 Case-Control Studies. Medicine (Baltimore), 95(9), I9. DOI: 10.1097/MD.0000000000002922. DOI: https://doi.org/10.1097/MD.0000000000002922
Yang, Q., Ciebiera, M., Bariani, M.V., Ali, M., Elkafas, H., & Boyer, T.G. (2022). Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocrine reviews, 43, 678-719. DOI: 10.1210/endrev/bnab039. DOI: https://doi.org/10.1210/endrev/bnab039
