Leiomyoma

BackgroundGlobally, common gynecological disorders such as Polycystic Ovary Syndrome (PCOS), endometriosis, uterine fibroids (non-malignant gynecological diseases), as well as cervical cancer, uterine cancer, and ovarian cancer (gynecological cancers), profoundly impact women's physical and mental health. The burden of these diseases exhibits significant geographical disparities across different countries and regions, making a comprehensive and precise assessment of the global burden of gynecological diseases particularly crucial. Such an assessment will facilitate the development of region-specific prevention and treatment strategies, contributing to a more effective response to these health challenges.MethodsIncidence, prevalence, mortality rates, and Disability-Adjusted Life Years (DALYs) data for the aforementioned gynecological conditions were obtained from the 2021 Global Burden of Disease (GBD) study and analyzed by age, location, and year. The burden associated with gynecological diseases was analyzed based on the Socio-demographic Index (SDI) and attributable risk factors. The Estimated Annual Percentage Change (EAPC) and its 95% Confidence Interval (CI) were used to assess temporal trends in burden.ResultsIn 2021, uterine fibroids were the leading non-malignant gynecological condition contributing to the highest Age-Standardized Incidence Rate (ASIR) and Age-Standardized Prevalence Rate (ASPR), with rates of 250.93 and 2841.07 per 100,000, respectively. Cervical cancer was the main contributor to the Age-Standardized Mortality Rate (ASMR) and Age-Standardized Disability Rate (ASDR) among the eight selected gynecological diseases, with rates of 6.62 and 226.28 per 100,000, respectively. From 1990 to 2021, the ASIR and ASPR for non-malignant gynecological conditions, such as PCOS and uterine fibroids, increased, while the ASDR for PCOS also rose. Among gynecological cancers, the ASIR for uterine cancer increased, while the ASPR for cervical cancer rose. However, the ASIR for cervical and ovarian cancers decreased, along with reductions in the ASMR and ASDR for these cancers and uterine cancer. There were notable regional disparities based on the SDI. In 2021, lower SDI regions had higher incidence, prevalence, mortality rates, and DALYs for endometriosis and cervical cancer, whereas higher SDI regions saw higher rates for PCOS, uterine fibroids, ovarian cancer, and uterine cancer, with more significant mortality and DALYs for ovarian and uterine cancers. The age distribution of these conditions varied. Non-malignant gynecological conditions, such as PCOS and uterine fibroids, primarily affect women aged 30-34 and 40-69. Endometriosis is most common in women aged 20-34, particularly between 25 and 29. Gynecological cancers, including cervical, uterine, and ovarian cancers, predominantly affect women over 35, especially between 40 and 69, with cervical cancer peaking at ages 50-54. Regarding attributable risk factors globally, 1% of cervical cancer deaths were linked to unsafe sexual behaviors, while a high Body Mass Index(BMI) contributed to 0.09% of ovarian cancer deaths and 0.34% of uterine cancer deaths.ConclusionThe global burden of these six gynecological conditions poses a significant public health challenge. There is an urgent need for international collaboration to advance the development of age and regionally differentiated management strategies for gynecological diseases, including the development of effective diagnostic screening tools and the implementation of high-quality, targeted prevention and treatment strategies.

BackgroundThe rise of short-video platforms, such as TikTok (Douyin in China) and Bilibili, has significantly influenced how health information is disseminated to the public. However, the quality, reliability, and effectiveness of health-related content on these platforms, particularly regarding uterine fibroids, remain underexplored. Uterine fibroids are a common medical condition that affects a substantial proportion of women worldwide. While these platforms have become vital sources of health education, misinformation and incomplete content may undermine their efficacy.ObjectiveThis study aims to address these gaps by evaluating the quality and dissemination effectiveness of uterine fibroid-related health information on TikTok and Bilibili.MethodsA total of 200 uterine fibroid-related videos (100 from TikTok and 100 from Bilibili) were selected through a keyword search. The videos were evaluated by 2 trained gynecological experts using the Global Quality Score (GQS) and a modified DISCERN (mDISCERN) tool. In addition, the Patient Education Materials Assessment Tool for Audio and Visual Materials was used to assess the understandability and actionability of the videos. Statistical analyses, including the Mann-Whitney U test, Spearman rank correlation, and stepwise regression analysis, were used to assess differences between platforms and identify predictors of video quality.ResultsThe results indicated that TikTok outperformed Bilibili in terms of user engagement metrics, such as likes, comments, shares, and followers (all PConclusionsThis study highlights the generally low quality of uterine fibroid-related health information on short-video platforms, although TikTok showed better performance in terms of engagement and quality. The involvement of medical professionals was found to enhance video quality. These findings underscore the need for improved oversight of health content on social media platforms and greater involvement of health care professionals to ensure the dissemination of accurate and reliable health information.

