Vanessa L Jacoby1, Alison Jacoby2, Lee A Learman3, Michael Schembri2, Steven E Gregorich4, Rebecca Jackson5, Miriam Kuppermann6. 1. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA. Electronic address: jacobyv@obgyn.ucsf.edu. 2. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA. 3. Department of Obstetrics and Gynecology, Indiana University School of Medicine, USA. 4. Medicine, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA. 5. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA; Epidemiology & Biostatistics, University of California, San Francisco, CA, USA. 6. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, 1635 Divisadero St, Suite 600, San Francisco, CA, USA; Epidemiology & Biostatistics, University of California, San Francisco, CA, USA; Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA.
Abstract
OBJECTIVE: To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids. STUDY DESIGN: Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery. RESULTS: Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001). CONCLUSION: UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.
OBJECTIVE: To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids. STUDY DESIGN: Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery. RESULTS:Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001). CONCLUSION: UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.
Authors: L M Marshall; D Spiegelman; M B Goldman; J E Manson; G A Colditz; R L Barbieri; M J Stampfer; D J Hunter Journal: Fertil Steril Date: 1998-09 Impact factor: 7.329
Authors: Mark A Hayden; Zehra Ordulu; C Scott Gallagher; Bradley J Quade; Raymond M Anchan; Nia Robinson Middleton; Serene S Srouji; Elizabeth A Stewart; Cynthia C Morton Journal: Cancer Genet Date: 2018-02-19