ImportanceUterine fibroids are benign tumors that can cause severe symptoms. Fibroid burden among Asian or Pacific Islander individuals, particularly in specific subgroups, remains largely unexamined.ObjectiveTo describe fibroid diagnosis rates by race and ethnicity.Design, setting, and participantsThis retrospective cohort study (January 2009 to December 2022) used data from electronic health records of the Kaiser Permanente Northern California (KPNC) integrated health care system. Eligible participants included female (sex assigned at birth) KPNC members aged 18 to 54 years with at least 12 months of continuous membership, no prior fibroid diagnosis, and no history of hysterectomy. Data were analyzed January to September 2024.ExposureRace and ethnicity was categorized into 9 groups: Black (African American, other Black [ie, any Black race or ethnicity not otherwise specified], and unknown Black race or ethnicity), East Asian (Chinese, Japanese, and Korean), Hispanic (Hispanic or Latino), South Asian (Asian Indian, Bangladeshi, East Indian, Nepali, Sri Lankan, and any South Asian ethnicity not otherwise specified), Southeast Asian (Filipino, Vietnamese, and other Southeast Asian [ie, any Southeast Asian ethnicity not otherwise specified]), White (White or White Middle Eastern), other Asian or Pacific Islander (Native Hawaiian or Pacific Islander, multiethnic Asian, and other or unspecified Asian ethnicity [ie, any Asian ethnicity not otherwise specified]), other races and ethnicities (American Indian or Alaska Native and multiracial), and unknown race or ethnicity.Main outcomes and measuresIncident fibroid diagnosis was identified using diagnostic codes. Poisson regression models were used to calculate incidence rates of fibroid diagnosis by racial and ethnic group, standardized to the 2022 US female population. Incidence rate ratios (IRRs) and 95% CIs compared incidence within each racial and ethnic group with White participants.ResultsA total of 1 917 794 patients were included (median [IQR] percentage, 7% [6%-7%] Black; 5% [5%-6%] East Asian; 22% [21%-23%] Hispanic; 3% [2%-3%] South Asian; 7% [7%-8%] Southeast Asian; 42% [39%-45%] White; 8% [6%-10%] other Asian or Pacific Islander; 2% [2%-2%] of other races and ethnicities; 4% [4%-5%] unknown or missing race and ethnicity), and 84 206 patients (4.4%) received a first fibroid diagnosis during the study period. Compared with White patients, there was a higher rate of fibroid diagnosis among Southeast Asian (IRR, 1.29; 95% CI, 1.26-1.33), East Asian (IRR, 1.47; 95% CI, 1.43-1.51), and South Asian patients (IRR, 1.71; 95% CI, 1.65-1.78). Black (IRR, 3.11; 95% CI, 3.05-3.17) and Hispanic patients (IRR, 1.37; 95% CI, 1.34-1.39) also had elevated rates of fibroid diagnosis. All Asian patients were less likely than other groups to have ICD-9 or ICD-10 coded symptoms before diagnosis.Conclusions and relevanceIn this cohort study of nearly 2 million KPNC patients, South Asian, East Asian, Southeast Asian, Hispanic, and Black patients had higher fibroid diagnosis rates than White patients. If diagnosis rates reflect true variation in disease prevalence, future research should identify sources of these disparities and strategies to reduce them.

The prevalence of uterine fibroids in pregnancy varies between 1.6% and 10.7%. Pregnancies involving uterine fibroids are generally uncomplicated. However, complications can occur, particularly in cases of multiple fibroids, when the fibroids are larger than 5 cm, or when they are located in the lower uterine segment. Between 10% and 30% of pregnant women with fibroids experience complications during pregnancy, labor, and the postpartum period. The most common complication during pregnancy, which can occur in 8% of women, is red degeneration. High-quality data on the relationship between fibroids and pregnancy outcome are very limited. Potential obstetric complications include preterm birth (increased risk, OR 1.5; 95% CI, 1.3-1.7), malpresentation of the baby (OR 2.65; 95% CI, 1.60-3.70), placental abruption (OR 2.63; 95% CI, 1.38-3.88), placenta previa (OR 2.21; 95% CI, 1.48-2.94), cesarean birth (OR 2.60; 95% CI, 2.02-3.18), postpartum hemorrhage (OR 2.95; 95% CI, 1.86-4.66), and other rare occurrences. Most women with uterine fibroids are able to deliver vaginally without complications. Cesarean birth is typically performed for standard obstetric indications. It is recommended that cesarean myomectomy should be avoided when possible.